WorldWideScience

Sample records for health facility closure

  1. 304 Concretion facility closure plan

    International Nuclear Information System (INIS)

    1990-04-01

    The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium Zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets in the 304 Concretion Facility, located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Concretion Facility (304 Facility). Clean closure of the 304 Facility is the proposed method for closure of the facility. Justification for this proposal is presented. 15 refs., 22 figs., 4 tabs

  2. 304 Concretion Facility Closure Plan

    International Nuclear Information System (INIS)

    1991-10-01

    The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with Zircaloy-2 and copper silicon allo , uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets (7.5-gal containers) in the 304 Concretion Facility (304 Facility), located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA) and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040 (Ecology 1991). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Facility. The strategy for closure of the 304 Facility is presented in Section 6.0

  3. Calcined solids storage facility closure study

    International Nuclear Information System (INIS)

    Dahlmeir, M.M.; Tuott, L.C.; Spaulding, B.C.

    1998-02-01

    The disposal of radioactive wastes now stored at the Idaho National Engineering and Environmental Laboratory is currently mandated under a open-quotes Settlement Agreementclose quotes (or open-quotes Batt Agreementclose quotes) between the Department of Energy and the State of Idaho. Under this agreement, all high-level waste must be treated as necessary to meet the disposal criteria and disposed of or made road ready to ship from the INEEL by 2035. In order to comply with this agreement, all calcined waste produced in the New Waste Calcining Facility and stored in the Calcined Solids Facility must be treated and disposed of by 2035. Several treatment options for the calcined waste have been studied in support of the High-Level Waste Environmental Impact Statement. Two treatment methods studied, referred to as the TRU Waste Separations Options, involve the separation of the high-level waste (calcine) into TRU waste and low-level waste (Class A or Class C). Following treatment, the TRU waste would be sent to the Waste Isolation Pilot Plant (WIPP) for final storage. It has been proposed that the low-level waste be disposed of in the Tank Farm Facility and/or the Calcined Solids Storage Facility following Resource Conservation and Recovery Act closure. In order to use the seven Bin Sets making up the Calcined Solids Storage Facility as a low-level waste landfill, the facility must first be closed to Resource Conservation and Recovery Act (RCRA) standards. This study identifies and discusses two basic methods available to close the Calcined Solids Storage Facility under the RCRA - Risk-Based Clean Closure and Closure to Landfill Standards. In addition to the closure methods, the regulatory requirements and issues associated with turning the Calcined Solids Storage Facility into an NRC low-level waste landfill or filling the bin voids with clean grout are discussed

  4. Calcined solids storage facility closure study

    Energy Technology Data Exchange (ETDEWEB)

    Dahlmeir, M.M.; Tuott, L.C.; Spaulding, B.C. [and others

    1998-02-01

    The disposal of radioactive wastes now stored at the Idaho National Engineering and Environmental Laboratory is currently mandated under a {open_quotes}Settlement Agreement{close_quotes} (or {open_quotes}Batt Agreement{close_quotes}) between the Department of Energy and the State of Idaho. Under this agreement, all high-level waste must be treated as necessary to meet the disposal criteria and disposed of or made road ready to ship from the INEEL by 2035. In order to comply with this agreement, all calcined waste produced in the New Waste Calcining Facility and stored in the Calcined Solids Facility must be treated and disposed of by 2035. Several treatment options for the calcined waste have been studied in support of the High-Level Waste Environmental Impact Statement. Two treatment methods studied, referred to as the TRU Waste Separations Options, involve the separation of the high-level waste (calcine) into TRU waste and low-level waste (Class A or Class C). Following treatment, the TRU waste would be sent to the Waste Isolation Pilot Plant (WIPP) for final storage. It has been proposed that the low-level waste be disposed of in the Tank Farm Facility and/or the Calcined Solids Storage Facility following Resource Conservation and Recovery Act closure. In order to use the seven Bin Sets making up the Calcined Solids Storage Facility as a low-level waste landfill, the facility must first be closed to Resource Conservation and Recovery Act (RCRA) standards. This study identifies and discusses two basic methods available to close the Calcined Solids Storage Facility under the RCRA - Risk-Based Clean Closure and Closure to Landfill Standards. In addition to the closure methods, the regulatory requirements and issues associated with turning the Calcined Solids Storage Facility into an NRC low-level waste landfill or filling the bin voids with clean grout are discussed.

  5. Health Facilities

    Science.gov (United States)

    Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, ... psychiatric care centers. When you choose a health facility, you might want to consider How close it ...

  6. 303-K Storage Facility closure plan

    International Nuclear Information System (INIS)

    1993-01-01

    Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5

  7. 105-DR Large Sodium Fire Facility closure activities evaluation report

    International Nuclear Information System (INIS)

    Adler, J.G.

    1996-01-01

    This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed

  8. Mixed Waste Management Facility closure at the Savannah River Site

    International Nuclear Information System (INIS)

    Bittner, M.F.

    1991-08-01

    The Mixed Waste Management Facility of the Savannah River Plant received hazardous and solid low level radioactive wastes from 1972 until 1986. Because this facility did not have a permit to receive hazardous wastes, a Resource Conservation and Recovery Act closure was performed between 1987 and 1990. This closure consisted of dynamic compaction of the waste trenches and placement of a 3-foot clay cap, a 2-foot soil cover, and a vegetative layer. Operations of the waste disposal facility, tests performed to complete the closure design, and the construction of the closure cap are discussed herein

  9. 3718-F Alkali Metal Treatment and Storage Facility Closure Plan

    International Nuclear Information System (INIS)

    1991-12-01

    Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references

  10. 3718-F Alkali Metal Treatment and Storage Facility Closure Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    1991-12-01

    Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references.

  11. 303-K Storage Facility: Report on FY98 closure activities

    International Nuclear Information System (INIS)

    Adler, J.G.

    1998-01-01

    This report summarizes and evaluates the decontamination activities, sampling activities, and sample analysis performed in support of the closure of the 303-K Storage Facility. The evaluation is based on the validated data included in the data validation package (98-EAP-346) for the 303-K Storage Facility. The results of this evaluation will be used for assessing contamination for the purpose of closing the 303-K Storage Facility as described in the 303-K Storage Facility Closure Plan, DOE/RL-90-04. The closure strategy for the 303-K Storage Facility is to decontaminate the interior of the north half of the 303-K Building to remove known or suspected dangerous waste contamination, to sample the interior concrete and exterior soils for the constituents of concern, and then to perform data analysis, with an evaluation to determine if the closure activities and data meet the closure criteria. The closure criteria for the 303-K Storage Facility is that the concentrations of constituents of concern are not present above the cleanup levels. Based on the evaluation of the decontamination activities, sampling activities, and sample data, determination has been made that the soils at the 303-K Storage Facility meet the cleanup performance standards (WMH 1997) and can be clean closed. The evaluation determined that the 303-K Building cannot be clean closed without additional closure activities. An additional evaluation will be needed to determine the specific activities required to clean close the 303-K Storage Facility. The radiological contamination at the 303-K Storage Facility is not addressed by the closure strategy

  12. Resource Conservation and Recovery Act Closure Plan for the Y-12 9409-5 Tank Storage Facility

    International Nuclear Information System (INIS)

    1995-02-01

    This document presents information on the closure of the Y-12 9409-5 Tank Storage Facility. Topics discussed include: facility description; closure history; closure performance standard; partial closure; maximum waste inventory; closure activities; schedule; and postclosure care

  13. Hexone Storage and Treatment Facility closure plan

    International Nuclear Information System (INIS)

    1992-11-01

    The HSTF is a storage and treatment unit subject to the requirements for the storage and treatment of dangerous waste. Closure is being conducted under interim status and will be completed pursuant to the requirements of Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and WAC 173-303-640. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. The known hazardous/dangerous waste remaining at the site before commencing other closure activities consists of the still vessels, a tarry sludge in the storage tanks, and residual contamination in equipment, piping, filters, etc. The treatment and removal of waste at the HSTF are closure activities as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and WAC 173-303

  14. 3718-F Alkali Metal Treatment and Storage Facility Closure Plan

    International Nuclear Information System (INIS)

    1992-11-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 3718-F Alkali Metal Treatment and Storage Facility (3718-F Facility), located in the 300 Area, was used to store and treat alkali metal wastes. Therefore, it is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989) and 40 CFR 270.1. Closure also will satisfy the thermal treatment facility closure requirements of 40 CFR 265.381. This closure plan presents a description of the 3718-F Facility, the history of wastes managed, and the approach that will be followed to close the facility. Only hazardous constituents derived from 3718-F Facility operations will be addressed

  15. 2727-S Nonradioactive Dangerous Waste Storage Facility clean closure evaluation report

    International Nuclear Information System (INIS)

    Luke, S.N.

    1994-01-01

    This report presents the analytical results of 2727-S NRDWS facility closure verification soil sampling and compares these results to clean closure criteria. The results of this comparison will determine if clean closure of the unit is regulatorily achievable. This report also serves to notify regulators that concentrations of some analytes at the site exceed sitewide background threshold levels (DOE-RL 1993b) and/or the limits of quantitation (LOQ). This report also presents a Model Toxics Control Act Cleanup (MTCA) (WAC 173-340) regulation health-based closure standard under which the unit can clean close in lieu of closure to background levels or LOQ in accordance with WAC 173-303-610. The health-based clean closure standard will be closure to MTCA Method B residential cleanup levels. This report reconciles all analyte concentrations reported above background or LOQ to this health-based cleanup standard. Regulator acceptance of the findings presented in this report will qualify the TSD unit for clean closure in accordance with WAC 173-303-610 without further TSD unit soil sampling, or soil removal and/or decontamination. Nondetected analytes require no further evaluation

  16. 2727-S Nonradioactive Dangerous Waste Storage Facility Closure Plan

    International Nuclear Information System (INIS)

    Wilczek, T.A.; Laws, J.R.; Izatt, R.D.

    1992-01-01

    This closure plan describes the activities for final closure of the 2727-S Nonradioactive Dangerous Waste Storage (NRDWS) Facility at the Hanford Site. The 2727-S NRDWS Facility provided container storage for nonradioactive dangerous and extremely hazardous wastes generated in the research and development laboratories, process operations, and maintenance and transportation functions throughout the Hanford Site. Storage operations began at the 2727-S NRDWS Facility March 14, 1983, and continued until December 30, 1986, when the last shipment of materials from the facility took place. These storage operations have been moved to the new 616 NRDWS Facility, which is an interim status unit located between the 200 East and 200 West Areas of the Hanford Site

  17. Engineering study for closure of 209E facility

    International Nuclear Information System (INIS)

    Brevick, C.H.; Heys, W.H.; Johnson, E.D.

    1997-01-01

    This document is an engineering study for evaluating alternatives to determine the most cost effective closure plan for the 209E Facility, Critical Mass Laboratory. This laboratory is located in the 200 East Area of the Hanford Site and contains a Critical Assembly Room and a Mix room were criticality experiments were once performed

  18. Engineering study for closure of 209E facility

    Energy Technology Data Exchange (ETDEWEB)

    Brevick, C.H.; Heys, W.H.; Johnson, E.D.

    1997-07-07

    This document is an engineering study for evaluating alternatives to determine the most cost effective closure plan for the 209E Facility, Critical Mass Laboratory. This laboratory is located in the 200 East Area of the Hanford Site and contains a Critical Assembly Room and a Mix room were criticality experiments were once performed.

  19. Waste Encapsulation and Storage Facility (WESF) Interim Status Closure Plan

    International Nuclear Information System (INIS)

    SIMMONS, F.M.

    2000-01-01

    This document describes the planned activities and performance standards for closing the Waste Encapsulation and Storage Facility (WESF). WESF is located within the 225B Facility in the 200 East Area on the Hanford Facility. Although this document is prepared based on Title 40 Code of Federal Regulations (CFR), Part 265, Subpart G requirements, closure of the storage unit will comply with Washington Administrative Code (WAC) 173-303-610 regulations pursuant to Section 5.3 of the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Action Plan (Ecology et al. 1996). Because the intention is to clean close WESF, postclosure activities are not applicable to this interim status closure plan. To clean close the storage unit, it will be demonstrated that dangerous waste has not been left onsite at levels above the closure performance standard for removal and decontamination. If it is determined that clean closure is not possible or environmentally is impracticable, the interim status closure plan will be modified to address required postclosure activities. WESF stores cesium and strontium encapsulated salts. The encapsulated salts are stored in the pool cells or process cells located within 225B Facility. The dangerous waste is contained within a double containment system to preclude spills to the environment. In the unlikely event that a waste spill does occur outside the capsules, operating methods and administrative controls require that waste spills be cleaned up promptly and completely, and a notation made in the operating record. Because dangerous waste does not include source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of this documentation. The information on radionuclides is provided only for general knowledge

  20. Final closure of a low level waste disposal facility

    International Nuclear Information System (INIS)

    Potier, J.M.

    1995-01-01

    The low-level radioactive waste disposal facility operated by the Agence Nationale pour la Gestion des Dechets Radioactifs near La Hague, France was opened in 1969 and is scheduled for final closure in 1996. The last waste package was received in June 1994. The total volume of disposed waste is approximately 525,000 m 3 . The site closure consists of covering the disposal structures with a multi-layer impervious cap system to prevent rainwater from infiltrating the waste isolation system. A monitoring system has been set up to verify the compliance of infiltration rates with hydraulic performance objectives (less than 10 liters per square meter and per year)

  1. 303-K Radioactive Mixed-Waste Storage Facility closure plan

    International Nuclear Information System (INIS)

    1991-11-01

    The Hanford Site, located northwest of Richland, Washington, houses reactors chemical-separation systems, and related facilities used for the production o special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 303-K Radioactive Mixed-Waste Storage Facility (303-K Facility) has been used since 1943 to store various radioactive,and dangerous process materials and wastes generated by the fuel manufacturing processes in the 300 Area. The mixed wastes are stored in US Department of Transportation (DOT)-specification containers (DOT 1988). The north end of the building was used for storage of containers of liquid waste and the outside storage areas were used for containers of solid waste. Because only the north end of the building was used, this plan does not include the southern end of the building. This closure plan presents a description of the facility, the history of materials and wastes managed, and a description of the procedures that will be followed to chose the 303-K Facility as a greater than 90-day storage facility. The strategy for closure of the 303-K Facility is presented in Chapter 6.0

  2. 105-DR large sodium fire facility closure Plan. Revision 2

    International Nuclear Information System (INIS)

    Ruck, F.A. III.

    1995-03-01

    The 105-DR Large Sodium Fire Facility (LSFF), which was operated 1972-1986, was a research laboratory that occupied the former ventilation supply room on the SW side of the 105-DR Reactor Facility. (The 105-DR defense reactor was shut down in 1964.) LSFF was used to investigate fire and safety aspects of large sodium or other metal alkali fires in the LMFBR facilities; it was also used to store and treat alkali metal waste. This closure plan presents a description of the unit, the history of the waste managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of LSFF is expected. It is located within the 100-DR-2 (source) and 100-HR-3 (groundwater) operable units, which will be addressed through the RCRA facility investigation/corrective measures study process

  3. 105-DR Large Sodium Fire Facility closure plan

    International Nuclear Information System (INIS)

    1993-05-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, and activities associated with nuclear energy development. The 105-DR Large Sodium Fire Facility (LSFF), which was in operation from about 1972 to 1986, was a research laboratory that occupied the former ventilation supply room on the southwest side of the 105-DR Reactor facility. The LSFF was established to provide a means of investigating fire and safety aspects associated with large sodium or other metal alkali fires in the liquid metal fast breeder reactor (LMFBR) facilities. The 105-DR Reactor facility was designed and built in the 1950's and is located in the 100-D Area of the Hanford Site. The building housed the 105-DR defense reactor, which was shut down in 1964. The LSFF was initially used only for engineering-scale alkali metal reaction studies. In addition, the Fusion Safety Support Studies program sponsored intermediate-size safety reaction tests in the LSFF with lithium and lithium lead compounds. The facility has also been used to store and treat alkali metal waste, therefore the LSFF is subject to the regulatory requirements for the storage and treatment of dangerous waste. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610. This closure plan presents a description of the facility, the history of waste managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of the LSFF is expected

  4. 105-DR Large Sodium Fire Facility closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    1993-05-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, and activities associated with nuclear energy development. The 105-DR Large Sodium Fire Facility (LSFF), which was in operation from about 1972 to 1986, was a research laboratory that occupied the former ventilation supply room on the southwest side of the 105-DR Reactor facility. The LSFF was established to provide a means of investigating fire and safety aspects associated with large sodium or other metal alkali fires in the liquid metal fast breeder reactor (LMFBR) facilities. The 105-DR Reactor facility was designed and built in the 1950`s and is located in the 100-D Area of the Hanford Site. The building housed the 105-DR defense reactor, which was shut down in 1964. The LSFF was initially used only for engineering-scale alkali metal reaction studies. In addition, the Fusion Safety Support Studies program sponsored intermediate-size safety reaction tests in the LSFF with lithium and lithium lead compounds. The facility has also been used to store and treat alkali metal waste, therefore the LSFF is subject to the regulatory requirements for the storage and treatment of dangerous waste. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610. This closure plan presents a description of the facility, the history of waste managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of the LSFF is expected.

  5. How Do We Turn This Thing Off? A Study to Determine an Approach for Making Curtailment of Service and Closure Decisions in Health Care Facilities.

    Science.gov (United States)

    1979-04-09

    22a. NAME OF RESPONSIBLE INDIVIDUAL 22b TELEPHONE (Include Area Code) 22c. OFFICE SYMBOL Lawrence M. Leahy, MAJ, MS (512) 221-6345 HSHA-IHC DO Form...Facilities. Germantown, MD.: Aspen Systems Corporation, 1976. Bierman, Harold Jr., Charles R. Bonini and Warren H. Hausman . Quantitative Analysis for Business...Assessment," Topics in Health Care Financing II, No. 4 ( Summer , 1976), 109-121. Drake, David F. and Kozak, David M. "A Primer on Antitrust and Hospital

  6. 303-K Storage Facility closure plan. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-15

    Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.

  7. Lesotho - Health Facility Survey

    Data.gov (United States)

    Millennium Challenge Corporation — The main objective of the 2011 Health Facility Survey (HFS) was to establish a baseline for informing the Health Project performance indicators on health facilities,...

  8. Procedures and techniques for closure of near surface disposal facilities for radioactive waste

    International Nuclear Information System (INIS)

    2001-12-01

    The overall objective of this report is to provide Member States with guidance on planning and implementation of closure of near surface disposal facilities for low and intermediate level radioactive waste. The specific objectives are to review closure concepts, requirements, and components of closure systems; to discuss issues and approaches to closure, including regulatory, economic, and technical aspects; and to present major examples of closure techniques used and/or considered by Member States. Some examples of closure experience from Member States are presented in the Appendix and were indexed separately

  9. Considerations for closure of low-level radioactive waste engineered disposal facilities

    International Nuclear Information System (INIS)

    1992-01-01

    Proper stabilization and closure of low-level radioactive waste disposal facilities require detailed planning during the early stages of facility development. This report provides considerations for host States, compact regions, and unaffiliated States on stabilization and closure of engineered low-level radioactive waste and mixed waste disposal facilities. A time line for planning closure activities, which identifies closure considerations to be addressed during various stages of a facility's development, is presented. Current Federal regulatory requirements and guidance for closure and post-closure are outlined. Significant differences between host State and Federal closure requirements are identified. Design features used as stabilization measures that support closure, such as waste forms and containers, backfill materials, engineered barrier systems, and site drainage systems, are described. These design features are identified and evaluated in terms of how they promote long-term site stability by minimizing water infiltration, controlling subsidence and surface erosion, and deterring intrusion. Design and construction features critical to successful closure are presented for covers and site drainage. General considerations for stabilization and closure operations are introduced. The role of performance and environmental monitoring during closure is described

  10. Reclamation and closure of an oil sands tailings facility

    Energy Technology Data Exchange (ETDEWEB)

    Sobkowicz, J. [Thurber Engineering Ltd., Calgary, AB (Canada); Morgenstern, N. [Alberta Univ., Edmonton, AB (Canada)

    2010-07-01

    This PowerPoint presentation discussed methods of ensuring the successful reclamation of oil sands tailings facilities. Tailings should be reclaimed as mining proceeds in order to avoid an excessive accumulation of fluid fine tailings (FFT). The volume of mature fine tailings (MFT) in ponds should be limited in order to ensure effective tailings management. The reclaimed landforms should have good geotechnical stability and be comprised of self-sustaining native vegetation. Strength is needed to allow for timely capping and initial reclamation, and stiffness is required to minimize future settlement and to allow for the construction of a closure landscape. Reclamation strategies were presented for fines-dominated tailings; sand-depleted tailings; and sand-dominated tailings. Energy Resources Conservation Board (ERCB) criteria for tailings reclamation were discussed, and various monitoring and performance assessment strategies were presented. tabs., figs.

  11. The 4843 Alkali Metal Storage Facility Closure Plan

    International Nuclear Information System (INIS)

    1991-06-01

    The 4843 AMSF has been used primarily to provide a centralized building to receive and store dangerous and mixed alkali metal waste, including sodium and lithium, which has been generated at the Fast Flux Test Facility and at various other Hanford Site operations that used alkali metals. Most of the dangerous and mixed alkali metal waste received consists of retired equipment from liquid sodium processes. The unit continues to store material. In general, only solid alkali metal waste that is water reactive is stored at the 4843 AMSF. The 4843 AMSF will be closed in a manner consistent with Ecology guidelines and regulations (WAC 173-303-610). The general closure procedure is detailed as follows

  12. Low-level radioactive waste disposal facility closure

    International Nuclear Information System (INIS)

    White, G.J.; Ferns, T.W.; Otis, M.D.; Marts, S.T.; DeHaan, M.S.; Schwaller, R.G.; White, G.J.

    1990-11-01

    Part I of this report describes and evaluates potential impacts associated with changes in environmental conditions on a low-level radioactive waste disposal site over a long period of time. Ecological processes are discussed and baselines are established consistent with their potential for causing a significant impact to low-level radioactive waste facility. A variety of factors that might disrupt or act on long-term predictions are evaluated including biological, chemical, and physical phenomena of both natural and anthropogenic origin. These factors are then applied to six existing, yet very different, low-level radioactive waste sites. A summary and recommendations for future site characterization and monitoring activities is given for application to potential and existing sites. Part II of this report contains guidance on the design and implementation of a performance monitoring program for low-level radioactive waste disposal facilities. A monitoring programs is described that will assess whether engineered barriers surrounding the waste are effectively isolating the waste and will continue to isolate the waste by remaining structurally stable. Monitoring techniques and instruments are discussed relative to their ability to measure (a) parameters directly related to water movement though engineered barriers, (b) parameters directly related to the structural stability of engineered barriers, and (c) parameters that characterize external or internal conditions that may cause physical changes leading to enhanced water movement or compromises in stability. Data interpretation leading to decisions concerning facility closure is discussed. 120 refs., 12 figs., 17 tabs

  13. Low-level radioactive waste disposal facility closure

    Energy Technology Data Exchange (ETDEWEB)

    White, G.J.; Ferns, T.W.; Otis, M.D.; Marts, S.T.; DeHaan, M.S.; Schwaller, R.G.; White, G.J. (EG and G Idaho, Inc., Idaho Falls, ID (USA))

    1990-11-01

    Part I of this report describes and evaluates potential impacts associated with changes in environmental conditions on a low-level radioactive waste disposal site over a long period of time. Ecological processes are discussed and baselines are established consistent with their potential for causing a significant impact to low-level radioactive waste facility. A variety of factors that might disrupt or act on long-term predictions are evaluated including biological, chemical, and physical phenomena of both natural and anthropogenic origin. These factors are then applied to six existing, yet very different, low-level radioactive waste sites. A summary and recommendations for future site characterization and monitoring activities is given for application to potential and existing sites. Part II of this report contains guidance on the design and implementation of a performance monitoring program for low-level radioactive waste disposal facilities. A monitoring programs is described that will assess whether engineered barriers surrounding the waste are effectively isolating the waste and will continue to isolate the waste by remaining structurally stable. Monitoring techniques and instruments are discussed relative to their ability to measure (a) parameters directly related to water movement though engineered barriers, (b) parameters directly related to the structural stability of engineered barriers, and (c) parameters that characterize external or internal conditions that may cause physical changes leading to enhanced water movement or compromises in stability. Data interpretation leading to decisions concerning facility closure is discussed. 120 refs., 12 figs., 17 tabs.

  14. Environmental assessment: Closure of the Waste Calcining Facility (CPP-633), Idaho National Engineering Laboratory

    International Nuclear Information System (INIS)

    1996-07-01

    The U.S. Department of Energy (DOE) proposes to close the Waste Calcining Facility (WCF). The WCF is a surplus DOE facility located at the Idaho Chemical Processing Plant (ICPP) on the Idaho National Engineering Laboratory (INEL). Six facility components in the WCF have been identified as Resource Conservation and Recovery Ace (RCRA)-units in the INEL RCRA Part A application. The WCF is an interim status facility. Consequently, the proposed WCF closure must comply with Idaho Rules and Standards for Hazardous Waste contained in the Idaho Administrative Procedures Act (IDAPA) Section 16.01.05. These state regulations, in addition to prescribing other requirements, incorporate by reference the federal regulations, found at 40 CFR Part 265, that prescribe the requirements for facilities granted interim status pursuant to the RCRA. The purpose of the proposed action is to reduce the risk of radioactive exposure and release of hazardous constituents and eliminate the need for extensive long-term surveillance and maintenance. DOE has determined that the closure is needed to reduce potential risks to human health and the environment, and to comply with the Idaho Hazardous Waste Management Act (HWMA) requirements

  15. Closure of hazardous and mixed radioactive waste management units at DOE facilities

    International Nuclear Information System (INIS)

    1990-06-01

    This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure of each of the following hazardous waste management units regulated under RCRA

  16. Closure Plan for the E-Area Low-Level Waste Facility

    Energy Technology Data Exchange (ETDEWEB)

    Cook, J.R.

    2000-10-30

    A closure plan has been developed to comply with the applicable requirements of the U.S. Department of Energy Order 435.2 Manual and Guidance. The plan is organized according to the specifications of the Format and Content Guide for U.S. Department of Energy Low-Level Waste Disposal Facility Closure Plans.

  17. Closure Plan for the E-Area Low-Level Waste Facility

    International Nuclear Information System (INIS)

    Cook, J.R.

    2000-01-01

    A closure plan has been developed to comply with the applicable requirements of the U.S. Department of Energy Order 435.2 Manual and Guidance. The plan is organized according to the specifications of the Format and Content Guide for U.S. Department of Energy Low-Level Waste Disposal Facility Closure Plans

  18. Defense Waste Processing Facility Canister Closure Weld Current Validation Testing

    Energy Technology Data Exchange (ETDEWEB)

    Korinko, P. S. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Maxwell, D. N. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2018-01-29

    Two closure welds on filled Defense Waste Processing Facility (DWPF) canisters failed to be within the acceptance criteria in the DWPF operating procedure SW4-15.80-2.3 (1). In one case, the weld heat setting was inadvertently provided to the canister at the value used for test welds (i.e., 72%) and this oversight produced a weld at a current of nominally 210 kA compared to the operating procedure range (i.e., 82%) of 240 kA to 263 kA. The second weld appeared to experience an instrumentation and data acquisition upset. The current for this weld was reported as 191 kA. Review of the data from the Data Acquisition System (DAS) indicated that three of the four current legs were reading the expected values, approximately 62 kA each, and the fourth leg read zero current. Since there is no feasible way by further examination of the process data to ascertain if this weld was actually welded at either the target current or the lower current, a test plan was executed to provide assurance that these Nonconforming Welds (NCWs) meet the requirements for strength and leak tightness. Acceptance of the welds is based on evaluation of Test Nozzle Welds (TNW) made specifically for comparison. The TNW were nondestructively and destructively evaluated for plug height, heat tint, ultrasonic testing (UT) for bond length and ultrasonic volumetric examination for weld defects, burst pressure, fractography, and metallography. The testing was conducted in agreement with a Task Technical and Quality Assurance Plan (TTQAP) (2) and applicable procedures.

  19. Republic of Korea. Closure concept development for LILW disposal facility in Republic of Korea

    International Nuclear Information System (INIS)

    2001-01-01

    Nuclear Environment Technology Institute (NETEC) of Korea Electric Power Corporation (KEPCO) is developing near surface disposal concepts for both a rock cavern type disposal facility, and a vault type facility; two types of facility are being considered to provide more options for LILW repository siting. The conceptual design for the vault type facility will be completed in 1999. As a part of conceptual design effort, a preliminary concept for the disposal facility closure has been identified

  20. Surplus Facilities and Resource Conservation and Recovery Act Closure program plan, fiscal year 1992

    International Nuclear Information System (INIS)

    Hughes, M.C.; Wahlen, R.K.; Winship, R.A.

    1991-10-01

    The Surplus Facilities and Resource Conservation and Recovery Act Closure program is responsible to US Department of Energy Field Office, Richland for the safe, cost-effective surveillance, maintenance, and decommissioning of surplus facilities at the Hanford Site. The Surplus Facilities and Resource Conservation and Recovery Act Closure program is also responsible to US Department of Energy Field Office, Richland for the program management of specific Resource Conservation and Recovery Act closures at the Hanford Site. This program plan addresses only the surplus facilities. The criteria used to evaluate each factor relative to decommissioning are based on the guidelines presented by the US Department of Energy Field Office, Richland, Environmental Restoration Division. The guidelines are consistent with the Westinghouse Hanford Company commitment to decommission Hanford Site retired facilities in the safest and most cost-effective way achievable. This document outlines the plan for managing these facilities until disposal

  1. Post-closure safety assessment of near surface disposal facilities for disused sealed radioactive sources

    International Nuclear Information System (INIS)

    Lee, Seunghee; Kim, Juyoul

    2017-01-01

    Highlights: • Post-closure safety assessment of near surface disposal facility for DSRS was performed. • Engineered vault and rock-cavern type were considered for normal and well scenario. • 14 C, 226 Ra, 241 Am were primary nuclides contributing large portion of exposure dose. • Near surface disposal of DSRSs containing 14 C, 226 Ra and 241 Am should be restricted. - Abstract: Great attention has been recently paid to the post-closure safety assessment of low- and intermediate-level radioactive waste (LILW) disposal facility for disused sealed radioactive sources (DSRSs) around the world. Although the amount of volume of DSRSs generated from industry, medicine and research and education organization was relatively small compared with radioactive wastes from commercial nuclear power plants, some DSRSs can pose a significant hazard to human health due to their high activities and long half-lives, if not appropriately managed and disposed. In this study, post-closure safety assessment was carried out for DSRSs generated from 1991 to 2014 in Korea in order to ensure long-term safety of near surface disposal facilities. Two kinds of disposal options were considered, i.e., engineered vault type disposal facility and rock-cavern type disposal facility. Rock-cavern type disposal facility has been under operation in Gyeongju city, republic of Korea since August 2015 and engineered vault type disposal facility will be constructed until December 2020 in the vicinity of rock-cavern disposal facility. Assessment endpoint was individual dose to the member of critical group, which was modeled by GoldSim, which has been widely used as probabilistic risk analysis software based on Monte Carlo simulation in the area of safety assessment of radioactive waste facilities. In normal groundwater scenario, the maximum exposure dose was extremely low, approximately 1 × 10 −7 mSv/yr, for both disposal options and satisfied the regulatory limit of 0.1 mSv/yr. However, in the

  2. Post-closure safety assessment of near surface disposal facilities for disused sealed radioactive sources

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seunghee; Kim, Juyoul, E-mail: gracemi@fnctech.com

    2017-03-15

    Highlights: • Post-closure safety assessment of near surface disposal facility for DSRS was performed. • Engineered vault and rock-cavern type were considered for normal and well scenario. • {sup 14}C, {sup 226}Ra, {sup 241}Am were primary nuclides contributing large portion of exposure dose. • Near surface disposal of DSRSs containing {sup 14}C, {sup 226}Ra and {sup 241}Am should be restricted. - Abstract: Great attention has been recently paid to the post-closure safety assessment of low- and intermediate-level radioactive waste (LILW) disposal facility for disused sealed radioactive sources (DSRSs) around the world. Although the amount of volume of DSRSs generated from industry, medicine and research and education organization was relatively small compared with radioactive wastes from commercial nuclear power plants, some DSRSs can pose a significant hazard to human health due to their high activities and long half-lives, if not appropriately managed and disposed. In this study, post-closure safety assessment was carried out for DSRSs generated from 1991 to 2014 in Korea in order to ensure long-term safety of near surface disposal facilities. Two kinds of disposal options were considered, i.e., engineered vault type disposal facility and rock-cavern type disposal facility. Rock-cavern type disposal facility has been under operation in Gyeongju city, republic of Korea since August 2015 and engineered vault type disposal facility will be constructed until December 2020 in the vicinity of rock-cavern disposal facility. Assessment endpoint was individual dose to the member of critical group, which was modeled by GoldSim, which has been widely used as probabilistic risk analysis software based on Monte Carlo simulation in the area of safety assessment of radioactive waste facilities. In normal groundwater scenario, the maximum exposure dose was extremely low, approximately 1 × 10{sup −7} mSv/yr, for both disposal options and satisfied the regulatory limit

  3. 3718-F Alkali Metal Treatment and Storage Facility Closure Plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1992-11-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 3718-F Alkali Metal Treatment and Storage Facility (3718-F Facility), located in the 300 Area, was used to store and treat alkali metal wastes. Therefore, it is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989) and 40 CFR 270.1. Closure also will satisfy the thermal treatment facility closure requirements of 40 CFR 265.381. This closure plan presents a description of the 3718-F Facility, the history of wastes managed, and the approach that will be followed to close the facility. Only hazardous constituents derived from 3718-F Facility operations will be addressed.

  4. Facility Closure Report for T-Tunnel (U12T), Area 12, Nevada Test Site, Nevada

    International Nuclear Information System (INIS)

    2008-01-01

    This Facility Closure Report (FCR) has been prepared to document the actions taken to permanently close the remaining accessible areas of U12t-Tunnel (T-Tunnel) in Area 12 of the Nevada Test Site (NTS). The closure of T-Tunnel was a prerequisite to transfer facility ownership from the Defense Threat Reduction Agency (DTRA) to the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO). Closure of the facility was accomplished with the cooperation and concurrence of both NNSA/NSO and the Nevada Division of Environmental Protection (NDEP). The purpose of this FCR is to document that the closure of T-Tunnel complied with the closure requirements specified in the Facility Closure Plan for N- and T-Tunnels Area 12, Nevada Test Site (Appendix D) and that the facility is ready for transfer to NNSA/NSO. The Facility Closure Plan (FCP) is provided in Appendix D. T-Tunnel is located approximately 42 miles north of Mercury in Area 12 of the NTS (Figure 1). Between 1970 and 1987, T-Tunnel was used for six Nuclear Weapons Effects Tests (NWETs). The tunnel was excavated horizontally into the volcanic tuffs of Rainier Mesa. The T-Tunnel complex consists of a main access drift with two NWET containment structures, a Gas Seal Plug (GSP), and a Gas Seal Door (GSD) (Figure 2). The T-Tunnel complex was mothballed in 1993 to preserve the tunnel for resumption of testing, should it happen in the future, to stop the discharge of tunnel effluent, and to prevent unauthorized access. This was accomplished by sealing the main drift GSD

  5. Financial risks of post-closure custodial care for the Barnwell radioactive waste disposal facility - 16155

    International Nuclear Information System (INIS)

    Baird, Robert D.; Newberry, William F.

    2009-01-01

    This paper reports evaluations of the adequacy of the Barnwell Extended Care Fund in light of identified risks, with the conclusion that the fund is sufficient to cover the costs and uncertainties associated with planned post-closure care of the Barnwell, South Carolina low-level radioactive waste disposal facility. It reviews background information pertinent to the facility's post-closure monitoring and maintenance and describes financial responsibility for post-closure activities. It identifies and briefly characterizes the activities planned to be conducted following facility closure and presents the midrange estimate of planned post-closure costs. The paper identifies and quantifies sources of uncertainty in activities and costs planned for post-closure care and presents 50-, 80-, and 95-percent confidence levels of planned costs. The fund is currently sufficient to cover some but not all of the costs that might be incurred as a result of unplanned events. The paper identifies, characterizes, and quantifies unplanned events, possible consequences, and probabilities of occurrence. The paper presents costs that might be incurred in responding to the unplanned initiating events and identifies levels of confidence that the fund is adequate to cover such costs. (authors)

  6. State Environmental Policy Act (SEPA) Checklist for the 105-DR Large Sodium Fire Facility Closure Plan

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 105-DR Large Sodium Fire Facility (LSFF), which was in operation from about 1972 to 1986, was a research laboratory that occupied the former ventilation supply room on the southwest side of the 105-DR Reactor facility. The LSFF was established to provide means of investigating fire and safety aspects associated with large sodium or other metal alkali fires in the liquid metal fast breeder reactor (LMFBR) facilities. The 105-DR Reactor facility was designed and built in the 1950's and is located in the 100-D Area of the Hanford Site. The building housed the DR defense reactor, which was shut down in 1964. The LSFF is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Clean closure is the proposed method of closure for the LSFF. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989). This closure plan presents a description of the facility, the history of wastes managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of the LSFF is expected.

  7. Supporting Fernald Site Closure with Integrated Health and Safety Plans as Documented Safety Analyses

    International Nuclear Information System (INIS)

    Kohler, S.; Brown, T.; Fisk, P.; Krach, F.; Klein, B.

    2004-01-01

    At the Fernald Closure Project (FCP) near Cincinnati, Ohio, environmental restoration activities are supported by Documented Safety Analyses (DSAs) that combine the required project-specific Health and Safety Plans, Safety Basis Requirements (SBRs), and Process Requirements (PRs) into single Integrated Health and Safety Plans (I-HASPs). These integrated DSAs employ Integrated Safety Management methodology in support of simplified restoration and remediation activities that, so far, have resulted in the decontamination and demolition (D and D) of over 200 structures, including eight major nuclear production plants. There is one of twelve nuclear facilities still remaining (Silos containing uranium ore residues) with its own safety basis documentation. This paper presents the status of the FCP's safety basis documentation program, illustrating that all of the former nuclear facilities and activities have now replaced. Basis of Interim Operations (BIOs) with I-HASPs as their safety basis during the closure process

  8. Results of Washington's phase two study on closure requirements for the Hanford commercial low-level waste facility

    International Nuclear Information System (INIS)

    Anderson, D.C.; Hana, S.L.

    1989-01-01

    This paper reports on the closure design objectives and cover alternatives resulting from the state of Washington's phase two study on closure and long-term care for the Hanford commercial low-level radioactive waste disposal facility. Four approaches to dealing with subsidence and two cover design alternatives are discussed in this paper, along with information on each layer of each cover. Objectives for closure of the Hanford low-level waste facility are also discussed

  9. Mixed Waste Management Facility (MWMF) closure, Savannah River Plant: Clay cap test section construction report

    Energy Technology Data Exchange (ETDEWEB)

    1988-02-26

    This report contains appendices 3 through 6 for the Clay Cap Test Section Construction Report for the Mixed Waste Management Facility (MWMF) closure at the Savannah River Plant. The Clay Cap Test Program was conducted to evaluate the source, lab. permeability, in-situ permeability, and compaction characteristics, representative of kaolin clays from the Aiken, South Carolina vicinity. (KJD)

  10. The Mixed Waste Management Facility closure and expansion at the Savannah River Site

    International Nuclear Information System (INIS)

    Bittner, M.F.; Frye-O'Bryant, R.C.

    1992-01-01

    Process wastes containing radioactive and hazardous constituents have been generated throughout the operational history of the Savannah River Site. Solid wastes containing low level radionuclides were buried in Low Level Radioactive Disposal Facility (LLRWDF). Until 1986, waste containing lead and cadmium was disposed of in the Mixed Waste Management Facility (MWMF) portion of LLRWDF. Between 1986 and 1990, waste containing F-listed hazardous rags were buried. Current Resource Conservation and Recovery Act (RCRA) regulations prohibit the disposal of these hazardous wastes at nonpermitted facilities. This paper describes the closure activities for the MWMF, completed in 1990 and plans proposed for the expansion of this closure to include the LLRWDF suspect solvent rag trenches

  11. Facility Closure Report for Tunnel U16a, Area 16, Nevada Test Site, Nevada

    International Nuclear Information System (INIS)

    2009-01-01

    U16a is not listed in the Federal Facility Agreement and Consent Order. The closure of U16a was sponsored by the Defense Threat Reduction Agency (DTRA) and performed with the cooperation of the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office and the Nevada Division of Environmental Protection. This report documents closure of this site as identified in the DTRA Fiscal Year 2008 Statement of Work, Task 6.3. Closure activities included: (1) Removing and disposing of a shack and its contents; (2) Disposing of debris from within the shack and in the vicinity of the tunnel entrance; (3) Verifying that the tunnel is empty; (4) Welding screened covers over tunnel vent holes to limit access and allow ventilation; and (5) Constructing a full-tunnel cross-section fibercrete bulkhead to prevent access to the tunnel Field activities were conducted from July to August 2008.

  12. Information collection regarding geoscientific monitoring techniques during closure of underground facility in crystalline rock

    International Nuclear Information System (INIS)

    Hosoya, Shinichi; Yamashita, Tadashi; Iwatsuki, Teruki; Saegusa, Hiromitsu; Onoe, Hironori; Ishibashi, Masayuki

    2016-01-01

    The Mizunami Underground Research Laboratory (MIU) project is being pursued by the Japan Atomic Energy Agency (JAEA) to enhance the reliability of geological disposal technologies through investigations of the deep geological environment in the crystalline host rock (granite) at Mizunami City in Gifu Prefecture, central Japan. On the occasion of the reform of the entire JAEA organization in 2014, JAEA identified the critical issues on the geoscientific research program: “Development of modelling technologies for mass transport”, “Development of drift backfilling technologies” and “Development of technologies for reducing groundwater inflow”, based on the latest results of the synthesizing R and D. The purposes of the “Development of drift backfilling technologies” are to develop closure methodology and technology, and long-term monitoring technology, and to evaluate resilience of geological environment. In order to achieve the purposes, previous information from the case example of underground facility constructed in crystalline rock in Europe has been collected in this study. In particular, the boundary conditions for the closure, geological characteristics, technical specifications, and method of monitoring have been focused. The information on the international project regarding drift closure test and development of monitoring technologies has also been collected. In addition, interviews were conducted to Finnish and Swedish specialists who have experiences involving planning, construction management, monitoring, and safety assessment for the closure to obtain the technical knowledge. Based on the collected information, concept and point of attention, which are regarding drift closure testing, and planning, execution management and monitoring on the closure of MIU, have been specified. (author)

  13. Phase 1 sampling and analysis plan for the 304 Concretion Facility closure activities

    International Nuclear Information System (INIS)

    Adler, J.G.

    1994-01-01

    This document provides guidance for the initial (Phase 1) sampling and analysis activities associated with the proposed Resource Conservation and Recovery Act of 1976 (RCRA) clean closure of the 304 Concretion Facility. Over its service life, the 304 Concretion Facility housed the pilot plants associated with cladding uranium cores, was used to store engineering equipment and product chemicals, was used to treat low-level radioactive mixed waste, recyclable scrap uranium generated during nuclear fuel fabrication, and uranium-titanium alloy chips, and was used for the repackaging of spent halogenated solvents from the nuclear fuels manufacturing process. The strategy for clean closure of the 304 Concretion Facility is to decontaminate, sample (Phase 1 sampling), and evaluate results. If the evaluation indicates that a limited area requires additional decontamination for clean closure, the limited area will be decontaminated, resampled (Phase 2 sampling), and the result evaluated. If the evaluation indicates that the constituents of concern are below action levels, the facility will be clean closed. Or, if the evaluation indicates that the constituents of concern are present above action levels, the condition of the facility will be evaluated and appropriate action taken. There are a total of 37 sampling locations comprising 12 concrete core, 1 concrete chip, 9 soil, 11 wipe, and 4 asphalt core sampling locations. Analysis for inorganics and volatile organics will be performed on the concrete core and soil samples. Separate concrete core samples will be required for the inorganic and volatile organic analysis (VOA). Analysis for inorganics only will be performed on the concrete chip, wipe, and asphalt samples

  14. State Environmental Policy Act (SEPA) environmental checklist forms for 304 Concretion Facility Closure Plan

    International Nuclear Information System (INIS)

    1993-11-01

    The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 304 Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 304 Facility, the history of materials and waste managed, and the procedures that will be followed to close the 304 Facility. The 304 Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5

  15. State Environmental Policy Act (SEPA) environmental checklist forms for 304 Concretion Facility Closure Plan. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    1993-11-01

    The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 304 Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 304 Facility, the history of materials and waste managed, and the procedures that will be followed to close the 304 Facility. The 304 Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.

  16. Closure End States for Facilities, Waste Sites, and Subsurface Contamination - 12543

    Energy Technology Data Exchange (ETDEWEB)

    Gerdes, Kurt; Chamberlain, Grover; Whitehurst, Latrincy; Marble, Justin [Office of Groundwater and Soil Remediation, U.S. Department of Energy, Washington, DC 20585 (United States); Wellman, Dawn [Pacific Northwest National Laboratory, Richland, Washington 99352 (United States); Deeb, Rula; Hawley, Elisabeth [ARCADIS U.S., Inc., Emeryville, CA 94608 (United States)

    2012-07-01

    The United States (U.S.) Department of Energy (DOE) manages the largest groundwater and soil cleanup effort in the world. DOE's Office of Environmental Management (EM) has made significant progress in its restoration efforts at sites such as Fernald and Rocky Flats. However, remaining sites, such as Savannah River Site, Oak Ridge Site, Hanford Site, Los Alamos, Paducah Gaseous Diffusion Plant, Portsmouth Gaseous Diffusion Plant, and West Valley Demonstration Project possess the most complex challenges ever encountered by the technical community and represent a challenge that will face DOE for the next decade. Closure of the remaining 18 sites in the DOE EM Program requires remediation of 75 million cubic yards of contaminated soil and 1.7 trillion gallons of contaminated groundwater, deactivation and decommissioning (D and D) of over 3000 contaminated facilities and thousands of miles of contaminated piping, removal and disposition of millions of cubic yards of legacy materials, treatment of millions of gallons of high level tank waste and disposition of hundreds of contaminated tanks. The financial obligation required to remediate this volume of contaminated environment is estimated to cost more than 7% of the to-go life-cycle cost. Critical in meeting this goal within the current life-cycle cost projections is defining technically achievable end states that formally acknowledge that remedial goals will not be achieved for a long time and that residual contamination will be managed in the interim in ways that are protective of human health and environment. Formally acknowledging the long timeframe needed for remediation can be a basis for establishing common expectations for remedy performance, thereby minimizing the risk of re-evaluating the selected remedy at a later time. Once the expectations for long-term management are in place, remedial efforts can be directed towards near-term objectives (e.g., reducing the risk of exposure to residual contamination

  17. ICPP calcined solids storage facility closure study. Volume II: Cost estimates, planning schedules, yearly cost flowcharts, and life-cycle cost estimates

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-02-01

    This document contains Volume II of the Closure Study for the Idaho Chemical Processing Plant Calcined Solids Storage Facility. This volume contains draft information on cost estimates, planning schedules, yearly cost flowcharts, and life-cycle costs for the four options described in Volume I: (1) Risk-Based Clean Closure; NRC Class C fill, (2) Risk-Based Clean Closure; Clean fill, (3) Closure to landfill Standards; NRC Class C fill, and (4) Closure to Landfill Standards; Clean fill.

  18. ICPP calcined solids storage facility closure study. Volume II: Cost estimates, planning schedules, yearly cost flowcharts, and life-cycle cost estimates

    International Nuclear Information System (INIS)

    1998-02-01

    This document contains Volume II of the Closure Study for the Idaho Chemical Processing Plant Calcined Solids Storage Facility. This volume contains draft information on cost estimates, planning schedules, yearly cost flowcharts, and life-cycle costs for the four options described in Volume I: (1) Risk-Based Clean Closure; NRC Class C fill, (2) Risk-Based Clean Closure; Clean fill, (3) Closure to landfill Standards; NRC Class C fill, and (4) Closure to Landfill Standards; Clean fill

  19. Lessons Learned from the On-Site Disposal Facility at Fernald Closure Project

    International Nuclear Information System (INIS)

    Kumthekar, U.A.; Chiou, J.D.

    2006-01-01

    The On-Site Disposal Facility (OSDF) at the U.S. Department of Energy's (DOE) Fernald Closure Project near Cincinnati, Ohio is an engineered above-grade waste disposal facility being constructed to permanently store low level radioactive waste (LLRW) and treated mixed LLRW generated during Decommissioning and Demolition (D and D) and soil remediation performed in order to achieve the final land use goal at the site. The OSDF is engineered to store 2.93 million cubic yards of waste derived from the remediation activities. The OSDF is intended to isolate its LLRW from the environment for at least 200 years and for up to 1,000 years to the extent practicable and achievable. Construction of the OSDF started in 1997 and waste placement activities will complete by the middle of April 2006 with the final cover (cap) placement over the last open cell by the end of Spring 2006. An on-site disposal alternative is considered critical to the success of many large-scale DOE remediation projects throughout the United States. However, for various reasons this cost effective alternative is not readily available in many cases. Over the last ten years Fluor Fernald Inc. has cumulated many valuable lessons learned through the complex engineering, construction, operation, and closure processes of the OSDF. Also in the last several years representatives from other DOE sites, State agencies, as well as foreign government agencies have visited the Fernald site to look for proven experiences and practices, which may be adapted for their sites. This paper present a summary of the major issues and lessons leaned at the Fernald site related to engineering, construction, operation, and closure processes for the disposal of remediation waste. The purpose of this paper is to share lessons learned and to benefit other projects considering or operating similar on-site disposal facilities from our successful experiences. (authors)

  20. Recommended management practices for operation and closure of shallow injection wells at DOE facilities

    International Nuclear Information System (INIS)

    1993-07-01

    The Safe Drinking Water Act established the Underground Injection Control (UIC) program to ensure that underground injection of wastes does not endanger an underground source of drinking water. Under UIC regulations, an injection well is a hole in the ground, deeper than it is wide, that receives wastes or other fluid substances. Types of injection wells range from deep cased wells to shallow sumps, drywells, and drainfields. The report describes the five classes of UIC wells and summarizes relevant regulations for each class of wells and for the UIC program. The main focus of the report is Class IV and V shallow injection wells. Class IV wells are prohibited and should be closed when they are identified. Class V wells are generally authorized by rule, but EPA or a delegated state may require a permit for a Class V well. This report provides recommendations on sound operating and closure practices for shallow injection wells. In addition the report contains copies of several relevant EPA documents that provide additional information on well operation and closure. Another appendix contains information on the UIC programs in 21 states in which there are DOE facilities discharging to injection wells. The appendix includes the name of the responsible regulatory agency and contact person, a summary of differences between the state's regulations and Federal regulations, and any closure guidelines for Class IV and V wells

  1. Health Facilities - Multiple Languages

    Science.gov (United States)

    ... Well-Being 10 - Medical Appointments - Amarɨñña / አማርኛ (Amharic) MP3 Siloam Family Health Center Arabic (العربية) Expand Section ... Well-Being 10 - Medical Appointments - myanma bhasa (Burmese) MP3 Siloam Family Health Center Dari (دری) Expand Section ...

  2. Resource Conservation and Recovery Act closure plan for the Intermediate-Level Transuranic Storage Facility mixed waste container storage units

    International Nuclear Information System (INIS)

    Nolte, E.P.; Spry, M.J.; Stanisich, S.N.

    1992-11-01

    This document describes the proposed plan for clean closure of the Intermediate-Level Transuranic Storage Facility mixed waste container storage units at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act closure requirements. Descriptions of the location, size, capacity, history, and current status of the units are included. The units will be closed by removing waste containers in storage, and decontamination structures and equipment that may have contacted waste. Sufficient sampling and documentation of all activities will be performed to demonstrate clean closure. A tentative schedule is provided in the form of a milestone chart

  3. HWMA/RCRA Closure Plan for the TRA Fluorinel Dissolution Process Mockup and Gamma Facilities Waste System

    International Nuclear Information System (INIS)

    K. Winterholler

    2007-01-01

    This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan was developed for the Test Reactor Area Fluorinel Dissolution Process Mockup and Gamma Facilities Waste System, located in Building TRA-641 at the Reactor Technology Complex (RTC), Idaho National Laboratory Site, to meet a further milestone established under the Voluntary Consent Order SITE-TANK-005 Action Plan for Tank System TRA-009. The tank system to be closed is identified as VCO-SITE-TANK-005 Tank System TRA-009. This closure plan presents the closure performance standards and methods for achieving those standards

  4. Fall 2010 Semiannual (III.H. and I.U.) Report for the HWMA/RCRA Post Closure Permit for the INTEC Waste Calcining Facility and the CPP 601/627/640 Facility at the INL Site

    Energy Technology Data Exchange (ETDEWEB)

    Boehmer, Ann

    2010-11-01

    The Waste Calcining Facility is located at the Idaho Nuclear Technology and Engineering Center. In 1999, the Waste Calcining Facility was closed under an approved Hazardous Waste Management Act/Resource Conservation and Recovery Act (HWMA/RCRA) Closure Plan. Vessels and spaces were grouted and then covered with a concrete cap. The Idaho Department of Environmental Quality issued a final HWMA/RCRA post-closure permit on September 15, 2003, with an effective date of October 16, 2003. This permit sets forth procedural requirements for groundwater characterization and monitoring, maintenance, and inspections of the Waste Calcining Facility to ensure continued protection of human health and the environment. The post closure permit also includes semiannual reporting requirements under Permit Conditions III.H. and I.U. These reporting requirements have been combined into this single semiannual report, as agreed between the Idaho Cleanup Project and Idaho Department of Environmental Quality. The Permit Condition III.H. portion of this report includes a description and the results of field methods associated with groundwater monitoring of the Waste Calcining Facility. Analytical results from groundwater sampling, results of inspections and maintenance of monitoring wells in the Waste Calcining Facility groundwater monitoring network, and results of inspections of the concrete cap are summarized. The Permit Condition I.U. portion of this report includes noncompliances not otherwise required to be reported under Permit Condition I.R. (advance notice of planned changes to facility activity which may result in a noncompliance) or Permit Condition I.T. (reporting of noncompliances which may endanger human health or the environment). This report also provides groundwater sampling results for wells that were installed and monitored as part of the Phase 1 post-closure period of the landfill closure components in accordance with HWMA/RCRA Landfill Closure Plan for the CPP-601 Deep

  5. CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 115: AREA 25 TEST CELL A FACILITY, NEVADA TEST SITE, NEVADA

    International Nuclear Information System (INIS)

    2006-01-01

    This Closure Report (CR) describes the activities performed to close CAU 115, Area 25 Test Cell A Facility, as presented in the NDEP-approved SAFER Plan (NNSA/NSO, 2004). The SAFER Plan includes a summary of the site history, process knowledge, and closure standards. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical and radiological data to confirm that the remediation goals were met and to document final site conditions. The approved closure alternative as presented in the SAFER Plan for CAU 115 (NNSA/NSO, 2004) was clean closure; however, closure in place was implemented under a Record of Technical Change (ROTC) to the SAFER Plan when radiological surveys indicated that the concrete reactor pad was radiologically activated and could not be decontaminated to meet free release levels. The ROTC is included as Appendix G of this report. The objectives of closure were to remove any trapped residual liquids and gases, dispose regulated and hazardous waste, decontaminate removable radiological contamination, demolish and dispose aboveground structures, remove the dewar as a best management practice (BMP), and characterize and restrict access to all remaining radiological contamination. Radiological contaminants of concern (COCs) included cobalt-60, cesium-137, strontium-90, uranium-234/235/236/238, and plutonium-239/240. Additional COCs included Resource Conservation and Recovery Act (RCRA) metals, polychlorinated biphenyls (PCBs), and asbestos

  6. Spring 2009 Semiannual (III.H. and I.U.) Report for the HWMA/RCRA Post-Closure Permit for the INTEC Waste Calcining Facility at the INL Site

    International Nuclear Information System (INIS)

    Boehmer, Ann M.

    2009-01-01

    The Waste Calcining Facility is located at the Idaho Nuclear Technology and Engineering Center. In 1999, the Waste Calcining Facility was closed under and approved Hazardous Waste Management Act/Resource Conservation and Recovery Act Closure plan. Vessels and spaces were grouted and then covered with a concrete cap. This permit sets forth procedural requirements for groundwater characterization and monitoring, maintenance, and inspections of the Waste Calcining Facility to ensure continued protection of human health and the environment.

  7. Spring 2009 Semiannual (III.H. and I.U.) Report for the HWMA/RCRA Post-Closure Permit for the INTEC Waste Calcining Facility at the INL Site

    Energy Technology Data Exchange (ETDEWEB)

    Boehmer, Ann M.

    2009-05-31

    The Waste Calcining Facility is located at the Idaho Nuclear Technology and Engineering Center. In 1999, the Waste Calcining Facility was closed under and approved Hazardous Waste Management Act/Resource Conservation and Recovery Act Closure plan. Vessels and spaces were grouted and then covered with a concrete cap. This permit sets forth procedural requirements for groundwater characterization and monitoring, maintenance, and inspections of the Waste Calcining Facility to ensure continued protection of human health and the environment.

  8. ICPP calcined solids storage facility closure study. Volume III: Engineering design files

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-02-01

    The following information was calculated to support cost estimates and radiation exposure calculations for closure activities at the Calcined Solids Storage Facility (CSSF). Within the estimate, volumes were calculated to determine the required amount of grout to be used during closure activities. The remaining calcine on the bin walls, supports, piping, and floor was also calculated to approximate the remaining residual calcine volumes at different stages of the removal process. The estimates for remaining calcine and vault void volume are higher than what would actually be experienced in the field, but are necessary for bounding purposes. The residual calcine in the bins may be higher than was is experienced in the field as it was assumed that the entire bin volume is full of calcine before removal activities commence. The vault void volumes are higher as the vault roof beam volumes were neglected. The estimations that follow should be considered rough order of magnitude, due to the time constraints as dictated by the project`s scope of work. Should more accurate numbers be required, a new analysis would be necessary.

  9. ICPP calcined solids storage facility closure study. Volume III: Engineering design files

    International Nuclear Information System (INIS)

    1998-02-01

    The following information was calculated to support cost estimates and radiation exposure calculations for closure activities at the Calcined Solids Storage Facility (CSSF). Within the estimate, volumes were calculated to determine the required amount of grout to be used during closure activities. The remaining calcine on the bin walls, supports, piping, and floor was also calculated to approximate the remaining residual calcine volumes at different stages of the removal process. The estimates for remaining calcine and vault void volume are higher than what would actually be experienced in the field, but are necessary for bounding purposes. The residual calcine in the bins may be higher than was is experienced in the field as it was assumed that the entire bin volume is full of calcine before removal activities commence. The vault void volumes are higher as the vault roof beam volumes were neglected. The estimations that follow should be considered rough order of magnitude, due to the time constraints as dictated by the project's scope of work. Should more accurate numbers be required, a new analysis would be necessary

  10. Simplifying documentation while approaching site closure: integrated health and safety plans as documented safety analysis

    International Nuclear Information System (INIS)

    Brown, Tulanda

    2003-01-01

    At the Fernald Closure Project (FCP) near Cincinnati, Ohio, environmental restoration activities are supported by Documented Safety Analyses (DSAs) that combine the required project-specific Health and Safety Plans, Safety Basis Requirements (SBRs), and Process Requirements (PRs) into single Integrated Health and Safety Plans (I-HASPs). By isolating any remediation activities that deal with Enriched Restricted Materials, the SBRs and PRs assure that the hazard categories of former nuclear facilities undergoing remediation remain less than Nuclear. These integrated DSAs employ Integrated Safety Management methodology in support of simplified restoration and remediation activities that, so far, have resulted in the decontamination and demolition (D and D) of over 150 structures, including six major nuclear production plants. This paper presents the FCP method for maintaining safety basis documentation, using the D and D I-HASP as an example

  11. The Necessary and Sufficient Closure Process Completion Report for Purex FacilitySurveillance and Maintenance

    International Nuclear Information System (INIS)

    Gerald, J.W.

    1997-10-01

    This document completes the U.S. Department of Energy Closure Process for Necessary and Sufficient Sets of Standards process for the Plutonium Uranium Extraction facility located at the Hanford Site in Washington State. This documentation is provided to support the Work Smart Standards set identified for the long-term surveillance and maintenance of PUREX. This report is organized into two volumes. Volume 1 contains the following sections: Section 1: Provides an introduction for the document Section 2: Provides a basis for initiating the N ampersand S process Section 3: Defines the work and hazards to be addressed Section 4: Identifies the N ampersand S set of standards and requirements Section 5: Provides the justification for adequacy of the work smart standards Section 6: Shows the criteria and qualifications of the teams Section 7: Describes the stakeholder participation and concerns Section 8: Provides a list of references used within the document

  12. Closure Report for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada National Security Site, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2011-09-29

    This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 116, Area 25 Test Cell C Facility. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996 [as amended March 2010]). CAU 116 consists of the following two Corrective Action Sites (CASs), located in Area 25 of the Nevada National Security Site: (1) CAS 25-23-20, Nuclear Furnace Piping and (2) CAS 25-41-05, Test Cell C Facility. CAS 25-41-05 consisted of Building 3210 and the attached concrete shield wall. CAS 25-23-20 consisted of the nuclear furnace piping and tanks. Closure activities began in January 2007 and were completed in August 2011. Activities were conducted according to Revision 1 of the Streamlined Approach for Environmental Restoration Plan for CAU 116 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2008). This CR provides documentation supporting the completed corrective actions and provides data confirming that closure objectives for CAU 116 were met. Site characterization data and process knowledge indicated that surface areas were radiologically contaminated above release limits and that regulated and/or hazardous wastes were present in the facility.

  13. United Kingdom. Development plan for the eventual closure of the UK Drigg nuclear surface low level waste disposal facility

    International Nuclear Information System (INIS)

    2001-01-01

    The Drigg site, owned and operated by BNFL, is the UK's principal site for the disposal of low level radioactive waste. The site has operated since 1959 and receives wastes from a wide range of sources including nuclear power stations, nuclear fuel cycle facilities, isotope manufacturing sites, universities, general industry and cleanup of historically contaminated sites. Disposals until the late 1980s were solely by tipping essentially loose wastes into excavated trenches. More recently, trench disposals have been phased out in preference to emplacement of containerised, conditioned wastes in concrete vaults. The standardised wasteform consists of high force compacted (or non-compactable) waste immobilised within 20 m 3 steel overpack containers by the addition of cementitious grout. Larger items of wastes are grouted directly, in situ in the vault. The disposal trenches have been completed with an interim cap, as will the vaults when filled. It is currently estimated that sufficient capacity remains at Drigg for disposals to continue until at least 2050. Post-operations it is planned that the site will enter a phase including shut down of operational facilities, emplacement of long term site closure features including a final closure cap and then to an institutional management phase. Planning has therefore been carried out as to the strategy for eventual closure of the site. This closure strategy is also underpinned by an engineering evaluation studies programme to develop and evaluate appropriate closure measures including assessment of the long term performance of such measures. This appendix summarizes some of this work

  14. Tank Closure Progress at the Department of Energy's Idaho National Engineering Laboratory Tank Farm Facility

    International Nuclear Information System (INIS)

    Butterworth, St.W.; Shaw, M.R.

    2009-01-01

    Significant progress continued at the U.S. Department of Energy (DOE) Idaho National Laboratory (INL) with the completion of the closure process to empty, clean and close radioactive liquid waste storage tanks at the Idaho Nuclear Technology and Engineering Center (INTEC) Tank Farm Facility (TFF). The TFF includes eleven 1,135.6-kL (300,000-gal) underground stainless steel storage tanks and four smaller, 113.5-kL (30,000-gal) stainless steel tanks, along with tank vaults, interconnecting piping, and ancillary equipment. The TFF tanks had historically been used to store a variety of radioactive liquid waste, including wastes associated with past spent nuclear fuel reprocessing. Four of the large storage tanks remain in use for waste storage while the other seven 1,135.6-kL (300,000-gal) tanks and the four 113.5-kL (30,000-gal) tanks have been emptied of waste, cleaned and filled with grout. Recent issuance of an Amended Record of Decision (ROD) in accordance with the National Environmental Policy Act, and a Waste Determination complying with Section 3116 of the Ronald W. Reagan National Defense Authorization Act (NDAA) for Fiscal Year 2005, allowed commencement of grouting activities on the cleaned tanks. The first three 113.5-kL (30,000-gal) tanks were grouted in the Fall of 2006 and the fourth tank and the seven 1,135.6-kL (300,000-gal) tanks were filled with grout in 2007 to provide long-term stability. During 2008 over seven miles of underground process piping along with associated tank valve boxes and secondary containment systems was stabilized with grout. Lessons learned were compiled and implemented during the closure process and will be utilized on the remaining four 1,135.6-kL (300,000-gal) underground stainless steel storage tanks. Significant progress has been made to clean and close emptied tanks at the INTEC TFF. Between 2002 and 2005, seven of the eleven 1,135.6-kL (300,000-gal) tanks and all four 113.5-kL (30,000-gal) tanks were cleaned and prepared

  15. Pre/post-closure assessment of groundwater pharmaceutical fate in a wastewater‑facility-impacted stream reach

    Science.gov (United States)

    Bradley, Paul M.; Barber, Larry B.; Clark, Jimmy M.; Duris, Joseph W.; Foreman, William T.; Furlong, Edward T.; Givens, Carrie E.; Hubbard, Laura E.; Hutchinson, Kasey J.; Journey, Celeste A.; Keefe, Steffanie H.; Kolpin, Dana W.

    2016-01-01

    Pharmaceutical contamination of contiguous groundwater is a substantial concern in wastewater-impacted streams, due to ubiquity in effluent, high aqueous mobility, designed bioactivity, and to effluent-driven hydraulic gradients. Wastewater treatment facility (WWTF) closures are rare environmental remediation events; offering unique insights into contaminant persistence, long-term wastewater impacts, and ecosystem recovery processes. The USGS conducted a combined pre/post-closure groundwater assessment adjacent to an effluent-impacted reach of Fourmile Creek, Ankeny, Iowa, USA. Higher surface-water concentrations, consistent surface-water to groundwater concentration gradients, and sustained groundwater detections tens of meters from the stream bank demonstrated the importance of WWTF effluent as the source of groundwater pharmaceuticals as well as the persistence of these contaminants under effluent-driven, pre-closure conditions. The number of analytes (110 total) detected in surface water decreased from 69 prior to closure down to 8 in the first post-closure sampling event approximately 30 d later, with a corresponding 2 order of magnitude decrease in the cumulative concentration of detected analytes. Post-closure cumulative concentrations of detected analytes were approximately 5 times higher in proximal groundwater than in surface water. About 40% of the 21 contaminants detected in a downstream groundwater transect immediately before WWTF closure exhibited rapid attenuation with estimated half-lives on the order of a few days; however, a comparable number exhibited no consistent attenuation during the year-long post-closure assessment. The results demonstrate the potential for effluent-impacted shallow groundwater systems to accumulate pharmaceutical contaminants and serve as long-term residual sources, further increasing the risk of adverse ecological effects in groundwater and the near-stream ecosystem.

  16. Site closure and perpetual care of a low-level radioactive waste disposal facility in semi-arid climate

    International Nuclear Information System (INIS)

    Singh, P.N.; Breeden, K.H.; Hana, S.L.A.

    1988-01-01

    A study has been performed on site closure and perpetual care and maintenance requirements for the commercially operated low-level radioactive waste (LLRW) disposal facility, referred to as the Richland Facility, on the Hanford Reservation near Richland, Washington. The study included a site assessment and identification and formulation of site specific design elements for closure and perpetual care and maintenance. This paper summarizes the observations, findings and conclusions resulting from Phase I of this study. Three release mechanisms and four destructive processes are considered in the conceptual closure design process. The release mechanisms considered include subsurface liquid movement, biological transport of wastes to the surface and subsurface gas movement. The destructive processes considered are wind erosion, biological penetration or damage of cover, vegetation destroying processes and subsidence and seismic activity. The closure design elements were developed with several key principles in mind. The primary goals were to prevent intrusion into, or exposure of, the waste; to prevent or minimize release from the trenches; to provide early warning of any release that should occur; and to provide definitive information as to whether or not any observed environmental contamination actually originated from the facility

  17. Closure Report for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Mark Burmeister

    2007-01-01

    This CR provides documentation and justification for the closure of CAU 118 without further corrective action. This justification is based on process knowledge and the results of the investigative and closure activities conducted in accordance with the CAU 118 SAFER Plan: Streamlined Approach for Environmental Restoration (SAFER) Plan for CAU 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada (NNSA/NSO, 2006). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. This CR also provides the analytical and radiological survey data to confirm that the remediation goals were met as specified in the CAU 118 SAFER Plan (NNSA/NSO, 2006). The Nevada Division of Environmental Protection (NDEP) approved the CAU 118 SAFER Plan (Murphy, 2006), which recommends closure in place with use restrictions (URs)

  18. Hungary. Closure issues for centralized waste treatment and disposal facility in Puspokszilagy, Hungary

    International Nuclear Information System (INIS)

    2001-01-01

    The facility was commissioned in 1976. At the time that its mission was formulated, the facility was designed to collect, transport, treat as necessary and dispose all radioactive waste originating from institutional use of radioactivity. The facility is government owned and presently operated by the Budapest branch of the State Public Health and Medical Officer Services. The disposal site is located on the ridge of a hill near Puspokszilagy village approximately 40 km Northeast of Budapest. The disposal units are located in Quaternary layers of silt and clay sequences. Annual average precipitation is approximately 650-700 mm. The facility is a typical shallow land, near surface engineered type disposal unit. There are concrete trenches and shallow wells for waste disposal purposes

  19. Soil sampling and analysis plan for the 3718-F Alkali Metal Treatment and Storage Facility closure activities

    Energy Technology Data Exchange (ETDEWEB)

    Sonnichsen, J.C.

    1997-05-01

    Amendment V.13.B.b to the approved closure plan (DOE-RL 1995a) requires that a soil sampling and analysis plan be prepared and submitted to the Washington State Department of Ecology (Ecology) for review and approval. Amendment V.13.B.c requires that a diagram of the 3718-F Alkali Metal Treatment and Storage Facility unit (the treatment, storage, and disposal [TSD] unit) boundary that is to be closed, including the maximum extent of operation, be prepared and submitted as part is of the soil sampling and analysis plan. This document describes the sampling and analysis that is to be performed in response to these requirements and amends the closure plan. Specifically, this document supersedes Section 6.2, lines 43--46, and Section 7.3.6 of the closure plan. Results from the analysis will be compared to cleanup levels identified in the closure plan. These cleanup levels will be established using residential exposure assumptions in accordance with the Model Toxics Control Act (MTCA) Cleanup Regulation (Washington Administrative Code [WAC] 173-340) as required in Amendment V.13.B.I. Results of all sampling, including the raw analytical data, a summary of analytical results, a data validation package, and a narrative summary with conclusions will be provided to Ecology as specified in Amendment V.13.B.e. The results and process used to collect and analyze the soil samples will be certified by a licensed professional engineer. These results and a certificate of closure for the balance of the TSD unit, as outlined in Chapter 7.0 of the approved closure plan (storage shed, concrete pad, burn building, scrubber, and reaction tanks), will provide the basis for a closure determination.

  20. Soil sampling and analysis plan for the 3718-F Alkali Metal Treatment and Storage Facility closure activities

    International Nuclear Information System (INIS)

    Sonnichsen, J.C.

    1997-01-01

    Amendment V.13.B.b to the approved closure plan (DOE-RL 1995a) requires that a soil sampling and analysis plan be prepared and submitted to the Washington State Department of Ecology (Ecology) for review and approval. Amendment V.13.B.c requires that a diagram of the 3718-F Alkali Metal Treatment and Storage Facility unit (the treatment, storage, and disposal [TSD] unit) boundary that is to be closed, including the maximum extent of operation, be prepared and submitted as part is of the soil sampling and analysis plan. This document describes the sampling and analysis that is to be performed in response to these requirements and amends the closure plan. Specifically, this document supersedes Section 6.2, lines 43--46, and Section 7.3.6 of the closure plan. Results from the analysis will be compared to cleanup levels identified in the closure plan. These cleanup levels will be established using residential exposure assumptions in accordance with the Model Toxics Control Act (MTCA) Cleanup Regulation (Washington Administrative Code [WAC] 173-340) as required in Amendment V.13.B.I. Results of all sampling, including the raw analytical data, a summary of analytical results, a data validation package, and a narrative summary with conclusions will be provided to Ecology as specified in Amendment V.13.B.e. The results and process used to collect and analyze the soil samples will be certified by a licensed professional engineer. These results and a certificate of closure for the balance of the TSD unit, as outlined in Chapter 7.0 of the approved closure plan (storage shed, concrete pad, burn building, scrubber, and reaction tanks), will provide the basis for a closure determination

  1. RCRA corrective action and closure

    International Nuclear Information System (INIS)

    1995-02-01

    This information brief explains how RCRA corrective action and closure processes affect one another. It examines the similarities and differences between corrective action and closure, regulators' interests in RCRA facilities undergoing closure, and how the need to perform corrective action affects the closure of DOE's permitted facilities and interim status facilities

  2. Cleanups In My Community (CIMC) - RCRA and Base Realignment and Closure (BRAC) Federal Facilities, National Layer

    Data.gov (United States)

    U.S. Environmental Protection Agency — This data layer provides access to Resource Conservation and Recovery Act (RCRA) Base Realignment and Closure (BRAC) sites as part of the CIMC web service. The...

  3. Final closure plan for the high-explosives open burn treatment facility at Lawrence Livermore National Laboratory Experimental Test Site 300

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, S.

    1997-04-01

    This document addresses the interim status closure of the HE Open Bum Treatment Facility, as detailed by Title 22, Division 4.5, Chapter 15, Article 7 of the Califonia Code of Regulations (CCR) and by Title 40, Code of Federal Regulations (CFR) Part 265, Subpart G, ``Closure and Post Closure.`` The Closure Plan (Chapter 1) and the Post- Closure Plan (Chapter 2) address the concept of long-term hazard elimination. The Closure Plan provides for capping and grading the HE Open Bum Treatment Facility and revegetating the immediate area in accordance with applicable requirements. The Closure Plan also reflects careful consideration of site location and topography, geologic and hydrologic factors, climate, cover characteristics, type and amount of wastes, and the potential for contaminant migration. The Post-Closure Plan is designed to allow LLNL to monitor the movement, if any, of pollutants from the treatment area. In addition, quarterly inspections will ensure that all surfaces of the closed facility, including the cover and diversion ditches, remain in good repair, thus precluding the potential for contaminant migration.

  4. Closure requirements

    International Nuclear Information System (INIS)

    Hutchinson, I.P.G.; Ellison, R.D.

    1992-01-01

    Closure of a waste management unit can be either permanent or temporary. Permanent closure may be due to: economic factors which make it uneconomical to mine the remaining minerals; depletion of mineral resources; physical site constraints that preclude further mining and beneficiation; environmental, regulatory or other requirements that make it uneconomical to continue to develop the resources. Temporary closure can occur for a period of several months to several years, and may be caused by factors such as: periods of high rainfall or snowfall which prevent mining and waste disposal; economic circumstances which temporarily make it uneconomical to mine the target mineral; labor problems requiring a cessation of operations for a period of time; construction activities that are required to upgrade project components such as the process facilities and waste management units; and mine or process plant failures that require extensive repairs. Permanent closure of a mine waste management unit involves the provision of durable surface containment features to protect the waters of the State in the long-term. Temporary closure may involve activities that range from ongoing maintenance of the existing facilities to the installation of several permanent closure features in order to reduce ongoing maintenance. This paper deals with the permanent closure features

  5. Closure Report for Corrective Action Unit 254: Area 25, R-MAD Decontamination Facility, Nevada Test Site, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    G. N. Doyle

    2002-02-01

    Corrective Action Unit (CAU) 254 is located in Area 25 of the Nevada Test Site (NTS), approximately 100 kilometers (km) (62 miles) northwest of Las Vegas, Nevada. The site is located within the Reactor Maintenance, Assembly and Disassembly (R-MAD) compound and consists of Building 3126, two outdoor decontamination pads, and surrounding areas within an existing fenced area measuring approximately 50 x 37 meters (160 x 120 feet). The site was used from the early 1960s to the early 1970s as part of the Nuclear Rocket Development Station program to decontaminate test-car hardware and tooling. The site was reactivated in the early 1980s to decontaminate a radiologically contaminated military tank. This Closure Report (CR) describes the closure activities performed to allow un-restricted release of the R-MAD Decontamination Facility.

  6. Health seeking behaviour and challenges in utilising health facilities ...

    African Journals Online (AJOL)

    ... and long distance to health facilities. Conclusions: There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy. Key words: Health seeking behaviour, Rural community, Health facilities, Challenges, Uganda ...

  7. 324 Facility special-case waste assessment in support of 324 closure (TPA milestone M-89-05)

    International Nuclear Information System (INIS)

    Hobart, R.L.

    1998-01-01

    Hanford Federal Facility Agreement and Consent Order, also known as the Tri-Party Agreement Milestone M-89-05, requires US Department of Energy, Richland Operations Office to complete a 324 Facility Special-Case Waste Assessment in Support of 324 Closure. This document, HNF-1270, has been prepared with the intent of meeting this regulatory commitment. Alternatives for the special-case wastes located in the 324 Building were defined and analyzed. Based on the criteria of safety, environmental, complexity of interfaces, risk, cost, schedule, and long-term operability and maintainability, the best alternative was chosen. Waste packaging and transportation options are also included in the recommendations. The waste disposition recommendations for the B-Cell dispersibles/tank heels and High-Level Vault packaged residuals are to direct them to the Plutonium Uranium Extraction Facility (PUREX) Number 2 storage tunnel

  8. Uranium ore mining in Spain with a focus on the closure and remediation measures in former production facilities

    International Nuclear Information System (INIS)

    Koch, H.; Blunck, S.; Lopez Romero, A.R.

    2004-01-01

    In early 2000, the uranium ore mining activities in Spain ceased. Since the middle of the last century, Spain had pushed ahead its own production of uranium concentrate with the formation of several companies (ENUSA, J.E.N.). In that period, Spain produced around 6000 t of uranium. With the completion of the operations at Andujar, La Haba and Elephante as well as Quercus at Saelices el Chico, the corporate tasks have shifted from building-up of a strategic uranium reserve to remediation and subsequent use of the locations. The operations have reached different remediation phases. While at Saelices el Chico remediation is still proceeding, the Andujar and La Haba locations are undergoing a monitoring phase as agreed for all former operating facilities. The estimated closure and remediation costs for the three operating facilities described amount to approx. 85 mio. Euro. In all three cases dealt with, however, these limited financial resources have been sufficient to successfully implement a closure and remediation concept that minimizes the risks from the facilities of uranium ore mining and processing with regard to the environment. (orig.)

  9. Mobilization plan for the Y-12 9409-5 tank storage facility RCRA closure plan. Final report. Revision 1

    International Nuclear Information System (INIS)

    1993-11-01

    This mobilization plan identifies the activities and equipment necessary to begin the field sampling for the Oak Ridge Y-12 9409-5 Diked Tank Storage Facility (DTSF) Resource Conservation and Recovery Act (RCRA) closure. Elements of the plan outline the necessary components of each mobilization task and identify whether SAIC or the Martin Marietta Energy Systems, Inc. Y-12 Environmental Restoration Division will be responsible for task coordination. Field work will be conducted in two phases: mobilization phase and soil sampling phase. Training and medical monitoring, access, permits and passes, decontamination/staging area, equipment, and management are covered in this document

  10. communicable diseases at health facilities in Ethiopia

    African Journals Online (AJOL)

    user

    unsatisfactory and it varied between urban (34%) and rural (5%) health facilities. In general, cervical ... data for planning and monitoring scale-up intervention ... authority, Ethiopia, 2016. Regions. Number of facilities Percentage. Tigray. 42. 8. Afar. 38. 7. Amhara. 61. 11. Oromiya. 99. 18. Somali. 43. 8. Beni. Gumuz. 30. 5.

  11. 100-D Ponds closure plan. Revision 1

    International Nuclear Information System (INIS)

    Petersen, S.W.

    1997-09-01

    The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure

  12. Dynamic modelling of costs and health consequences of school closure during an influenza pandemic

    Directory of Open Access Journals (Sweden)

    Xue Yiting

    2012-11-01

    Full Text Available Abstract Background The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Methods We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school and closure durations (1–10 weeks, given pandemics with basic reproductive number of 1.5, 2.0 or 2.5. Results The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility, closing schools would not be cost-effective, regardless of the age target of school children. Conclusions School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism.

  13. Health Services Utilization Patterns Associated with Emergency Department Closure

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders

    2011-01-01

    , 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...

  14. Closure of 324 Facility potential HEPA filter failure unreviewed safety questions

    International Nuclear Information System (INIS)

    Enghusen, M.B.

    1997-01-01

    This document summarizes the activities which occurred to resolve an Unreviewed Safety Question (USQ) for the 324 Facility [Waste Technology Engineering Laboratory] involving Potential HEPA Filter Breach. The facility ventilation system had the capacity to fail the HEPA filters during accident conditions which would totally plug the filters. The ventilation system fans were modified which lowered fan operating parameters and prevented HEPA filter failures which might occur during accident conditions

  15. CLOSURE OF THE FAST FLUX TEST FACILITY (FFTF) CURRENT STATUS and FUTURE PLANS

    International Nuclear Information System (INIS)

    LESPERANCE, C.P.

    2007-01-01

    The Fast Flux Test Facility (FFTF) was a 400 MWt sodium-cooled fast reactor situated on the U.S. Department of Energy's (DOE) Hanford Site in the southeastern portion of Washington State. DOE issued the final order to shut down the facility in 2001, when it was concluded that there was no longer a need for FFTF. Deactivation activities are in progress to remove or stabilize major hazards and deactivate systems to achieve end points documented in the project baseline. The reactor has been defueled, and approximately 97% of the fuel has been removed from the facility. Approximately 97% of the sodium has been drained from the plant's systems and placed into an on-site Sodium Storage Facility. The residual sodium will be kept frozen under a blanket of inert gas until it is removed later as part of the facility's decontamination and decommissioning (D and D). Plant systems have been shut down and placed in a low-risk state to minimize requirements for surveillance and maintenance. D and D work cannot begin until an Environmental Impact Statement has been prepared to evaluate various end state options and to provide a basis for selecting one of the options. The Environmental Impact Statement is expected to be issued in 2009

  16. CLOSURE OF THE FAST FLUX TEST FACILITY (FFTF) CURRENT STATUS & FUTURE PLANS

    Energy Technology Data Exchange (ETDEWEB)

    LESPERANCE, C.P.

    2007-05-23

    The Fast Flux Test Facility (FFTF) was a 400 MWt sodium-cooled fast reactor situated on the U.S. Department of Energy's (DOE) Hanford Site in the southeastern portion of Washington State. DOE issued the final order to shut down the facility in 2001, when it was concluded that there was no longer a need for FFTF. Deactivation activities are in progress to remove or stabilize major hazards and deactivate systems to achieve end points documented in the project baseline. The reactor has been defueled, and approximately 97% of the fuel has been removed from the facility. Approximately 97% of the sodium has been drained from the plant's systems and placed into an on-site Sodium Storage Facility. The residual sodium will be kept frozen under a blanket of inert gas until it is removed later as part of the facility's decontamination and decommissioning (D&D). Plant systems have been shut down and placed in a low-risk state to minimize requirements for surveillance and maintenance. D&D work cannot begin until an Environmental Impact Statement has been prepared to evaluate various end state options and to provide a basis for selecting one of the options. The Environmental Impact Statement is expected to be issued in 2009.

  17. Legionnaires' Disease: a Problem for Health Care Facilities

    Science.gov (United States)

    ... Clips Legionnaires’ Disease A problem for health care facilities Language: English (US) Español (Spanish) Recommend on Facebook ... drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have ...

  18. 10 CFR 61.52 - Land disposal facility operation and disposal site closure.

    Science.gov (United States)

    2010-01-01

    ... DISPOSAL OF RADIOACTIVE WASTE Technical Requirements for Land Disposal Facilities § 61.52 Land disposal... wastes by placing in disposal units which are sufficiently separated from disposal units for the other... between any buried waste and the disposal site boundary and beneath the disposed waste. The buffer zone...

  19. Health at risk in immigration detention facilities

    Directory of Open Access Journals (Sweden)

    Ioanna Kotsioni

    2013-09-01

    Full Text Available Since 2004 Médecins Sans Frontières (MSF has provided medical and psychosocial support for asylum seekers and migrants held in different immigration detention facilities across Europe (in Greece, Malta, Italy and Belgium where the life, health and human dignity of vulnerable people are being put at risk.

  20. Safety Research Experiment Facility Project. Conceptual design report. Volume V. Reactor vessel and closure

    International Nuclear Information System (INIS)

    1975-12-01

    The Prestressed Concrete Reactor Vessel (PCRV) will serve as the primary pressure retaining structure for the Safety Research Experiment Facility (SAREF) reactor. The reactor core, control rod drive room, primary heat exchangers, and gas circulators will be located in cavities within the PCRV. The orientation of these cavities, except for the control rod drive room, will be similar to the high-temperature gas-cooled reactor (HTGR) designs that are currently proposed or under design. Due to the nature of this type of structure, all biological and radiological shielding requirements are incorporated into the basic vessel design. At the midcore plane there are three radially oriented slots that will extend from the outside surface of the PCRV to the reactor core liner. These slots will accommodate each of the fuel motion monitoring systems which will be part of the observation apparatus used with the loop experiments

  1. Grout for closure of the demonstration vault at the US DOE Hanford Facility. Final report

    International Nuclear Information System (INIS)

    Wakeley, L.D.; Ernzen, J.J.

    1992-08-01

    The Waterways Experiment Station (WES) developed a grout to be used as a cold- (nonradioactive) cap or void-fill grout between the solidified low-level waste and the cover blocks of a demonstration vault for disposal of phosphate-sulfate waste (PSW) at the US Department of Energy (DOE) Hanford Facility. The project consisted of formulation and evaluation of candidate grouts and selection of the best candidate grout, followed by a physical scale-model test to verify grout performance under project-specific conditions. Further, the project provided data to verify numerical models (accomplished elsewhere) of stresses and isotherms inside the Hanford demonstration vault. Evaluation of unhardened grout included obtaining data on segregation, bleeding, flow, and working time. For hardened grout, strength, volume stability, temperature rise, and chemical compatibility with surrogate wasteform grout were examined. The grout was formulated to accommodate unique environmental boundary conditions (vault temperature = 45 C) and exacting regulatory requirements (mandating less than 0.1% shrinkage with no expansion and no bleeding); and to remain pumpable for a minimum of 2 hr. A grout consisting of API Class H oil-well cement, an ASTM C 618 Class F fly ash, sodium bentonite clay, and a natural sand from the Hanford area met performance requirements in laboratory studies. It is recommended for use in the DOE Hanford demonstration PSW vault

  2. POST-CLOSURE INSPECTION REPORT FOR CORRECTIVE ACTION UNIT 92: AREA 6 DECON PAD FACILITY, NEVADA. TEST SITE NEVADA, FOR THE PERIOD JANUARY 2004 - DECEMBER 2004

    International Nuclear Information System (INIS)

    BECHTEL NEVADA

    2005-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility, Nevada Test Site, Nevada. CAU 92 was closed in accordance with the Resource Conservation and Recovery Act (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection, 1995) and the Federal Facility Agreement and Consent Order of 1996 on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs): CAS 06-04-01, Decon Pad oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02, Decontamination Pond (RCRA), requires post-closure inspections. CAS 06-04-01, Decon Pad Oil/Water Separator, is located inside the fence at the Building 6-605 compound. This report covers the annual period January 2004 through December 2004

  3. Washeteria closures, infectious disease and community health in rural Alaska: a review of clinical data in Kivalina, Alaska

    Directory of Open Access Journals (Sweden)

    Timothy K. Thomas

    2013-08-01

    Full Text Available Background. Kivalina is a northwest Alaska barrier island village of 400 people vulnerable to storm surges exacerbated recently by delayed winter sea and shore ice formation. The village has no in-home piped water or sewage; the “washeteria” is the only structure providing public showers, laundry facilities and flush toilets. In October 2004, a storm damaged the washeteria septic system resulting in prolonged facility closures. We assessed rates of gastrointestinal, respiratory and skin infections potentially impacted by prolonged washeteria closures. Methods. We obtained washeteria closure dates from 2003 to July 2009 and defined >7 day closure as prolonged. We received de-identified data on all Kivalina clinic visits from 2003 to 2009 and selected visits with ICD-9 diagnosis codes for respiratory, skin, or gastrointestinal infection; subsequent same patient/same illness-category visits within 14 days were excluded. We compared annual visit rates, for all ages combined, before (2003–2004 and after (2005–2009 the “2004” storm. Results. The washeteria had prolonged closures for 34 days (4.7% in the 2 years 2003–2004 and 864 days (51.7% between January 2005 and July 2009. Closures ranged from 8 to 248 days. Respiratory infection rates declined significantly from 1.32 visits/person/year in the 2003–2004 period to 0.99 visits/person/year in the 2005–2009 period. There was a significant increase in skin infection rates after 2004, peaking at 0.28 visits/person/year in 2007 and then declining significantly to 0.15 visits/person/year in 2009. Gastrointestinal infection rates remained stable and low throughout (average: 0.05 visits/person/year. No temporal association was observed between respiratory, gastrointestinal or skin infection rates and prolonged washeteria closures. Conclusion. The Kivalina washeteria was closed frequently and for extended periods between 2005 and 2009. Initial closures possibly resulted in increased skin

  4. Effectiveness of counseling at primary health facilities: Level of ...

    African Journals Online (AJOL)

    Effectiveness of counseling at primary health facilities: Level of knowledge of antenatal attendee and their ... Objectives: To determine the effectiveness of counseling on HIV done in primary health facilities ... AJOL African Journals Online.

  5. MAPPING OF HEALTH FACILITIES IN JIMETA METROPOLIS: A ...

    African Journals Online (AJOL)

    PROF EKWUEME

    one of the major problems hindering the proper planning and monitoring of the various health facilities ... A digital map, showing the spatial distribution of health facilities in Jimeta metropolis .... mapping process to quicken map production.

  6. Addendum to the Closure Report for Corrective Action Unit 113: Area 25 R-MAD Facility, Nevada National Security Site, Nevada

    International Nuclear Information System (INIS)

    2011-01-01

    This addendum to the Closure Report for Corrective Action Unit 113: Area 25, Reactor Maintenance, Assembly, and Disassembly Facility, Building 3110, Nevada Test Site, Nevada, DOE/NV--891-VOL I-Rev. 1, dated July 2003, provides details of demolition, waste disposal, and use restriction (UR) modification for Corrective Action Unit 113, Area 25 R-MAD Facility. Demolition was completed on July 15, 2010, when the last of the building debris was disposed. Final field activities were concluded on August 30, 2010, after all equipment was demobilized and UR signs were posted. This work was funded by the American Recovery and Reinvestment Act.

  7. HWMA/RCRA Closure Plan for the Basin Facility Basin Water Treatment System - Voluntary Consent Order NEW-CPP-016 Action Plan

    International Nuclear Information System (INIS)

    Evans, S. K.

    2007-01-01

    This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan for the Basin Water Treatment System located in the Basin Facility (CPP-603), Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Laboratory Site, was developed to meet future milestones established under the Voluntary Consent Order. The system to be closed includes units and associated ancillary equipment included in the Voluntary Consent Order NEW-CPP-016 Action Plan and Voluntary Consent Order SITE-TANK-005 Tank Systems INTEC-077 and INTEC-078 that were determined to have managed hazardous waste. The Basin Water Treatment System will be closed in accordance with the requirements of the Hazardous Waste Management Act/Resource Conservation and Recovery Act, as implemented by the Idaho Administrative Procedures Act 58.01.05.009 and 40 Code of Federal Regulations 265, to achieve 'clean closure' of the tank system. This closure plan presents the closure performance standards and methods of achieving those standards for the Basin Water Treatment Systems

  8. HWMA/RCRA Closure Plan for the Basin Facility Basin Water Treatment System - Voluntary Consent Order NEW-CPP-016 Action Plan

    Energy Technology Data Exchange (ETDEWEB)

    Evans, S. K.

    2007-11-07

    This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan for the Basin Water Treatment System located in the Basin Facility (CPP-603), Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Laboratory Site, was developed to meet future milestones established under the Voluntary Consent Order. The system to be closed includes units and associated ancillary equipment included in the Voluntary Consent Order NEW-CPP-016 Action Plan and Voluntary Consent Order SITE-TANK-005 Tank Systems INTEC-077 and INTEC-078 that were determined to have managed hazardous waste. The Basin Water Treatment System will be closed in accordance with the requirements of the Hazardous Waste Management Act/Resource Conservation and Recovery Act, as implemented by the Idaho Administrative Procedures Act 58.01.05.009 and 40 Code of Federal Regulations 265, to achieve "clean closure" of the tank system. This closure plan presents the closure performance standards and methods of achieving those standards for the Basin Water Treatment Systems.

  9. The Environmental Agency's Assessment of the Post-Closure Safety Case for the BNFL DRIGG Low Level Radioactive Waste Disposal Facility

    International Nuclear Information System (INIS)

    Streatfield, I. J.; Duerden, S. L.; Yearsley, R. A.

    2002-01-01

    The Environment Agency is responsible, in England and Wales, for authorization of radioactive waste disposal under the Radioactive Substances Act 1993. British Nuclear Fuels plc (BNFL) is currently authorized by the Environment Agency to dispose of solid low level radioactive waste at its site at Drigg, near Sellafield, NW England. As part of a planned review of this authorization, the Environment Agency is currently undertaking an assessment of BNFL's Post-Closure Safety Case Development Programme for the Drigg disposal facility. This paper presents an outline of the review methodology developed and implemented by the Environment Agency specifically for the planned review of BNFL's Post-Closure Safety Case. The paper also provides an overview of the Environment Agency's progress in its on-going assessment programme

  10. POST-CLOSURE INSPECTION REPORT FOR CORRECTIVE ACTION UNIT 92: AREA 6 DECON POND FACILITY, NEVADA TEST SITE, NEVADA FOR CALENDAR YEAR 2005

    International Nuclear Information System (INIS)

    2006-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility, Nevada Test Site, Nevada. CAU 92 was closed in accordance with the Resource Conservation and Recovery Act (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection (NDEP), 1995) and the Federal Facility Agreement and Consent Order of 1996. Closure activities were completed on February 16, 1999, and the Closure Report (U.S. Department of Energy, Nevada Operations Office, 1999) was approved and a Notice of Completion issued by the NDEP on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs): CAS 06-04-01, Decon Pad Oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02 requires post-closure inspections. Visual inspections of the cover and fencing at CAS 06-05-02 are performed quarterly. Additional inspections are conducted if precipitation occurs in excess of 1.28 centimeters (cm) (0.50 inches [in]) in a 24-hour period. This report covers calendar year 2005. Quarterly site inspections were performed in March, June, September, and December of 2005. All observations indicated the continued integrity of the unit. No issues or concerns were noted, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A. Five additional inspections were performed after precipitation events that exceeded 1.28 cm (0.50 in) within a 24-hour period during 2005. No significant changes in site conditions were noted during these inspections, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A. Precipitation records for 2005 are included in Appendix C

  11. Increased patient delays in care after the closure of Martin Luther King Hospital: implications for monitoring health system changes.

    Science.gov (United States)

    Walker, Kara Odom; Leng, Mei; Liang, Li-Jung; Forge, Nell; Morales, Leo; Jones, Loretta; Brown, Arleen

    2011-01-01

    The safety net system remains an important part of the health care system for uninsured and minority populations, however, the closure of safety net hospitals changes the availability of care. Using community-based participatory research methods, we explored the impact of hospital closure among late middle aged and elderly racial/ethnic minorities in South Los Angeles. Telephone survey of participants in both 2008, after hospital closure, and 2003, before hospital closure, who self-identified as African American or Latino, were over the age of 50 and lived in zip codes of South Los Angeles. We developed multiple logistic regression models on imputed data sets weighted for non-response and adjusted for self-reported measures of demographic and clinical characteristics to examine the odds of reporting delays in care. After adjusting for covariates known to influence access to care and distributed differently in the two survey samples, we found significantly greater delays in care. Following the closure of the Martin Luther King, Jr. safety net hospital, the adjusted odds ratios were 1.70 (95% CI 1.01, 2.87) for delays in care, 1.88 (95% Cl 1.06, 3.13) for problems receiving needed medical care, and 2.62 (95% CI 1.46, 4.67) for seeing a specialist. Our survey of older minority adults in South Los Angeles found increased delays in access to care for needed medical services after the closure of Martin Luther King, Jr. Hospital. As health care reform unfolds, monitoring for changes in access to care that may result from new policies will be important to address future disparities, particularly for vulnerable populations.

  12. Spatial Distribution and Accessibility of Health Facilities in Akwa ...

    African Journals Online (AJOL)

    This paper therefore analyzed the spatial patterns of healthcare facilities in Akwa ... Data on six health indicator variables were obtained and analyzed to assess ... of healthcare facilities and thus hinders good access to high quality healthcare ...

  13. Distribution and Utilization of Health Facilities in Calabar Metropolis ...

    African Journals Online (AJOL)

    The level of accessibility increases with increasing utilization. Distance was a barrier to the utilization of health facilities due to the uneven distribution of health facilities and the inability of patients to overcome economic distance. Greater investment by government in the health sector would guarantee more equitable access ...

  14. Elimination of mercury in health care facilities.

    Science.gov (United States)

    2000-03-01

    Mercury is a persistent, bioaccumulative toxin that has been linked to numerous health effects in humans and wildlife. It is a potent neurotoxin that may also harm the brain, kidneys, and lungs. Unborn children and young infants are at particular risk for brain damage from mercury exposure. Hospitals' use of mercury in chemical solutions, thermometers, blood pressure gauges, batteries, and fluorescent lamps makes these facilities large contributors to the overall emission of mercury into the environment. Most hospitals recognize the dangers of mercury. In a recent survey, four out of five hospitals stated that they have policies in place to eliminate the use of mercury-containing products. Sixty-two percent of them require vendors to disclose the presence of mercury in chemicals that the hospitals purchase. Only 12 percent distribute mercury-containing thermometers to new parents. Ninety-two percent teach their employees about the health and environmental effects of mercury, and 46 percent teach all employees how to clean up mercury spills. However, the same study showed that many hospitals have not implemented their policies. Forty-two percent were not aware whether they still purchased items containing mercury. In addition, 49 percent still purchase mercury thermometers, 44 percent purchase mercury gastrointestinal diagnostic equipment, and 64 percent still purchase mercury lab thermometers.

  15. Closure Strategy for a Waste Disposal Facility with Multiple Waste Types and Regulatory Drivers at the Nevada Test Site - 8422

    International Nuclear Information System (INIS)

    D Wieland; V Yucel; L Desotell; G Shott; J Wrapp

    2008-01-01

    The U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) plans to close the waste and classified material storage cells in the southeast quadrant of the Area 5 Radioactive Waste Management Site (RWMS), informally known as the '92-Acre Area', by 2011. The 25 shallow trenches and pits and the 13 Greater Confinement Disposal (GCD) borings contain various waste streams including low-level waste (LLW), low-level mixed waste (LLMW), transuranic (TRU), mixed transuranic (MTRU), and high specific activity LLW. The cells are managed under several regulatory and permit programs by the U.S. Department of Energy (DOE) and the Nevada Division of Environmental Protection (NDEP). Although the specific closure requirements for each cell vary, 37 closely spaced cells will be closed under a single integrated monolayer evapotranspirative (ET) final cover. One cell will be closed under a separate cover concurrently. The site setting and climate constrain transport pathways and are factors in the technical approach to closure and performance assessment. Successful implementation of the integrated closure plan requires excellent communication and coordination between NNSA/NSO and the regulators

  16. Closure report for N Reactor

    International Nuclear Information System (INIS)

    1994-01-01

    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule

  17. Closure report for N Reactor

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

  18. WASH and gender in health care facilities: The uncharted territory.

    Science.gov (United States)

    Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

    2017-11-08

    Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

  19. Road Closures

    Data.gov (United States)

    Montgomery County of Maryland — This is an up to date map of current road closures in Montgomery County.This dataset is updated every few minutes from the Department of Transportation road closure...

  20. Post-Closure Inspection Report for Corrective Action Unit 92: Area 6 Decon Pond Facility, Nevada Test Site, Nevada, for Calendar Year 2006

    International Nuclear Information System (INIS)

    NSTec Environmental Restoration

    2007-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility. CAU 92 was closed according to the ''Resource Conservation and Recovery Act'' (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection [NDEP], 1995) and the ''Federal Facility Agreement and Consent Order'' (FFACO) of 1996 (FFACO, 1996). Closure activities were completed on February 16, 1999, and the Closure Report (U.S. Department of Energy, Nevada Operations Office, 1999) was approved and a Notice of Completion issued by NDEP on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs), CAS 06-04-01, Decon Pad Oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02 requires post-closure inspections. Visual inspections of the cover and fencing at CAS 06-05-02 are performed quarterly. Additional inspections are conducted if precipitation occurs in excess of 1.28 centimeters (cm) (0.50 inches [in.]) in a 24-hour period. This report covers calendar year 2006. Quarterly site inspections were performed in March, June, September, and December of 2006. All observations indicated the continued integrity of the unit. No issues or concerns were noted, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A of this report, and photographs taken during the site inspections are included in Appendix B of this report. One additional inspection was performed after a precipitation event that exceeded 1.28 cm (0.50 in.) within a 24-hour period during 2006. No significant changes in site conditions were noted during this inspection, and no corrective actions were necessary. A copy of the inspection checklist and field notes completed during this additional inspection is included in Appendix A of this report. Precipitation records for 2006

  1. Field Sampling Plan for Closure of the Central Facilities Area Sewage Treatment Plant Lagoon 3 and Land Application Area

    International Nuclear Information System (INIS)

    Lewis, Michael George

    2016-01-01

    This field sampling plan describes sampling of the soil/liner of Lagoon 3 at the Central Facilities Area Sewage Treatment Plant. The lagoon is to be closed, and samples obtained from the soil/liner will provide information to determine if Lagoon 3 and the land application area can be closed in a manner that renders it safe to human health and the environment. Samples collected under this field sampling plan will be compared to Idaho National Laboratory background soil concentrations. If the concentrations of constituents of concern exceed the background level, they will be compared to Comprehensive Environmental Response, Compensation, and Liability Act preliminary remediation goals and Resource Conservation and Recovery Act levels. If the concentrations of constituents of concern are lower than the background levels, Resource Conservation and Recovery Act levels, or the preliminary remediation goals, then Lagoon 3 and the land application area will be closed. If the Resource Conservation and Recovery Act levels and/or the Comprehensive Environmental Response, Compensation, and Liability Act preliminary remediation goals are exceeded, additional sampling and action may be required.

  2. Field Sampling Plan for Closure of the Central Facilities Area Sewage Treatment Plant Lagoon 3 and Land Application Area

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Michael George [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-10-01

    This field sampling plan describes sampling of the soil/liner of Lagoon 3 at the Central Facilities Area Sewage Treatment Plant. The lagoon is to be closed, and samples obtained from the soil/liner will provide information to determine if Lagoon 3 and the land application area can be closed in a manner that renders it safe to human health and the environment. Samples collected under this field sampling plan will be compared to Idaho National Laboratory background soil concentrations. If the concentrations of constituents of concern exceed the background level, they will be compared to Comprehensive Environmental Response, Compensation, and Liability Act preliminary remediation goals and Resource Conservation and Recovery Act levels. If the concentrations of constituents of concern are lower than the background levels, Resource Conservation and Recovery Act levels, or the preliminary remediation goals, then Lagoon 3 and the land application area will be closed. If the Resource Conservation and Recovery Act levels and/or the Comprehensive Environmental Response, Compensation, and Liability Act preliminary remediation goals are exceeded, additional sampling and action may be required.

  3. Regulatory measures for occupational health monitoring in BARC facilities

    International Nuclear Information System (INIS)

    Rajdeep; Chattopadhyay, S.

    2017-01-01

    Bhabha Atomic Research Centre (BARC) is the premier organization actively engaged in the research and developmental activities related to nuclear science and technology for the benefit of society and the nation. BARC has various facilities like nuclear fuel fabrication facilities, research reactors, spent fuel storage facilities, nuclear fuel re-cycling facilities, radioactive waste management facilities, machining workshops and various Physics, Chemistry and Biological laboratories. In BARC, aspects related to Occupational Safety and Health (OSH) are given paramount importance. The issues related OSH are subjected to multi-tier review process. BARC Safety Council (BSC) is the apex committee in the three-tier safety and security review framework of BARC. BSC functions as regulatory body for BARC facilities. BSC is responsible for occupational safety and health of employees in BARC facilities

  4. Derivation of quantitative acceptance criteria for disposal of radioactive waste to near surface facilities: Development and implementation of an approach for the post-closure phase

    International Nuclear Information System (INIS)

    Torres, C.

    2000-01-01

    The International Atomic Energy Agency has established a project to develop and illustrate, through practical examples, an approach that allows the derivation of quantitative waste acceptance criteria for near surface disposal of radioactive waste. The first phase focussed on the derivation of example post-closure safety waste acceptance criteria through the use of a safety assessment approach that allows for the derivation of values in a clear and well documented manner. The approach consists of five steps: the specification of the assessment context; the description of the disposal system; the development and justification of scenarios; the formulation and implementation of models; and the calculation and derivation of example values. The approach has been successfully used to derive activity values for the disposal of radioactive waste to illustrative near surface facilities. (author)

  5. Contingent post-closure plan, hazardous waste management units at selected maintenance facilities, US Army National Training Center, Fort Irwin, California

    International Nuclear Information System (INIS)

    1992-01-01

    The National Training Center (NTC) at Fort Irwin, California, is a US Army training installation that provides tactical experience for battalion/task forces and squadrons in a mid- to high-intensity combat scenario. Through joint exercises with US Air Force and other services, the NTC also provides a data source for improvements of training doctrines, organization, and equipment. To meet the training and operational needs of the NTC, several maintenance facilities provide general and direct support for mechanical devices, equipment, and vehicles. Maintenance products used at these facilities include fuels, petroleum-based oils, lubricating grease, various degreasing solvents, antifreeze (ethylene glycol), transmission fluid, brake fluid, and hydraulic oil. Used or spent petroleum-based products generated at the maintenance facilities are temporarily accumulated in underground storage tanks (USTs), collected by the NTC hazardous waste management contractor (HAZCO), and stored at the Petroleum, Oil, and Lubricant (POL) Storage Facility, Building 630, until shipped off site to be recovered, reused, and/or reclaimed. Spent degreasing solvents and other hazardous wastes are containerized and stored on-base for up to 90 days at the NTC's Hazardous Waste Storage Facility, Building 703. The US Environmental Protection Agency (EPA) performed an inspection and reviewed the hazardous waste management operations of the NTC. Inspections indicated that the NTC had violated one or more requirements of Subtitle C of the Resource Conservation and Recovery Act (RCRA) and as a result of these violations was issued a Notice of Noncompliance, Notice of Necessity for Conference, and Proposed Compliance Schedule (NON) dated October 13, 1989. The following post-closure plan is the compliance-based approach for the NTC to respond to the regulatory violations cited in the NON

  6. Health Care Facilities Resilient to Climate Change Impacts

    Directory of Open Access Journals (Sweden)

    Jaclyn Paterson

    2014-12-01

    Full Text Available Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

  7. Emergence of a Policy, closure of a sector: regarding the management of penitentiary health care in Brazil.

    Science.gov (United States)

    Batista E Silva, Martinho Braga

    2016-06-01

    The aim of this study is to understand recent transformations in penitentiary health care management in Brazil, during the implementation of the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System, and the closure of the National Sector for Penitentiary Health Care. The scientific problem investigated is the language of penitentiary health care policy. The theoretical-methodological framework adopted is Pierre Bourdieu's genetic structuralism. In this manner, we carry out an analysis of documents and public statements in search of State categories and classifications. We note the consolidation of a state classification that separates the 'penitentiary' domain from the 'prison' domain, as well as the creation of the State category of 'person deprived of liberty in the prison system'. Penitentiary health care management constitutes itself as a question of primary care.

  8. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    ... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

  9. ART Attrition across Health Facilities Implementing Option B+ in Haiti.

    Science.gov (United States)

    Myrtil, Martine Pamphile; Puttkammer, Nancy; Gloyd, Stephen; Robinson, Julia; Yuhas, Krista; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner

    2018-01-01

    Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti. We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients. There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition. Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.

  10. [Organization of workplace first aid in health care facilities].

    Science.gov (United States)

    Ciavarella, M; Sacco, A; Bosco, Maria Giuseppina; Chinni, V; De Santis, A; Pagnanelli, A

    2007-01-01

    Laws D.Lgs. 626/94 and D.I. 388/03 attach particular importance to the organization of first aid in the workplace. Like every other enterprise, also hospitals and health care facilities have the obligation, as foreseen by the relevant legislation, to organize and manage first aid in the workplace. To discuss the topic in the light of the guidelines contained in the literature. We used the references contained in the relevant literature and in the regulations concerning organization of first aid in health care facilities. The regulations require the general manager of health care facilities to organize the primary intervention in case of emergencies in all health care facilities (health care or administrative, territorial and hospitals). In health care facilities the particular occupational risks, the general access of the public and the presence of patients who are already assumed to have altered states of health, should be the reason for particular care in guaranteeing the best possible management of a health emergency in the shortest time possible.

  11. History of health studies around nuclear facilities: a methodologival consideration

    International Nuclear Information System (INIS)

    Tokuhata, G.K.; Smith, M.W.

    1981-01-01

    A brief historical review was made of low-level radiation studies for general populations living around nuclear facilities. In addition, technical and methodological problems were identified and discussed which often arise in all epidemiological studies designed to determine the possible health effects of low-level radiation released from nuclear facilities. Need for extremely large populations for prospective cancer studies was discussed, but accompanying ascertainment difficulties were also emphasized. More epidemiological studies are needed to provide adequate assessment of the potential health hazards of nuclear facilities

  12. prevalence and correlates of utilization of health facilities in ...

    African Journals Online (AJOL)

    Musumali

    2007-10-11

    Oct 11, 2007 ... of the expectant women did not deliver at a health facility ... health service utilization for childbirth such as education5-8, maternal age 3,6, parity6,8, economic status7, cultural factors and beliefs, lack of skilled staff at primary.

  13. 42 CFR 476.78 - Responsibilities of health care facilities.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) General Provisions... 42 Public Health 4 2010-10-01 2010-10-01 false Responsibilities of health care facilities. 476.78...

  14. 42 CFR 476.76 - Cooperation with health care facilities.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs) General Provisions... 42 Public Health 4 2010-10-01 2010-10-01 false Cooperation with health care facilities. 476.76...

  15. Left Atrial Appendage Closure Device With Delivery System: A Health Technology Assessment

    Science.gov (United States)

    Nevis, Immaculate; Falk, Lindsey; Wells, David; Higgins, Caroline

    2017-01-01

    Background Atrial fibrillation is a common cardiac arrhythmia, and 15% to 20% of those who have experienced stroke have atrial fibrillation. Treatment options to prevent stroke in people with atrial fibrillation include pharmacological agents such as novel oral anticoagulants or nonpharmacological devices such as the left atrial appendage closure device with delivery system (LAAC device). The objectives of this health technology assessment were to assess the clinical effectiveness and cost-effectiveness of the LAAC device versus novel oral anticoagulants in patients without contraindications to oral anticoagulants and versus antiplatelet agents in patients with contraindications to oral anticoagulants. Methods We performed a systematic review and network meta-analysis. We also conducted an economic literature review, economic evaluation, and budget impact analysis to assess the cost-effectiveness and budget impact of the LAAC device compared with novel oral anticoagulants and oral antiplatelet agents (e.g., aspirin). We also spoke with patients to better understand their preferences, perspectives, and values. Results Seven randomized controlled studies met the inclusion criteria for indirect comparison. Five studies assessed the effectiveness of novel oral anticoagulants versus warfarin, and two studies compared the LAAC device with warfarin. No studies were identified that compared the LAAC device with aspirin in patients in whom oral anticoagulants were contraindicated. Using the random effects model, we found that the LAAC device was comparable to novel oral anticoagulants in reducing stroke (odds ratio [OR] 0.85; credible interval [Cr.I] 0.63–1.05). Similarly, the reduction in the risk of all-cause mortality was comparable between the LAAC device and novel oral anticoagulants (OR 0.71; Cr.I 0.49–1.22). The LAAC device was found to be superior to novel oral anticoagulants in preventing hemorrhagic stroke (OR 0.45; Cr.I 0.29–0.79), whereas novel oral

  16. Guidelines for Management Information Systems in Canadian Health Care Facilities

    Science.gov (United States)

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  17. Quality Assurance Project Plan for Closure of the Central Facilities Area Sewage Treatment Plant Lagoon 3 and Land Application Area

    International Nuclear Information System (INIS)

    Lewis, Michael G.

    2016-01-01

    This quality assurance project plan describes the technical requirements and quality assurance activities of the environmental data collection/analyses operations to close Central Facilities Area Sewage treatment Plant Lagoon 3 and the land application area. It describes the organization and persons involved, the data quality objectives, the analytical procedures, and the specific quality control measures to be employed. All quality assurance project plan activities are implemented to determine whether the results of the sampling and monitoring performed are of the right type, quantity, and quality to satisfy the requirements for closing Lagoon 3 and the land application area.

  18. Quality Assurance Project Plan for Closure of the Central Facilities Area Sewage Treatment Plant Lagoon 3 and Land Application Area

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Michael G. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-10-01

    This quality assurance project plan describes the technical requirements and quality assurance activities of the environmental data collection/analyses operations to close Central Facilities Area Sewage treatment Plant Lagoon 3 and the land application area. It describes the organization and persons involved, the data quality objectives, the analytical procedures, and the specific quality control measures to be employed. All quality assurance project plan activities are implemented to determine whether the results of the sampling and monitoring performed are of the right type, quantity, and quality to satisfy the requirements for closing Lagoon 3 and the land application area.

  19. Sound & Vibration 20 Design Guidelines for Health Care Facilities

    CERN Document Server

    Tocci, Gregory; Cavanaugh, William

    2013-01-01

    Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

  20. Computerized health physics record system at a Canadian fabrication facility

    International Nuclear Information System (INIS)

    Thind, K.S.

    1984-01-01

    This poster session will describe the types of Health Physics data input into a Hewlett-Packard 3000 computer. The Health Physics data base at this facility includes the following: employee hours data, airborne uranium concentrations, external dosemetry (badge readings), internal dosemetry (bioassay) and environmental health physics (stack sample results) data. It will describe the types of outputs achievable in the form of various reports, such as: individual employee health physics report for a given period, a general health physics summary report for a given period, individual urinalysis report, local air concentration report and graphs. The use of this computerized health physics record system in the overall radiation protection program at this facility is discussed

  1. [Anesthesia practice in Catalan hospitals and other health care facilities].

    Science.gov (United States)

    Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

    2006-05-24

    The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident

  2. Video Surveillance in Mental Health Facilities: Is it Ethical?

    Science.gov (United States)

    Stolovy, Tali; Melamed, Yuval; Afek, Arnon

    2015-05-01

    Video surveillance is a tool for managing safety and security within public spaces. In mental health facilities, the major benefit of video surveillance is that it enables 24 hour monitoring of patients, which has the potential to reduce violent and aggressive behavior. The major disadvantage is that such observation is by nature intrusive. It diminishes privacy, a factor of huge importance for psychiatric inpatients. Thus, an ongoing debate has developed following the increasing use of cameras in this setting. This article presents the experience of a medium-large academic state hospital that uses video surveillance, and explores the various ethical and administrative aspects of video surveillance in mental health facilities.

  3. An Application of Business Process Management to Health Care Facilities.

    Science.gov (United States)

    Hassan, Mohsen M D

    The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

  4. Mapping of health facilities in Jimeta Metropolis: a digital approach ...

    African Journals Online (AJOL)

    In planning for any suitable development in any field, the primary requirement is the relevant data and maps. This is one of the major problems hindering the proper planning and monitoring of the various health facilities located in Jimeta metropolis. Survey techniques -were employed for the acquisition of data, GPS was ...

  5. A spatial decision support system for special health facility location ...

    African Journals Online (AJOL)

    Access to healthcare is a determinant of the wellbeing of the people. Planning the location and distribution of health facilities to ensure efficiency and equity in the face of limited resources can be challenging, especially where the type of care requires expensive equipments and specialists. This study attempts to provide a ...

  6. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: To determine the incidence, clinical presentation, risk factors and management outcomes of ectopic pregnancies in a tertiary health facility. Methods: A retrospective ...

  7. Missed vaccination opportunities at a secondary health facility in ...

    African Journals Online (AJOL)

    The study aimed to identify missed vaccination visits and the associated factors in children presenting at the general out-patient clinic of a secondary health facility in Ilorin, Nigeria. Method: Through a descriptive cross-sectional study, the vaccination data of all children seen at the out-patient clinic were critically reviewed ...

  8. [Quality Indicators of Primary Health Care Facilities in Austria].

    Science.gov (United States)

    Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

    2017-07-11

    Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda.

    Science.gov (United States)

    Musoke, David; Boynton, Petra; Butler, Ceri; Musoke, Miph Boses

    2014-12-01

    The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.

  10. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    OpenAIRE

    Alam, Khurshid; Ahmed, Shakil

    2010-01-01

    Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

  11. Community health facility preparedness for a cholera surge in Haiti.

    Science.gov (United States)

    Mobula, Linda Meta; Jacquet, Gabrielle A; Weinhauer, Kristin; Alcidas, Gladys; Thomas, Hans-Muller; Burnham, Gilbert

    2013-01-01

    With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities' ability to respond to a surge in cholera cases. Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)'s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility's response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as well as a surge of patients. A total of 119 hospital staff from seven sites participated in the simulation exercise including community health workers, clinicians, managers, pharmacists, cleaners, and security guards. Clinics that had challenges during the simulated clinical care of patients were those that did not appropriately treat all cholera patients according to protocol, particularly those that were vulnerable, those that would need additional staff to properly treat patients during a surge of cholera, and those that required a better inventory of supplies. Simulation-based activities have the potential to identify healthcare delivery system vulnerabilities that are amenable to intervention prior to a cholera surge.

  12. Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

    Science.gov (United States)

    Dixon, Brian E; Colvard, Cyril; Tierney, William M

    2014-06-24

    Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

  13. The group-lending model and social closure: microcredit, exclusion, and health in Bangladesh.

    Science.gov (United States)

    Schurmann, Anna T; Johnston, Heidi Bart

    2009-08-01

    According to social exclusion theory, health risks are positively associated with involuntary social, economic, political and cultural exclusion from society. In this paper, a social exclusion framework has been used, and available literature on microcredit in Bangladesh has been reviewed to explore the available evidence on associations among microcredit, exclusion, and health outcomes. The paper addresses the question of whether participation in group-lending reduces health inequities through promoting social inclusion. The group-lending model of microcredit is a development intervention in which small-scale credit for income-generation activities is provided to groups of individuals who do not have material collateral. The paper outlines four pathways through which microcredit can affect health status: financing care in the event of health emergencies; financing health inputs such as improved nutrition; as a platform for health education; and by increasing social capital through group meetings and mutual support. For many participants, the group-lending model of microcredit can mitigate exclusionary processes and lead to improvements in health for some; for others, it can worsen exclusionary processes which contribute to health disadvantage.

  14. The Group-lending Model and Social Closure: Microcredit, Exclusion, and Health in Bangladesh

    Science.gov (United States)

    Johnston, Heidi Bart

    2009-01-01

    According to social exclusion theory, health risks are positively associated with involuntary social, economic, political and cultural exclusion from society. In this paper, a social exclusion framework has been used, and available literature on microcredit in Bangladesh has been reviewed to explore the available evidence on associations among microcredit, exclusion, and health outcomes. The paper addresses the question of whether participation in group-lending reduces health inequities through promoting social inclusion. The group-lending model of microcredit is a development intervention in which small-scale credit for income-generation activities is provided to groups of individuals who do not have material collateral. The paper outlines four pathways through which microcredit can affect health status: financing care in the event of health emergencies; financing health inputs such as improved nutrition; as a platform for health education; and by increasing social capital through group meetings and mutual support. For many participants, the group-lending model of microcredit can mitigate exclusionary processes and lead to improvements in health for some; for others, it can worsen exclusionary processes which contribute to health disadvantage. PMID:19761085

  15. Review of occupational exposure patterns in Indian Health Care Facilities

    International Nuclear Information System (INIS)

    Senthilkumar, M.; Nehru, R.M.; Sonawane, A.U.

    2016-01-01

    Monitoring of individual radiation is a prime part of the radiation protection programme. The primary justification for monitoring helps achieve and demonstrate an appropriate level of protection and can demonstrate compliance with regulatory requirements, contribute to the control of operations and design of installations. Atomic Energy (Radiation Protection) Rules 2004 advocates that radiation surveillance is mandatory for all radiation workers. The largest group of individuals exposed occupationally to artificial radiation sources is that employed in health care facilities such as Diagnostic Radiology, Radiation Therapy and Nuclear Medicine. In this work, a comprehensive analysis was carried out on occupational exposure data for the period 2000 to 2014 to bring a measure of radiation protection infrastructure quality in health care facilities

  16. Health and environmental aspects of nuclear fuel cycle facilities

    International Nuclear Information System (INIS)

    1996-11-01

    The purpose of the present publication is to give a generic description of health and environmental aspects of nuclear fuel cycle facilities. Primarily the report is meant to stand alone; however, because of the content of the publication and in the context of the DECADES project, it may serve as a means of introducing specialists in other fuel cycles to the nuclear fuel cycle. Refs, figs, tabs

  17. Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya

    Directory of Open Access Journals (Sweden)

    Kabare Margaret

    2011-09-01

    Full Text Available Abstract Background Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs. In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability Methods We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. Results HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. Conclusions There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources

  18. Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya.

    Science.gov (United States)

    Goodman, Catherine; Opwora, Antony; Kabare, Margaret; Molyneux, Sassy

    2011-09-22

    Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to

  19. The Behavioral Health Role in Nursing Facility Social Work.

    Science.gov (United States)

    Myers, Dennis R; Rogers, Robin K; LeCrone, Harold H; Kelley, Katherine

    2017-09-01

    Types of compromised resident behaviors licensed nursing facility social workers encounter, the behavioral health role they enact, and effective practices they apply have not been the subject of systematic investigation. Analyses of 20 in-depth interviews with Bachelor of Social Work (BSW)/Master of Social Work (MSW) social workers averaging 8.8 years of experience identified frequently occurring resident behaviors: physical and verbal aggression/disruption, passive disruption, socially and sexually inappropriateness. Six functions of the behavioral health role were care management, educating, investigating, preventing, mediating, and advocating. Skills most frequently applied were attention/affirmation/active listening, assessment, behavior management, building relationship, teamwork, and redirection. Narratives revealed role rewards as well as knowledge deficits, organizational barriers, personal maltreatment, and frustrations. Respondents offered perspectives and prescriptions for behavioral health practice in this setting. The findings expand understanding of the behavioral health role and provide an empirical basis for more research in this area. Recommendations, including educational competencies, are offered.

  20. Restaurant closures

    CERN Document Server

    Novae Restauration

    2012-01-01

    Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

  1. 40 CFR 264.178 - Closure.

    Science.gov (United States)

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

  2. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  3. A spatial national health facility database for public health sector planning in Kenya in 2008

    Directory of Open Access Journals (Sweden)

    Gething Peter W

    2009-03-01

    Full Text Available Abstract Background Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. For health information systems to function well, a reliable inventory of health service providers is critical. The spatial referencing of service providers to allow their representation in a geographic information system is vital if the full planning potential of such data is to be realized. Methods A disparate series of contemporary lists of health service providers were used to update a public health facility database of Kenya last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods, including global positioning systems, was used to map service providers. These spatially-referenced data were combined with high-resolution population maps to analyze disparity in geographic access to public health care. Findings The updated 2008 database contained 5,334 public health facilities (67% ministry of health; 28% mission and nongovernmental organizations; 2% local authorities; and 3% employers and other ministries. This represented an overall increase of 1,862 facilities compared to 2003. Most of the additional facilities belonged to the ministry of health (79% and the majority were dispensaries (91%. 93% of the health facilities were spatially referenced, 38% using global positioning systems compared to 21% in 2003. 89% of the population was within 5 km Euclidean distance to a public health facility in 2008 compared to 71% in 2003. Over 80% of the population outside 5 km of public health service providers was in the sparsely settled pastoralist areas of the country. Conclusion We have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for

  4. A spatial national health facility database for public health sector planning in Kenya in 2008.

    Science.gov (United States)

    Noor, Abdisalan M; Alegana, Victor A; Gething, Peter W; Snow, Robert W

    2009-03-06

    Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. For health information systems to function well, a reliable inventory of health service providers is critical. The spatial referencing of service providers to allow their representation in a geographic information system is vital if the full planning potential of such data is to be realized. A disparate series of contemporary lists of health service providers were used to update a public health facility database of Kenya last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods, including global positioning systems, was used to map service providers. These spatially-referenced data were combined with high-resolution population maps to analyze disparity in geographic access to public health care. The updated 2008 database contained 5,334 public health facilities (67% ministry of health; 28% mission and nongovernmental organizations; 2% local authorities; and 3% employers and other ministries). This represented an overall increase of 1,862 facilities compared to 2003. Most of the additional facilities belonged to the ministry of health (79%) and the majority were dispensaries (91%). 93% of the health facilities were spatially referenced, 38% using global positioning systems compared to 21% in 2003. 89% of the population was within 5 km Euclidean distance to a public health facility in 2008 compared to 71% in 2003. Over 80% of the population outside 5 km of public health service providers was in the sparsely settled pastoralist areas of the country. We have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for improving planning. Expansion in public health care in Kenya has

  5. NIF conventional facilities construction health and safety plan

    International Nuclear Information System (INIS)

    Benjamin, D W

    1998-01-01

    The purpose of this Plan is to outline the minimum health and safety requirements to which all participating Lawrence Livermore National Laboratory (LLNL) and non-LLNL employees (excluding National Ignition Facility [NIF] specific contractors and subcontractors covered under the construction subcontract packages (e.g., CSP-9)-see Construction Safety Program for the National Ignition Facility [CSP] Section I.B. ''NIF Construction Contractors and Subcontractors'' for specifics) shall adhere to for preventing job-related injuries and illnesses during Conventional Facilities construction activities at the NIF Project. For the purpose of this Plan, the term ''LLNL and non-LLNL employees'' includes LLNL employees, LLNL Plant Operations staff and their contractors, supplemental labor, contract labor, labor-only contractors, vendors, DOE representatives, personnel matrixed/assigned from other National Laboratories, participating guests, and others such as visitors, students, consultants etc., performing on-site work or services in support of the NIF Project. Based upon an activity level determination explained in Section 1.2.18, in this document, these organizations or individuals may be required by site management to prepare their own NIF site-specific safety plan. LLNL employees will normally not be expected to prepare a site-specific safety plan. This Plan also outlines job-specific exposures and construction site safety activities with which LLNL and non-LLNL employees shall comply

  6. Liberia_WADC00004_OHDR_Health_Facilities2010

    Data.gov (United States)

    United Nations Cartographic Section — This data is based on the survey questionnaire, which are included in the table belowWhat county is this facility in?What is the facility name?Is this facility a...

  7. The impact of hospital closures on geographical access: Evidence from four southeastern states of the United States

    Directory of Open Access Journals (Sweden)

    M.L. Burkey

    Full Text Available This paper examines the effects of hospital closures on geographical access by potential patients, using data from four southeastern U.S. states. Using optimization models designed to minimize the adverse effects of hospital closures, extensive computations are performed and the results are discussed. The effects of the closures on the rural areas is also investigated. Finally, the paper determines which hospitals are most likely among those to be closed assuming that up to 10% of the existing hospitals in each of the four states were to be shut down. The overall conclusion of the empirical findings is that while differences exist among the states, efficiency, coverage, and equality measures for geographical access do not suffer significantly if only a few hospitals are closed in each state, provided these closures are done optimally to minimize impact. Further, for efficiency objectives, decision makers can follow a sequential strategy for closures and still be guaranteed optimality. The paper also discusses the effects of hospital closures on equity and it examines whether or not rural areas are disproportionately affected by closures. Keywords: Health care, Access to health care, Proximity, Hospital closures, Location problems, Facility planning

  8. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Science.gov (United States)

    2010-10-01

    ... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities and home health agencies. 415.204 Section 415.204 Public Health CENTERS FOR MEDICARE & MEDICAID...

  9. Health Resources Statistics; Health Manpower and Health Facilities, 1968. Public Health Service Publication No. 1509.

    Science.gov (United States)

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    This report is a part of the program of the National Center for Health Statistics to provide current statistics as baseline data for the evaluation, planning, and administration of health programs. Part I presents data concerning the occupational fields: (1) administration, (2) anthropology and sociology, (3) data processing, (4) basic sciences,…

  10. Mental Health Facilities, This file contains the name, address, contact and some licensing information for the Mental Health facilities in Maryland., Published in 2010, Smaller than 1:100000 scale, Maryland Department of Health and Mental Hygiene.

    Data.gov (United States)

    NSGIC State | GIS Inventory — Mental Health Facilities dataset current as of 2010. This file contains the name, address, contact and some licensing information for the Mental Health facilities in...

  11. Health risks for the population living in the vicinity of an Integrated Waste Management Facility: Screening environmental pollutants

    International Nuclear Information System (INIS)

    Domingo, José L.; Rovira, Joaquim; Vilavert, Lolita; Nadal, Martí; Figueras, María J.; Schuhmacher, Marta

    2015-01-01

    We performed a screening investigation to assess the human health risks of the Integrated Waste Management Facility (IWMF: mechanical–biological treatment (MBT) plant plus municipal solid waste incinerator (MSWI); Ecoparc-3) of Barcelona (Spain). Air concentrations of pollutants potentially released by the MBT plant (VOCs and bioaerosols) and the MSWI (trace elements, PCDD/Fs and PCBs) were determined. Trace elements, PCDD/Fs and PCBs were also analyzed in soil samples. The concentrations of trace elements and bioaerosols were similar to those previously reported in other areas of similar characteristics, while formaldehyde was the predominant VOC. Interestingly, PCDD/F concentrations in soil and air were the highest ever reported near a MSWI in Catalonia, being maximum concentrations 10.8 ng WHO-TEQ/kg and 41.3 fg WHO-TEQ/m 3 , respectively. In addition, there has not been any reduction in soils, even after the closure of a power plant located adjacently. Human health risks of PCDD/F exposure in the closest urban nucleus located downwind the MSWI are up to 10-times higher than those nearby other MSWIs in Catalonia. Although results must be considered as very preliminary, they are a serious warning for local authorities. We strongly recommend to conduct additional studies to confirm these findings and, if necessary, to implement measures to urgently mitigate the impact of the MSWI on the surrounding environment. We must also state the tremendous importance of an individual evaluation of MSWIs, rather than generalizing their environmental and health risks. - Highlights: • Health risks of an Integrated Waste Management Facility in Catalonia are assessed. • PCDD/F exposure near this facility is up to 10-times higher than that near others. • Environmental monitoring of incineration plants should be performed case-by-case. • Since results are very preliminary, confirmatory studies should be conducted

  12. Health risks for the population living in the vicinity of an Integrated Waste Management Facility: Screening environmental pollutants

    Energy Technology Data Exchange (ETDEWEB)

    Domingo, José L., E-mail: joseluis.domingo@urv.cat [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Rovira, Joaquim [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Departament d' Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia (Spain); Vilavert, Lolita; Nadal, Martí [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Figueras, María J. [Microbiology Unit, School of Medicine, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Schuhmacher, Marta [Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201 Reus, Catalonia (Spain); Departament d' Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007 Tarragona, Catalonia (Spain)

    2015-06-15

    We performed a screening investigation to assess the human health risks of the Integrated Waste Management Facility (IWMF: mechanical–biological treatment (MBT) plant plus municipal solid waste incinerator (MSWI); Ecoparc-3) of Barcelona (Spain). Air concentrations of pollutants potentially released by the MBT plant (VOCs and bioaerosols) and the MSWI (trace elements, PCDD/Fs and PCBs) were determined. Trace elements, PCDD/Fs and PCBs were also analyzed in soil samples. The concentrations of trace elements and bioaerosols were similar to those previously reported in other areas of similar characteristics, while formaldehyde was the predominant VOC. Interestingly, PCDD/F concentrations in soil and air were the highest ever reported near a MSWI in Catalonia, being maximum concentrations 10.8 ng WHO-TEQ/kg and 41.3 fg WHO-TEQ/m{sup 3}, respectively. In addition, there has not been any reduction in soils, even after the closure of a power plant located adjacently. Human health risks of PCDD/F exposure in the closest urban nucleus located downwind the MSWI are up to 10-times higher than those nearby other MSWIs in Catalonia. Although results must be considered as very preliminary, they are a serious warning for local authorities. We strongly recommend to conduct additional studies to confirm these findings and, if necessary, to implement measures to urgently mitigate the impact of the MSWI on the surrounding environment. We must also state the tremendous importance of an individual evaluation of MSWIs, rather than generalizing their environmental and health risks. - Highlights: • Health risks of an Integrated Waste Management Facility in Catalonia are assessed. • PCDD/F exposure near this facility is up to 10-times higher than that near others. • Environmental monitoring of incineration plants should be performed case-by-case. • Since results are very preliminary, confirmatory studies should be conducted.

  13. Evaluating health risks in communities near nuclear facilities

    International Nuclear Information System (INIS)

    Ruttenber, A.J.

    1992-01-01

    Over the past 10 years, epidemiologic studies have been the most popular approach to examining health risks to populations near nuclear facilities. A review of these studies has identified a number of methodologic problems, particularly with regard to establishing causal relations between radiation exposure and disease. Recently, in the United States, dose reconstruction and risk assessment projects have been conducted as alternatives to epidemiologic studies. This paper reviews the problems associated with epidemiologic studies and discusses how dose reconstruction and risk assessment can serve as alternatives to epidemiologic studies. Examples are also provided to demonstrate how these techniques can be used to explore the feasibility of epidemiologic studies, and how dose reconstruction data can improve the quality of epidemiologic studies

  14. National ignition facility environment, safety, and health management plan

    International Nuclear Information System (INIS)

    1995-11-01

    The ES ampersand H Management Plan describes all of the environmental, safety, and health evaluations and reviews that must be carried out in support of the implementation of the National Ignition Facility (NIF) Project. It describes the policy, organizational responsibilities and interfaces, activities, and ES ampersand H documents that will be prepared by the Laboratory Project Office for the DOE. The only activity not described is the preparation of the NIF Project Specific Assessment (PSA), which is to be incorporated into the Programmatic Environmental Impact Statement for Stockpile Stewardship and Management (PEIS). This PSA is being prepared by Argonne National Laboratory (ANL) with input from the Laboratory participants. As the independent NEPA document preparers ANL is directly contracted by the DOE, and its deliverables and schedule are agreed to separately with DOE/OAK

  15. Strategic planning and marketing research for older, inner-city health care facilities: a case study.

    Science.gov (United States)

    Wood, V R; Robertson, K R

    1992-01-01

    Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.

  16. Characteristics of U.S. Mental Health Facilities That Offer Suicide Prevention Services.

    Science.gov (United States)

    Kuramoto-Crawford, S Janet; Smith, Kelley E; McKeon, Richard

    2016-01-01

    This study characterized mental health facilities that offer suicide prevention services or outcome follow-up after discharge. The study analyzed data from 8,459 U.S. mental health facilities that participated in the 2010 National Mental Health Services Survey. Logistic regression analyses were used to compare facilities that offered neither of the prevention services with those that offered both or either service. About one-fifth of mental health facilities reported offering neither suicide prevention services nor outcome follow-up. Approximately one-third offered both, 25% offered suicide prevention services only, and 21% offered only outcome follow-up after discharge. Facilities that offered neither service were less likely than facilities that offered either to offer comprehensive support services or special programs for veterans; to offer substance abuse services; and to be accredited, licensed, or certified. Further examination of facilitators and barriers in implementing suicide prevention services in mental health facilities is warranted.

  17. Health physics manual of good practices for accelerator facilities

    International Nuclear Information System (INIS)

    Casey, W.R.; Miller, A.J.; McCaslin, J.B.; Coulson, L.V.

    1988-04-01

    It is hoped that this manual will serve both as a teaching aid as well as a useful adjunct for program development. In the context of application, this manual addresses good practices that should be observed by management, staff, and designers since the achievement of a good radiation program indeed involves a combined effort. Ultimately, radiation safety and good work practices become the personal responsibility of the individual. The practices presented in this manual are not to be construed as mandatory rather they are to be used as appropriate for the specific case in the interest of radiation safety. As experience is accrued and new data obtained in the application of this document, ONS will update the guidance to assure that at any given time the guidance reflects optimum performance consistent with current technology and practice.The intent of this guide therefore is to: define common health physics problems at accelerators; recommend suitable methods of identifying, evaluating, and managing accelerator health physics problems; set out the established safety practices at DOE accelerators that have been arrived at by consensus and, where consensus has not yet been reached, give examples of safe practices; introduce the technical literature in the accelerator health physics field; and supplement the regulatory documents listed in Appendix D. Many accelerator health physics problems are no different than those at other kinds of facilities, e.g., ALARA philosophy, instrument calibration, etc. These problems are touched on very lightly or not at all. Similarly, this document does not cover other hazards such as electrical shock, toxic materials, etc. This does not in any way imply that these problems are not serious. 160 refs

  18. Observations on early and delayed colostomy closure.

    Science.gov (United States)

    Tade, A O; Salami, B A; Ayoade, B A

    2011-06-01

    Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

  19. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

    Science.gov (United States)

    Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

    2015-05-01

    Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

  20. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

    Science.gov (United States)

    Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

    2015-01-01

    In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (pprivate facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both

  1. Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

    Science.gov (United States)

    Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

    2018-04-16

    Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

  2. 40 CFR 264.119 - Post-closure notices.

    Science.gov (United States)

    2010-07-01

    ...) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Closure... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... disposal unit of the facility. For hazardous wastes disposed of before January 12, 1981, the owner or...

  3. Intervention to promote physical health in staff within mental health facilities and the impact on patients' physical health

    DEFF Research Database (Denmark)

    Hjorth, Peter; Davidsen, Annette S; Kilian, Reinhold

    2016-01-01

    of an intervention programme for improving physical health in staff working in longtermpsychiatric treatment facilities. Furthermore, the paper measured the association betweenstaff’s changes in physical health and the patients’ changes in physical health. Methods: Thestudy was a cluster randomized controlled 12......-month intervention study, and the interventionwas active awareness on physical health. Results: In the intervention group the staff reducedtheir waist circumference by 2.3 cm (95% CI: 0.3–4.4) when controlling for gender, age andcigarette consumption. In the control group, the staff changed their waist...... blood pressure was seen. Indications that staff acted aspositive role models for the patients’ physical health were seen....

  4. Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments.

    Science.gov (United States)

    Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

    2017-12-01

    Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa. Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed. A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions

  5. Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda.

    Science.gov (United States)

    Buregyeya, Esther; Nuwaha, Fred; Verver, Suzanne; Criel, Bart; Colebunders, Robert; Wanyenze, Rhoda; Kalyango, Joan N; Katamba, Achilles; Mitchell, Ellen Mh

    2013-08-01

    Tuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks--governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.

  6. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

    Science.gov (United States)

    Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

    2016-11-01

    The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  7. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  8. Hospital-acquired infections in a Nigerian tertiary health facility: An ...

    African Journals Online (AJOL)

    Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports. ... This study evaluated the occurrence of HAI in a foremost tertiary health facility over a 5-year period for the purpose of reinforcing control efforts. Materials and Methods: A retrospective survey of records from the infection control ...

  9. Repository Closure and Sealing Approach

    International Nuclear Information System (INIS)

    A.T. Watkins

    2000-01-01

    The scope of this analysis will be to develop the conceptual design of the closure seals and their locations in the Subsurface Facilities. The design will be based on the recently established program requirements for transitioning to the Site Recommendation (SR) design as outlined by ''Approach to Implementing the Site Recommendation Baseline'' (Stroupe 2000) and the ''Monitored Geologic Repository Project Description Document'' (CRWMS M andO 1999b). The objective of this analysis will be to assist in providing a description for the Subsurface Facilities System Description Document, Section 2 and finally to document any conclusions reached in order to contribute and provide support to the SR. This analysis is at a conceptual level and is considered adequate to support the SR design. The final closure barriers and seals for the ventilation shafts, and the north and south ramps will require these openings to be permanently sealed to limit excessive air and water inflows and prevent human intrusion. The major tasks identified with closure in this analysis are: (1) Developing the overall subsurface seal layout and identifying design and operational interfaces for the Subsurface Facilities. (2) Summarizing the general site conditions and general rock characteristic with respect to seal location and describing the seal selected. (3) Identify seal construction materials, methodology of construction and strategic locations including design of the seal and plugs. (4) Discussing methods to prevent human intrusion

  10. Improving water, sanitation and hygiene in health-care facilities, Liberia.

    Science.gov (United States)

    Abrampah, Nana Mensah; Montgomery, Maggie; Baller, April; Ndivo, Francis; Gasasira, Alex; Cooper, Catherine; Frescas, Ruben; Gordon, Bruce; Syed, Shamsuzzoha Babar

    2017-07-01

    The lack of proper water and sanitation infrastructures and poor hygiene practices in health-care facilities reduces facilities' preparedness and response to disease outbreaks and decreases the communities' trust in the health services provided. To improve water and sanitation infrastructures and hygiene practices, the Liberian health ministry held multistakeholder meetings to develop a national water, sanitation and hygiene and environmental health package. A national train-the-trainer course was held for county environmental health technicians, which included infection prevention and control focal persons; the focal persons acted as change agents. In Liberia, only 45% of 701 surveyed health-care facilities had an improved water source in 2015, and only 27% of these health-care facilities had proper disposal for infectious waste. Local ownership, through engagement of local health workers, was introduced to ensure development and refinement of the package. In-county collaborations between health-care facilities, along with multisectoral collaboration, informed national level direction, which led to increased focus on water and sanitation infrastructures and uptake of hygiene practices to improve the overall quality of service delivery. National level leadership was important to identify a vision and create an enabling environment for changing the perception of water, sanitation and hygiene in health-care provision. The involvement of health workers was central to address basic infrastructure and hygiene practices in health-care facilities and they also worked as stimulators for sustainable change. Further, developing a long-term implementation plan for national level initiatives is important to ensure sustainability.

  11. Regulatory review and confidence building in post-closure safety assessments and safety cases for near surface disposal facilities-IAEA ASAM coordinated research programme

    International Nuclear Information System (INIS)

    Gonzales, A.; Simeonov, G.; Bennett, D.G.; Nys, V.; Ben Belfadhel, M.

    2005-01-01

    Some years ago, the IAEA successfully concluded a Coordinated Research Program (CRP) called Islam, which focussed on the development of an Improved Safety Assessment Methodology for near-surface radioactive waste disposal facilities. In November 2002, and as an extension of ISAM, the IAEA launched a new CRP called ASAM, designed to test the Application of the Safety Assessment Methodology by considering a range of near-surface disposal facilities. The ASAM work programme is being implemented by three application working groups and two cross-cutting working groups. The application working groups are testing the applicability of the ISAM methodology by assessing an existing disposal facility in Hungary, a copper mine in South Africa, and a hypothetical facility containing heterogenous wastes, such as disused sealed sources. The first cross-cutting working group is addressing a number of technical issues that are common to all near-surface disposal facilities, while the second group, the Regulatory Review Working Group (RRWG) is developing guidance on how to gain confidence in safety assessments and safety cases, and on how to conduct regulatory reviews of safety assessments. This paper provides a brief overview of the work being conducted by the Regulatory Review Working Group. (author)

  12. Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

    Science.gov (United States)

    Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

    2018-04-18

    The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a

  13. Full closure strategic analysis.

    Science.gov (United States)

    2014-07-01

    The full closure strategic analysis was conducted to create a decision process whereby full roadway : closures for construction and maintenance activities can be evaluated and approved or denied by CDOT : Traffic personnel. The study reviewed current...

  14. Sternal exploration or closure

    Science.gov (United States)

    VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection ... in the wound to look for signs of infection Remove dead or infected ... use a VAC (vacuum-assisted closure) dressing. It is a negative ...

  15. Development and use of a master health facility list: Haiti's experience during the 2010 earthquake response.

    Science.gov (United States)

    Rose-Wood, Alyson; Heard, Nathan; Thermidor, Roody; Chan, Jessica; Joseph, Fanor; Lerebours, Gerald; Zugaldia, Antonio; Konkel, Kimberly; Edwards, Michael; Lang, Bill; Torres, Carmen-Rosa

    2014-08-01

    Master health facility lists (MHFLs) are gaining attention as a standards-based means to uniquely identify health facilities and to link facility-level data. The ability to reliably communicate information about specific health facilities can support an array of health system functions, such as routine reporting and emergency response operations. MHFLs support the alignment of donor-supported health information systems with county-owned systems. Recent World Health Organization draft guidance promotes the utility of MHFLs and outlines a process for list development and governance. Although the potential benefits of MHFLs are numerous and may seem obvious, there are few documented cases of MHFL construction and use. The international response to the 2010 Haiti earthquake provides an example of how governments, nongovernmental organizations, and others can collaborate within a framework of standards to build a more complete and accurate list of health facilities. Prior to the earthquake, the Haitian Ministry of Health (Ministère de la Santé Publique et de la Population [MSPP]) maintained a list of public-sector health facilities but lacked information on privately managed facilities. Following the earthquake, the MSPP worked with a multinational group to expand the completeness and accuracy of the list of health facilities, including information on post-quake operational status. This list later proved useful in the response to the cholera epidemic and is now incorporated into the MSPP's routine health information system. Haiti's experience demonstrates the utility of MHFL formation and use in crisis as well as in the routine function of the health information system.

  16. American Health Information Management Association. Position statement. Issue: managing health information in facility mergers and acquisitions.

    Science.gov (United States)

    1994-04-01

    Healthcare facility mergers and acquisitions are becoming more common as the industry consolidates. Many critical issues must be considered in mergers and acquisitions, including the management of patient health information. In addition to operational issues, licensure, regulatory, and accreditation requirements must be addressed. To ensure availability of health information to all legitimate users, patient records should be consolidated or linked in the master patient index. A record retention policy should be developed and implemented to meet user needs and assure compliance with legal, regulatory, and accreditation requirements. If health information from closed facilities will be stored for a period of time, its integrity and confidentiality must be preserved, and it must be readily accessible for patient care. The compatibility and functionality of existing information systems should be assessed, and a plan should be formulated for integration of the systems to the extent possible. Such integration may be essential for the organization to successfully meet the demands of integrated delivery systems. Existing databases should be maintained in an accessible form to meet anticipated future needs.

  17. Patient-, health worker-, and health facility-level determinants of correct malaria case management at publicly funded health facilities in Malawi: results from a nationally representative health facility survey.

    Science.gov (United States)

    Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-02-20

    Prompt and effective case management is needed to reduce malaria morbidity and mortality. However, malaria diagnosis and treatment is a multistep process that remains problematic in many settings, resulting in missed opportunities for effective treatment as well as overtreatment of patients without malaria. Prior to the widespread roll-out of malaria rapid diagnostic tests (RDTs) in late 2011, a national, cross-sectional, complex-sample, health facility survey was conducted in Malawi to assess patient-, health worker-, and health facility-level factors associated with malaria case management quality using multivariate Poisson regression models. Among the 2,019 patients surveyed, 34% had confirmed malaria defined as presence of fever and parasitaemia on a reference blood smear. Sixty-seven per cent of patients with confirmed malaria were correctly prescribed the first-line anti-malarial, with most cases of incorrect treatment due to missed diagnosis; 31% of patients without confirmed malaria were overtreated with an anti-malarial. More than one-quarter of patients were not assessed for fever or history of fever by health workers. The most important determinants of correct malaria case management were patient-level clinical symptoms, such as spontaneous complaint of fever to health workers, which increased both correct treatment and overtreatment by 72 and 210%, respectively (pfacility-level factors were significantly associated with case management quality. Introduction of RDTs holds potential to improve malaria case management in Malawi, but health workers must systematically assess all patients for fever, and then test and treat accordingly, otherwise, malaria control programmes might miss an opportunity to dramatically improve malaria case management, despite better diagnostic tools.

  18. Risk and Performance Analyses Supporting Closure of WMA C at the Hanford Site in Southeast Washington

    International Nuclear Information System (INIS)

    Eberlein, Susan J.; Bergeron, Marcel P.; Kemp, Christopher J.; Hildebrand, R. Douglas; Aly, Alaa; Kozak, Matthew; Mehta, Sunil; Connelly, Michael

    2013-01-01

    The Office of River Protection under the U.S. Department of Energy (DOE) is pursuing closure of the Single-Shell Tank (SST) Waste Management Area (WMA) C as stipulated by the Hanford Federal Facility Agreement and Consent Order (HFFACO) under federal requirements and work tasks will be done under the State-approved closure plans and permits. An initial step in meeting the regulatory requirements is to develop a baseline risk assessment representing current conditions based on available characterization data and information collected at the WMA C location. The baseline risk assessment will be supporting a Resource Conservation and Recovery Act of 1976 (RCRA) Field Investigation (RFI)/Corrective Measures Study (CMS) for WMA closure and RCRA corrective action. Complying with the HFFACO conditions also involves developing a long-term closure Performance Assessment (PA) that evaluates human health and environmental impacts resulting from radionuclide inventories in residual wastes remaining in WMA C tanks and ancillary equipment. This PA is being developed to meet the requirements necessary for closure authorization under DOE Order 435.1 and Washington State Hazardous Waste Management Act. To meet the HFFACO conditions, the long-term closure risk analysis will include an evaluation of human health and environmental impacts from hazardous chemical inventories along with other performance Comprehensive Environmental Response, Compensation, and Liability Act Appropriate and Applicable Requirements (CERCLA ARARs) in residual wastes left in WMA C facilities after retrieval and removal. This closure risk analysis is needed to needed to comply with the requirements for permitted closure. Progress to date in developing a baseline risk assessment of WMA C has involved aspects of an evaluation of soil characterization and groundwater monitoring data collected as a part of the RFI/CMS and RCRA monitoring. Developing the long-term performance assessment aspects has involved the

  19. Risk and Performance Analyses Supporting Closure of WMA C at the Hanford Site in Southeast Washington

    Energy Technology Data Exchange (ETDEWEB)

    Eberlein, Susan J.; Bergeron, Marcel P.; Kemp, Christopher J.

    2013-11-11

    The Office of River Protection under the U.S. Department of Energy (DOE) is pursuing closure of the Single-Shell Tank (SST) Waste Management Area (WMA) C as stipulated by the Hanford Federal Facility Agreement and Consent Order (HFFACO) under federal requirements and work tasks will be done under the State-approved closure plans and permits. An initial step in meeting the regulatory requirements is to develop a baseline risk assessment representing current conditions based on available characterization data and information collected at the WMA C location. The baseline risk assessment will be supporting a Resource Conservation and Recovery Act of 1976 (RCRA) Field Investigation (RFI)/Corrective Measures Study (CMS) for WMA closure and RCRA corrective action. Complying with the HFFACO conditions also involves developing a long-term closure Performance Assessment (PA) that evaluates human health and environmental impacts resulting from radionuclide inventories in residual wastes remaining in WMA C tanks and ancillary equipment. This PA is being developed to meet the requirements necessary for closure authorization under DOE Order 435.1 and Washington State Hazardous Waste Management Act. To meet the HFFACO conditions, the long-term closure risk analysis will include an evaluation of human health and environmental impacts from hazardous chemical inventories along with other performance Comprehensive Environmental Response, Compensation, and Liability Act Appropriate and Applicable Requirements (CERCLA ARARs) in residual wastes left in WMA C facilities after retrieval and removal. This closure risk analysis is needed to needed to comply with the requirements for permitted closure. Progress to date in developing a baseline risk assessment of WMA C has involved aspects of an evaluation of soil characterization and groundwater monitoring data collected as a part of the RFI/CMS and RCRA monitoring. Developing the long-term performance assessment aspects has involved the

  20. Closure of the Oak Ridge National Laboratory Hydrofracture Facility: An opportunity to study the fate of radioactive wastes disposed of by subsurface injection

    International Nuclear Information System (INIS)

    Haase, C.S.; Von Damm, K.L.; Stow, S.H.

    1987-01-01

    At Oak Ridge National Laboratory, subsurface injection has been used to dispose of liquid low-level nuclear waste for the past two decades. The process consists of mixing the liquid waste with cement and other additives to form a slurry that is injected under pressure through a cased well into a low-permeability shale at a depth of approximately 300 m (1000 ft). The slurry spreads from the well along hydraulic fractures and sets to form irregularly shaped grout sheets of up to 200 m (650 ft) in radius. Closure-related site characterization provides a unique opportunity to study the fate of the injected wastes. A series of monitoring wells are in place to measure groundwater chemistries within the injection strata and within overlying and underlying confining units. Initial results indicate that contaminated groundwater surrounds the grout sheets in the injection zone, extending at least as far as 300 m (1000 ft) from the injection well; contaminated groundwater is largely and perhaps exclusively confined to the host formation; and of the 90 Sr and 137 Cs radionuclides disposed of, only 90 Sr is present in the contaminated groundwater. The illite-rich mineralogy of the injection formation strongly absorbs 137 Cs and greatly retards its migration. Movement of 90 Sr is not as greatly retarded by the injection formation. Geochemical modeling is being used to identify and to evaluate hydrogeological controls on 90 Sr behavior. Preliminary results suggest that the groundwaters within the injection formation are saturated with Sr from natural sources, and that 90 Sr mobility may be lessened by precipitation/dissolution reactions associated with such a saturated condition. 27 refs., 4 figs., 2 tabs

  1. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

    Directory of Open Access Journals (Sweden)

    Jeannie Samuel

    2016-12-01

    Full Text Available Background and objective: Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design: Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results: Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions: Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women

  2. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

  3. Closure The Definitive Guide

    CERN Document Server

    Bolin, Michael

    2010-01-01

    If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

  4. Health and Safety Management for Small-scale Methane Fermentation Facilities

    Science.gov (United States)

    Yamaoka, Masaru; Yuyama, Yoshito; Nakamura, Masato; Oritate, Fumiko

    In this study, we considered health and safety management for small-scale methane fermentation facilities that treat 2-5 ton of biomass daily based on several years operation experience with an approximate capacity of 5 t·d-1. We also took account of existing knowledge, related laws and regulations. There are no qualifications or licenses required for management and operation of small-scale methane fermentation facilities, even though rural sewerage facilities with a relative similar function are required to obtain a legitimate license. Therefore, there are wide variations in health and safety consciousness of the operators of small-scale methane fermentation facilities. The industrial safety and health laws are not applied to the operation of small-scale methane fermentation facilities. However, in order to safely operate a small-scale methane fermentation facility, the occupational safety and health management system that the law recommends should be applied. The aims of this paper are to clarify the risk factors in small-scale methane fermentation facilities and encourage planning, design and operation of facilities based on health and safety management.

  5. Referral of children seeking care at private health facilities in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K.; Buregyeya, Esther; Rutebemberwa, Elizeus

    2017-01-01

    Background In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health...... facilities in order to explore ways of improving treatment and referral of sick children in this sector. Methods A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant...... interviews with private providers and community members. Results A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick...

  6. Closure plan for the M-Area settling basin and vicinity at the Savannah River Plant

    International Nuclear Information System (INIS)

    Colven, W.P.; Pickett, J.B.; Muska, C.F.; Boone, L.F.

    1988-03-01

    The closure plan for the M-Area settling basin and vicinity was originally submitted to the South Carolina Department of Health and Environmental Control (SCDHEC) Bureau of Solid and Hazardous Waste Management in September 1984. The plan was revised in July and November 1985 in response to SCDHEC comments. After public comment in April through July 1986, the closure plan was conditionally approved by SCDHEC in March 1987. The conditions included (1) providing a temporary wastewater treatment facility to process the water remaining in the basin, (2) using a burn box to limit ash emissions from burning in the basin, (3) obtaining SCDHEC approval prior to operating the leach field, and (4) completing all closure activities within three years of the startup date

  7. They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana.

    Science.gov (United States)

    Boah, Michael; Mahama, Abraham B; Ayamga, Emmanuel A

    2018-05-03

    Research has shown that use of antenatal services by pregnant women and delivery in health facilities with skilled birth attendants contribute to better delivery outcomes. However, a gap exists in Ghana between the use of antenatal care provided by health facilities and delivery in health facilities with skilled birth attendants by pregnant women. This study sought to identify the predictors of health facility delivery by women in a rural district in Ghana. This was a cross-sectional study conducted in June 2016. Women who delivered in the past 6 months preceding the study were interviewed. Data on socio-demographic characteristics, use of antenatal care, place of delivery and reasons for home delivery were collected from study participants. Chi-square test and multiple logistic regression analysis were used to assess an association between women's socio-demographic and obstetric characteristics and place of delivery at 95% confidence interval. The study found that 98.8% of women received antenatal care services at least once during their recent pregnancy, and 67.9% attended antenatal care at least four times before delivery. However, 61.9% of the women delivered in a health facility with a skilled attendant. The frequently mentioned reason for home delivery was "unaware of onset of labour and delivery". The odds for delivery at a health facility were reduced among women with four living children [(AOR = 0.07, CI = 0.15-0.36, p = 0.001)], with no exposure to delivery care information [(AOR = 0.06, CI = 0.01-0.34, p = 0.002), who started their first ANC visit from the second trimester of pregnancy[(AOR = 0.003, CI = 0.01-0.15, p facilities although visits to antenatal care sessions were high, an indication that there was the need to intensify health education on early initiation of antenatal care, signs of labour and delivery, and importance of health facility delivery.

  8. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

    Directory of Open Access Journals (Sweden)

    Peter Waiswa

    2015-03-01

    Full Text Available Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007. Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was

  9. Health physics manual of good practices for tritium facilities

    International Nuclear Information System (INIS)

    Blauvelt, R.K.; Deaton, M.R.; Gill, J.T.

    1991-12-01

    The purpose of this document is to provide written guidance defining the generally accepted good practices in use at Department of Energy (DOE) tritium facilities. A open-quotes good practiceclose quotes is an action, policy, or procedure that enhances the radiation protection program at a DOE site. The information selected for inclusion in this document should help readers achieve an understanding of the key radiation protection issues at tritium facilities and provide guidance as to what characterizes excellence from a radiation protection point of view. The ALARA (As Low as Reasonable Achievable) program at DOE sites should be based, in part, on following the good practices that apply to their operations

  10. Approaches to the management of waste from health care facilities in Czech Republic and Kazakhstan

    OpenAIRE

    Kaireshev, Ruslan

    2015-01-01

    Waste from healthcare facilities or similar facilities includes components of various physical, chemical and biological character that require special approaches during the handling, specifically with regard to possible risks to human health and the environment. Nowadays a challenge for waste management system becomes waste produced in healthcare facilities and contributes too many reasons, such as population growth and rising life expectancy. The rate of waste production from healthcare faci...

  11. Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

    Science.gov (United States)

    Novignon, Jacob; Nonvignon, Justice

    2017-06-12

    Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private

  12. Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia.

    Science.gov (United States)

    Asseffa, Netsanet Abera; Bukola, Fawole; Ayodele, Arowojolu

    2016-11-16

    Maternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth. A cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery. Data from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband's level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth. Efforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.

  13. Quality of the delivery services in health facilities in Northern Ethiopia.

    Science.gov (United States)

    Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen

    2017-03-09

    Substantial improvements have been observed in the coverage of and access to maternal health service, especially in skilled birth attendants, in Ethiopia. However, the quality of care has been lagging behind. Therefore, this study investigated the status of the quality of delivery services in Northern Ethiopia. A facility based survey was conducted from December 2014 to February 2015 in Northern Ethiopia. The quality of delivery service was assessed in 32 health facilities using a facility audit checklist, by reviewing delivery, by conducting in-depth interview and observation, and by conducting exit interviews with eligible mothers. Facilities were considered as 'good quality' if they scored positively on 75% of the quality indicators set in the national guidelines for all the three components; input (materials, infrastructure, and human resource), process (adherence to standard care procedures during intrapartum and immediate postpartum periods) and output (the mothers' satisfaction and utilization of lifesaving procedures). Overall 2 of 32 (6.3%) of the study facilities fulfilled all the three quality components; input, process and output. Two of the three components were assessed as good in 11 of the 32 (34.4%) health facilities. The input quality was the better of the other quality components; which was good in 21 out of the 32 (65.6%) health facilities. The process and output quality was good in only 10 of the 32 (31.3%) facilities. Only 6.3% of the studied health facilities had good quality in all three dimensions of quality measures that was done in accordance to the national delivery service guidelines. The most compromised quality component was the process. Systematic and sustained efforts need to be strengthened to improve all dimensions of quality in order to achieve the desired quality of delivery services and increase the proportion of births occurring in health facilities.

  14. Determinants Of Poor Utilization Of Orthodox Health Facilities In A ...

    African Journals Online (AJOL)

    Large volume of work was disliked by 93.2w% and being addressed by fist name was cherished by 89.8% of the respondents. Lack of guidance in moving round some was of the facilities was highlighted by 58.9%, while financial difficulty was experienced by 50.6% of respondents. Conclusion: Development of community ...

  15. Older Adult Participation in Health Promotion Programs: Perspectives of Facility Administrators

    Science.gov (United States)

    Wright, Tim; Hyner, Gerald C.

    2011-01-01

    Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…

  16. Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study

    Directory of Open Access Journals (Sweden)

    Frank Felix Mosha

    2013-03-01

    Full Text Available Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59% of the facilities visited provided circumcision services and only 46/203 (24% of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority – 190/203 (95% – of the health practitioners require additional training prior to providing circumcision services. Most facilities – 63/69 (91% – had all basic supplies (gloves, basin, chlorine and waste disposal necessary for infection prevention, 44/69 (65% provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90% had the capability to perform at least minor surgery. However, only 25/69 (36% and 15/69 (22% of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting

  17. Reliability assessment of underground shaft closure

    International Nuclear Information System (INIS)

    Fossum, A.F.; Munson, D.E.

    1994-01-01

    The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties

  18. Development of a web based GIS for health facilities mapping ...

    African Journals Online (AJOL)

    Hilary Mushonga

    Key Words: Spatial Decision Support System, Web GIS, Mapping, Health geography. 1. Introduction ... Health geography is an area of medical research that incorporates geographic techniques into the study of ... street water pump. Once the ...

  19. Implementation phase – Strengthening community to health facility ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Home · What we do ... Access to quality sexual and reproductive health information, services, prenatal services, and delivery services is ... should contribute to strengthening and improving the quality of provincial maternal health services.

  20. Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan.

    Science.gov (United States)

    Zaidi, Shehla; Riaz, Atif; Rabbani, Fauziah; Azam, Syed Iqbal; Imran, Syeda Nida; Pradhan, Nouhseen Akber; Khan, Gul Nawaz

    2015-11-25

    The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase

  1. Development of a web based GIS for health facilities mapping ...

    African Journals Online (AJOL)

    Around the world health professionals and authorities, in many cases, do not have the ability to visualize health related spatial information to make timely decisions. The high cost of deploying a desktop Geographical Information System (GIS) for Public Health management coupled with the need for specialised training in ...

  2. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

  3. pattern of anti diabetic drug prescription at a health facility in jos

    African Journals Online (AJOL)

    Administrator

    Jos Journal of Medicine, Volume 9 No. 1. PATTERN OF ANTI ... diabetic drug prescription at a private health facility in North Central Nigeria. Methodology: this was a ... Figure gender distribution of subjects ( 0 = males 1. = females ). Regimen.

  4. 34 CFR 75.683 - Health or safety standards for facilities.

    Science.gov (United States)

    2010-07-01

    ... Conditions Must Be Met by a Grantee? Other Requirements for Certain Projects § 75.683 Health or safety... to the facilities that the grantee uses for the project. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

  5. Treatment compliance and challenges among tuberculosis patients across selected health facilities in Osun State Nigeria.

    Science.gov (United States)

    Ajao, K O; Ogundun, O A; Afolabi, O T; Ojo, T O; Atiba, B P; Oguntunase, D O

    2014-12-01

    Tuberculosis (TB) is a major public health problem in the world and Africa has approximately one quarter of the world's cases. One of the greatest challenges facing most TB programmes is the non-compliance to TB treatment among TB patients. This study aimed at determining the challenges of management of tuberculosis (TB) across selected Osun State health facilities. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 102 TB patients in the health facilities. The instrument measured socio-demographic variables, patient related factors, socio-economic variables, health care system related factors to TB disease and treatment. Data were analysed and summarized using descriptive and inferential statistics. Statistical significance was placed at p facilities (χ2 = 21.761, p facility and patient-related factors were largely responsible.

  6. Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi.

    Science.gov (United States)

    Carvajal-Aguirre, Liliana; Mehra, Vrinda; Amouzou, Agbessi; Khan, Shane M; Vaz, Lara; Guenther, Tanya; Kalino, Maggie; Zaka, Nabila

    2017-12-01

    Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P  = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P  < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of

  7. Health facility-based data on women receiving sulphadoxine-pyrimethamine during pregnancy in Tanzania

    DEFF Research Database (Denmark)

    Mubyazi, Godfrey M.; Byskov, Jens; Magnussen, Pascal

    2014-01-01

    A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care (ANC) clinics in Mkuranga and Mufindi districts.......A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care (ANC) clinics in Mkuranga and Mufindi districts....

  8. Health physics considerations at a neutron therapy facility cyclotron

    International Nuclear Information System (INIS)

    Kleck, J.H.; Krueger, D.J.; Mc Laughlin, J.E.; Smathers, J.B.

    1987-01-01

    The U.C.L.A. Neutron Therapy Facility (NTF) is one of four such facilities in the United States currently involved in NCI sponsored trials of neutron therapy and reflects the present interest in the use of high energy neutron beams for treating certain types of human cancers. The NTF houses a CP-45 negative ion cyclotron which accelerates a 46 MeV proton beam for production of neutrons from a beryllium target. In addition to patient treatment, the NTF is involved in the production of positron emitting radioisotopes for diagnostic use in Positron Emission Tomography (PET). The activation of therapy treatment collimators, positron and neutron target systems, and a high and rapidly varying external radiation environment in a clinical setting have contributed to the need for a comprehensive radiation control program in which patient care is balanced with the maintenance of occupational exposures to ALARA levels

  9. Health physics manual of good practices for tritium facilities

    Energy Technology Data Exchange (ETDEWEB)

    Blauvelt, R.K.; Deaton, M.R.; Gill, J.T. [and others

    1991-12-01

    The purpose of this document is to provide written guidance defining the generally accepted good practices in use at Department of Energy (DOE) tritium facilities. A {open_quotes}good practice{close_quotes} is an action, policy, or procedure that enhances the radiation protection program at a DOE site. The information selected for inclusion in this document should help readers achieve an understanding of the key radiation protection issues at tritium facilities and provide guidance as to what characterizes excellence from a radiation protection point of view. The ALARA (As Low as Reasonable Achievable) program at DOE sites should be based, in part, on following the good practices that apply to their operations.

  10. Health physics experience with nondestructive X-radiation facilities in the US Air Force

    International Nuclear Information System (INIS)

    Stencel, J.R.; Piltingsrud, H.V.

    1976-01-01

    Radiation safety experience in the construction and use of enclosed nondestructive inspection (NDI) facilities in the US Air Force, has reaffirmed the constant need for the health physicist to continually monitor and assit in upgrading these facilities. Health physics contributions include evaluation of initial shielding requirements, proper selection of construction material, insuring that adequate safety devices are installed and adequate personnel dosimetry devices are available, surveying the facility, and assisting in the safety education program. There is a need to better define NDI warning/safety devices, using the National Bureau of Standards, (NBS) Handbook 107 as the most applicable guide

  11. Health workers' knowledge of and attitudes towards computer applications in rural African health facilities.

    Science.gov (United States)

    Sukums, Felix; Mensah, Nathan; Mpembeni, Rose; Kaltschmidt, Jens; Haefeli, Walter E; Blank, Antje

    2014-01-01

    The QUALMAT (Quality of Maternal and Prenatal Care: Bridging the Know-do Gap) project has introduced an electronic clinical decision support system (CDSS) for pre-natal and maternal care services in rural primary health facilities in Burkina Faso, Ghana, and Tanzania. To report an assessment of health providers' computer knowledge, experience, and attitudes prior to the implementation of the QUALMAT electronic CDSS. A cross-sectional study was conducted with providers in 24 QUALMAT project sites. Information was collected using structured questionnaires. Chi-squared tests and one-way ANOVA describe the association between computer knowledge, attitudes, and other factors. Semi-structured interviews and focus groups were conducted to gain further insights. A total of 108 providers responded, 63% were from Tanzania and 37% from Ghana. The mean age was 37.6 years, and 79% were female. Only 40% had ever used computers, and 29% had prior computer training. About 80% were computer illiterate or beginners. Educational level, age, and years of work experience were significantly associated with computer knowledge (pworkplace. Given the low levels of computer knowledge among rural health workers in Africa, it is important to provide adequate training and support to ensure the successful uptake of electronic CDSSs in these settings. The positive attitudes to computers found in this study underscore that also rural care providers are ready to use such technology.

  12. Public Health Risks from Mismanagement of Healthcare Wastes in Shinyanga Municipality Health Facilities, Tanzania

    Directory of Open Access Journals (Sweden)

    Kizito Kuchibanda

    2015-01-01

    Full Text Available The increase of healthcare facilities in Shinyanga municipality has resulted in an increase of healthcare wastes, which poses serious threats to the environment, health workers, and the general public. This research was conducted to investigate management practices of healthcare wastes in Shinyanga municipality with a view of assessing health risks to health workers and the general public. The study, which was carried out in three hospitals, involved the use of questionnaires, in-depth interview, and observation checklist. The results revealed that healthcare wastes are not quantified or segregated in all the three hospitals. Healthcare wastes at the Shinyanga Regional Referral Hospital are disposed of by on-site incineration and burning and some wastes are disposed off-site. At Kolandoto DDH only on-site burning and land disposal are practiced, while at Kambarage UHC healthcare solid wastes are incinerated, disposed of on land disposal, and burned. Waste management workers do not have formal training in waste management techniques and the hospital administrations pay very little attention to appropriate management of healthcare wastes. In light of this, it is evident that management of healthcare solid wastes is not practiced in accordance with the national and WHO’s recommended standards.

  13. Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

    Science.gov (United States)

    Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

    2017-12-01

    Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women's use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities' capacity to provide newborn care services in low and middle income countries. In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally-representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn-related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential

  14. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Directory of Open Access Journals (Sweden)

    Patrick G Ilboudo

    Full Text Available Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$ 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  15. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Science.gov (United States)

    Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

    2017-01-01

    Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  16. Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: A focus group study.

    Science.gov (United States)

    Traynor, Michael; Nissen, Nina; Lincoln, Carol; Buus, Niels

    2015-07-01

    In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Using classification tree modelling to investigate drug prescription practices at health facilities in rural Tanzania

    Directory of Open Access Journals (Sweden)

    Kajungu Dan K

    2012-09-01

    Full Text Available Abstract Background Drug prescription practices depend on several factors related to the patient, health worker and health facilities. A better understanding of the factors influencing prescription patterns is essential to develop strategies to mitigate the negative consequences associated with poor practices in both the public and private sectors. Methods A cross-sectional study was conducted in rural Tanzania among patients attending health facilities, and health workers. Patients, health workers and health facilities-related factors with the potential to influence drug prescription patterns were used to build a model of key predictors. Standard data mining methodology of classification tree analysis was used to define the importance of the different factors on prescription patterns. Results This analysis included 1,470 patients and 71 health workers practicing in 30 health facilities. Patients were mostly treated in dispensaries. Twenty two variables were used to construct two classification tree models: one for polypharmacy (prescription of ≥3 drugs on a single clinic visit and one for co-prescription of artemether-lumefantrine (AL with antibiotics. The most important predictor of polypharmacy was the diagnosis of several illnesses. Polypharmacy was also associated with little or no supervision of the health workers, administration of AL and private facilities. Co-prescription of AL with antibiotics was more frequent in children under five years of age and the other important predictors were transmission season, mode of diagnosis and the location of the health facility. Conclusion Standard data mining methodology is an easy-to-implement analytical approach that can be useful for decision-making. Polypharmacy is mainly due to the diagnosis of multiple illnesses.

  18. Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda

    Directory of Open Access Journals (Sweden)

    Joharifard Shahrzad

    2012-12-01

    Full Text Available Abstract Background The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249–584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Methods Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18–50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. Results Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839], possessing health insurance (OR = 3.812 [1.795 - 8.097], managing household finances (OR = 1.897 [1.046 - 3.439], attending more antenatal care visits (OR = 1.567 [1.163 - 2.112], delivering more recently (OR = 1.438 [1.120 - 1.847] annually, and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km were independently associated with facility delivery. Conclusions The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a

  19. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    DR Marwa

    north-western Tanzania. GIVENESS ... Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. .... Irrational use of drugs occurs in all countries and causes harm to people (El Mahalli 2012).

  20. factors influencing the choice of health care providing facility among

    African Journals Online (AJOL)

    In the public sector ... Objectives: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local ... the consumer of healthcare services cannot control. ..... Acquisition of Stable Food.

  1. 9. Staff competencies at health facilities implementing an outpatient ...

    African Journals Online (AJOL)

    Esem

    2006-09-26

    Sep 26, 2006 ... an Outpatient Therapeutic Programme for Severely ... ¹Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia. ²National Food and ...... professional practices of a three-day course on.

  2. Identifying Factors for Worker Motivation in Zambia's Rural Health Facilities.

    Science.gov (United States)

    Cross, Samuel S; Baernholdt, Dr Marianne

    2017-01-01

    Within Zambia there is a shortage of health workers in rural areas. This study aims to identify motivating factors for retaining rural health workers. Sixty rural health workers completed surveys and 46 were interviewed. They rated the importance of six motivating factors and discussed these and other factors in interviews. An interview was conducted with a Government Human Resources Manager (HR Manager) to elicit contextual information. All six factors were identified as being very important motivators, as were two additional factors. Additional career training was identified by many as the most important factor. Comparison of results and the HR Manager interview revealed that workers lacked knowledge about opportunities and that the HR manager was aware of barriers to career development. The Zambian government might better motivate and retain rural health workers by offering them any combination of identified factors, and by addressing the barriers to career development.

  3. From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya.

    Science.gov (United States)

    Tomedi, Angelo; Stroud, Sophia R; Maya, Tania Ruiz; Plaman, Christopher R; Mwanthi, Mutuku A

    2015-07-16

    To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0% in the control and intervention groups, respectively (p facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

  4. Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

    Science.gov (United States)

    Burger, Nicholas E; Kopf, Daniel; Spreng, Connor P; Yoong, Joanne; Sood, Neeraj

    2012-01-01

    Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business

  5. Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

    Directory of Open Access Journals (Sweden)

    Nicholas E Burger

    Full Text Available BACKGROUND: Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa, but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. METHODOLOGY/PRINCIPAL FINDINGS: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent. Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent, accounting (Ghana: 45 percent; Kenya: 27 percent, and inventory control (Ghana: 41 percent; Kenya: 24 percent. A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. CONCLUSIONS/SIGNIFICANCE: The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to

  6. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alam Khurshid

    2010-06-01

    Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

  7. The potential migration effect of rural hospital closures

    DEFF Research Database (Denmark)

    Sørensen, Jens Fyhn Lykke

    2008-01-01

    to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

  8. Laser programs facility management plan for environment, safety, and health

    International Nuclear Information System (INIS)

    Cruz, G.E.

    1996-01-01

    The Lawrence Livermore National Laboratory's (LLNL) Laser Programs ES ampersand H policy is established by the Associate Director for Laser Programs. This FMP is one component of that policy. Laser Programs personnel design, construct and operate research and development equipment located in various Livermore and Site 300 buildings. The Programs include a variety of activities, primarily laser research and development, inertial confinement fusion, isotope separation, and an increasing emphasis on materials processing, imaging systems, and signal analysis. This FMP is a formal statement of responsibilities and controls to assure operational activities are conducted without harm to employees, the general public, or the environment. This plan identifies the hazards associated with operating a large research and development facility and is a vehicle to control and mitigate those hazards. Hazards include, but are not limited to: laser beams, hazardous and radioactive materials, criticality, ionizing radiation or x rays, high-voltage electrical equipment, chemicals, and powered machinery

  9. Drug availability and health facility usage in a Bamako Initiative and ...

    African Journals Online (AJOL)

    Background: The availability of drugs on a continuous basis is paramount to the success of any health care system. The Bamako Initiative (BI) had provision of essential drugs as one of its key thrusts in order to improve the utilization of health facilities. This study compared the perceived availability of essential drugs and ...

  10. A study on the service radii and accessibility to health facilities in ...

    African Journals Online (AJOL)

    Government policies over the years has centered on the provision and delivery of healthcare to all. Spatial distribution of health facilities is subject to a number of social and commercial influences and healthcare needs of the population. The objective of this paper analyzed the service radii and accessibility of health ...

  11. 42 CFR 475.105 - Prohibition against contracting with health care facilities.

    Science.gov (United States)

    2010-10-01

    ... facilities. 475.105 Section 475.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Utilization and Quality Control Quality Improvement Organizations § 475.105 Prohibition against contracting...

  12. Pattern of Eclampsia in a Tertiary Health Facility Situated in a Semi ...

    African Journals Online (AJOL)

    ANNALS

    Annals of African Medicine. Vol. 6, No.4; 2007:164 – 167. Pattern of Eclampsia in a Tertiary Health Facility Situated in a Semi-Rural ... In Kano State (which is in the same zone as the place where this study was conducted), eclampsia .... eclampsia. RHL commentary. The WHO. Reproductive Health Library No 8. Update Soft.

  13. Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

    NARCIS (Netherlands)

    Vesel, Linda; Manu, Alexander; Lohela, Terhi J.; Gabrysch, Sabine; Okyere, Eunice; ten Asbroek, Augustinus H. A.; Hill, Zelee; Agyemang, Charlotte Tawiah; Owusu-Agyei, Seth; Kirkwood, Betty R.

    2013-01-01

    To assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in health facilities in rural Ghana, and to link this with demand for facility deliveries and admissions. Health facility assessment survey and population-based surveillance data. Seven districts in

  14. Tubular closure device

    International Nuclear Information System (INIS)

    Klahn, F.C.; Nolan, J.H.; Wills, C.

    1982-01-01

    This invention relates to a closure mechanism for closing openings such as the bore of a conduit and for releasably securing members within the bore. More particularly, this invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holders used in nuclear reactors

  15. Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

    Science.gov (United States)

    Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-01-01

    Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have

  16. Comparison of a Commonwealth-initiated regional radiation oncology facility in Toowoomba with a Queensland Health facility

    International Nuclear Information System (INIS)

    Poulsen, M.; Ramsay, R.; Gogna, K.; Middleton, M.; Martin, J.; Khoo, E.; Wong, W.; McQuitty, S.; Walpole, E.; Fairweather, R.

    2010-01-01

    The aim was to compare a private Commonwealth-initiated regional radiation oncology facility in Toowoomba with a Queensland Health facility (QHF) in Brisbane. The comparison concentrated on staffing, case mix and operational budgets, but was not able to look at changes in access to services. Data were collected from the two facilities from January 2008 to June 2008 inclusive. A number of factors were compared, including case mix, staffing levels, delay times for treatment, research, training and treatment costs. The case mix between the two areas was similar with curative treatments making up just over half the work load in both centres and two-thirds the work being made up of cancers of breast and prostate. Staffing levels were leaner in Toowoomba, especially in the areas of nursing, administration and trial coordinators. Research activity was slightly higher in Toowoomba. The average medicare cost per treatment course was similar in both centres ($5000 per course). Total costs of an average treatment including patient, State and Commonwealth costs, showed a 30% difference in costing favouring Toowoomba. This regional radiation oncology centre has provided state-of-the-art cancer care that is close to home for patients living in the Darling Downs region. Both public and private patients have been treated with modest costs to the patient and significant savings to QH. The case mix is similar to the QHF, and there has been significant activity in clinical research. A paperless working environment is one factor that has allowed staffing levels to be reduced. Ongoing support from Governments are required if private facilities are to participate in important ongoing staff training.

  17. 200 West Ash Pit Demolition Site closure plan

    International Nuclear Information System (INIS)

    1992-11-01

    The Hanford Facility is owned by the US Government and operated by the US Department of Energy, Richland Field Office. Dangerous waste and mixed waste (containing both radioactive and dangerous components) are managed and produced on the Hanford Facility. Westinghouse Hanford Company is a major contractor to the US Department of Energy, Richland Field Office and serves as cooperator of the 200 West Ash Pit Demolition Site, the unit addressed in this closure plan. The 200 West Ash Pit Demolition Site Closure Plan consists of a Part A Permit Application (Revision 3) and a closure plan. An explanation of the Part A Permit Application revision is provided at the beginning of the Part A section. The closure plan consists of nine chapters and three appendices. This 200 West Ash Pit Demolition Site Closure Plan submittal contains information current as of October 15, 1992

  18. Leadership of public health facilities in different climes | Nigerian ...

    African Journals Online (AJOL)

    In view of perceived marginalization of allied health professionals (AHPs) by the medical doctors, there are agitations by them for appointment to the position of the Medical Directors of hospitals. There are however unanswered questions. This article appraises the current situation and compares what is being done in ...

  19. Regulatory role and approach of BARC Safety Council in safety and occupational health in BARC facilities

    International Nuclear Information System (INIS)

    Rajdeep; Jayarajan, K.; Taly, Y.K.

    2016-01-01

    Bhabha Atomic Research Centre is involved in multidisciplinary research and developmental activities, related to peaceful use of nuclear energy and its societal benefits. In order to achieve high level of performance of these facilities, the best efforts are made to maintain good health of the plant personnel and good working conditions. BARC Safety Council (BSC), which is the regulatory body for BARC facilities, regulates radiation safety, industrial safety and surveillance of occupational health, by implementing various rules and guidelines in BARC facilities. BARC Safety framework consists of various committees in a 3-tier system. The first tier is BSC, which is the apex body authorized for issuing directives, permissions, consents and authorizations. It is having responsibility of ensuring protection and safety of public, environment, personnel and facilities of BARC through enforcement of radiation protection and industrial safety programmes. Besides the 18 committees in 2"n"d tier, there are 6 other expert committees which assist in functioning of BSC. (author)

  20. Perception and prevalence of work-related health hazards among health care workers in public health facilities in southern India.

    Science.gov (United States)

    Senthil, Arasi; Anandh, Balasubramanian; Jayachandran, Palsamy; Thangavel, Gurusamy; Josephin, Diana; Yamini, Ravindran; Kalpana, Balakrishnan

    2015-01-01

    Health care workers (HCWs) are exposed to occupational related health hazards. Measuring worker perception and the prevalence of these hazards can help facilitate better risk management for HCWs, as these workers are envisaged to be the first point of contact, especially in resource poor settings. To describe the perception of occupational health hazards and self-reported exposure prevalence among HCWs in Southern India. We used cross sectional design with stratified random sampling of HCWs from different levels of health facilities and categories in a randomly selected district in Southern India. Data on perception and exposure prevalence were collected using a structured interview schedule developed by occupational health experts and administered by trained investigators. A total of 482 HCWs participated. Thirty nine percent did not recognize work-related health hazards, but reported exposure to at least one hazard upon further probing. Among the 81·5% who reported exposure to biological hazard, 93·9% had direct skin contact with infectious materials. Among HCWs reporting needle stick injury, 70·5% had at least one in the previous three months. Ergonomic hazards included lifting heavy objects (42%) and standing for long hours (37%). Psychological hazards included negative feelings (20·3%) and verbal or physical abuse during work (20·5%). More than a third of HCWs failed to recognize work-related health hazards. Despite training in handling infectious materials, HCWs reported direct skin contact with infectious materials and needle stick injuries. RESULTS indicate the need for training oriented toward behavioral change and provision of occupational health services.

  1. Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

    Science.gov (United States)

    Thwala, Siphiwe Bridget Pearl; Blaauw, Duane; Ssengooba, Freddie

    2018-01-01

    Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (pfacilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

  2. Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study.

    Science.gov (United States)

    Brooks, Mohamad I; Thabrany, Hasbullah; Fox, Matthew P; Wirtz, Veronika J; Feeley, Frank G; Sabin, Lora L

    2017-02-02

    The growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia's strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia's aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization. We used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers. In 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03-1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01-1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents' village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation. Poor women with

  3. Facility Design and Health Management Program at the Sinnhuber Aquatic Research Laboratory.

    Science.gov (United States)

    Barton, Carrie L; Johnson, Eric W; Tanguay, Robert L

    2016-07-01

    The number of researchers and institutions moving to the utilization of zebrafish for biomedical research continues to increase because of the recognized advantages of this model. Numerous factors should be considered before building a new or retooling an existing facility. Design decisions will directly impact the management and maintenance costs. We and others have advocated for more rigorous approaches to zebrafish health management to support and protect an increasingly diverse portfolio of important research. The Sinnhuber Aquatic Research Laboratory (SARL) is located ∼3 miles from the main Oregon State University campus in Corvallis, Oregon. This facility supports several research programs that depend heavily on the use of adult, larval, and embryonic zebrafish. The new zebrafish facility of the SARL began operation in 2007 with a commitment to build and manage an efficient facility that diligently protects human and fish health. An important goal was to ensure that the facility was free of Pseudoloma neurophilia (Microsporidia), which is very common in zebrafish research facilities. We recognize that there are certain limitations in space, resources, and financial support that are institution dependent, but in this article, we describe the steps taken to build and manage an efficient specific pathogen-free facility.

  4. Health physics and quality control management of a cyclotron-based PET facility

    International Nuclear Information System (INIS)

    Jerabek, P.A.

    1995-01-01

    This paper provides an overview of the operation and management of a Positron Emission Tomography (PET) facility at the University of Texas. The facility components are discussed from an operations perspective with an emphasis on devices, and on practices and procedures which are implemented to ensure that personnel exposures are as low as reasonably achievable. The cyclotron-based PET facility uses in-house production of PET radioisotopes for preparation of radiopharmaceuticals. A combination of specially designed cyclotron equipped devices, radiopharmaceutical preparation devices, and shielded devices along with health physics practices have helped to make PET operations become routine

  5. Factors influencing women's preference for health facility deliveries in Jharkhand state, India: a cross sectional analysis.

    Science.gov (United States)

    Bhattacharyya, Sanghita; Srivastava, Aradhana; Roy, Reetabrata; Avan, Bilal I

    2016-03-07

    Expanding institutional deliveries is a policy priority to achieve MDG5. India adopted a policy to encourage facility births through a conditional cash incentive scheme, yet 28% of deliveries still occur at home. In this context, it is important to understand the care experience of women who have delivered at home, and also at health facilities, analyzing any differences, so that services can be improved to promote facility births. This study aims to understand women's experience of delivery care during home and facility births, and the factors that influence women's decisions regarding their next place of delivery. A community-based cross-sectional survey was undertaken in a district of Jharkhand state in India. Interviews with 500 recently delivered women (210 delivered at facility and 290 delivered at home) included socio-demographic characteristics, experience of their recent delivery, and preference of future delivery site. Data analysis included frequencies, binary and multiple logistic regressions. There is no major difference in the experience of care between home and facility births, the only difference in care being with regard to pain relief through massage, injection and low cost of delivery for those having home births. 75% women wanted to deliver their next child at a facility, main reasons being availability of medicine (29.4%) and perceived health benefits for mother and baby (15%). Women with higher education (AOR = 1.67, 95% CI = 1.04-3.07), women who were above 25 years (AOR = 2.14, 95% CI = 1.26-3.64), who currently delivered at facility (AOR = 5.19, 95% CI = 2.97-9.08) and had health problem post-delivery (AOR = 1.85, 95% CI = 1.08-3.19) were significant predictors of future facility-based delivery. The predictors for facility deliveries include, availability of medicines and supplies, potential health benefits for the mother and newborn and the perception of good care from the providers. There is a growing

  6. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

  7. Medical equipment in government health facilities: Missed opportunities

    OpenAIRE

    Pardeshi Geeta

    2005-01-01

    BACKGROUND: The availability and optimal utilization of medical equipment is important for improving the quality of health services. Significant investments are made for the purchase, maintenance and repair of medical equipment. Inadequate management of these equipment will result in financial losses and deprive the public of the intended benefits. This analysis is based on the conceptual framework drawn from the WHO recommended- lifecycle of medical equipment. AIMS: (1) To identify the probl...

  8. Criticality assessment of LLRWDF closure

    International Nuclear Information System (INIS)

    Sarrack, A.G.; Weber, J.H.; Woody, N.D.

    1992-01-01

    During the operation of the Low Level Radioactive Waste Disposal Facility (LLRWDF), large amounts (greater than 100 kg) of enriched uranium (EU) were buried. This EU came primarily from the closing and decontamination of the Naval Fuels Facility in the time period from 1987--1989. Waste Management Operations (WMO) procedures were used to keep the EU boxes separated to prevent possible criticality during normal operation. Closure of the LLRWDF is currently being planned, and waste stabilization by Dynamic Compaction (DC) is proposed. Dynamic compaction will crush the containers in the LLRWDF and result in changes in their geometry. Research of the LLRWDF operations and record keeping practices have shown that the EU contents of trenches are known, but details of the arrangement of the contents cannot be proven. Reviews of the trench contents, combined with analysis of potential critical configurations, revealed that some portions of the LLRWDF can be expected to be free of criticality concerns while other sections have credible probabilities for the assembly of a critical mass, even in the uncompacted configuration. This will have an impact on the closure options and which trenches can be compacted

  9. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

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

    Directory of Open Access Journals (Sweden)

    Gertrude Namazzi

    2015-03-01

    Full Text Available 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

  11. Implementing RCRA during facility deactivation

    International Nuclear Information System (INIS)

    Lebaron, G.J.

    1997-01-01

    RCRA regulations require closure of permitted treatment, storage and disposal (TSD) facilities within 180 days after cessation of operations, and this may essentially necessitate decommissioning to complete closure. A more cost effective way to handle the facility would be to significantly reduce the risk to human health and the environment by taking it from its operational status to a passive, safe, inexpensive-to-maintain surveillance and maintenance condition (deactivation) prior to decommissioning. This paper presents an innovative approach to the cost effective deactivation of a large, complex chemical processing facility permitted under RCRA. The approach takes into account risks to the environment posed by this facility in comparison to risks posed by neighboring facilities at the site. The paper addresses the manner in which: 1) stakeholders and regulators were involved; 2) identifies a process by which the project proceeds and regulators and stakeholders were involved; 3) end points were developed so completion of deactivation was clearly identified at the beginning of the project, and 4) innovative practices were used to deactivate more quickly and cost effectively

  12. Assisted Living Facilities - CARE_LONG_TERM_FACILITIES_ISDH_IN: Residential Care Facilities, Nursing Homes, and Hospices in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

    Data.gov (United States)

    NSGIC State | GIS Inventory — CARE_LONG_TERM_FACILITIES_ISDH_IN is a point shapefile showing the locations of 86 residential care facilities, 525 long-term care facilities (nursing homes), and 81...

  13. Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia

    DEFF Research Database (Denmark)

    Phiri, Selia Ng'anjo; Kiserud, Torvid; Kvåle, Gunnar

    2014-01-01

    of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban-rural residence. RESULTS: There were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth......BACKGROUND: Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban...... areas of three districts in Kenya, Tanzania and Zambia. METHODS: A population-based survey was conducted in 2007 as part of the 'REsponse to ACcountable priority setting for Trust in health systems' (REACT) project. Stratified random cluster sampling was used and the data included information on place...

  14. Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities

    Science.gov (United States)

    Aliabadi, Amir A.; Rogak, Steven N.; Bartlett, Karen H.; Green, Sheldon I.

    2011-01-01

    Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk. PMID:22162813

  15. Process Evaluation of Communitisation Programme in Public Sector Health Facilities, Mokokchung District, Nagaland, 2015.

    Science.gov (United States)

    Tushi, Aonungdok; Kaur, Prabhdeep

    2017-01-01

    Public sector health facilities were poorly managed due to a history of conflict in Nagaland, India. Government of Nagaland introduced "Nagaland Communitisation of Public Institutions and Services Act" in 2002. Main objectives of the evaluation were to review the functioning of Health Center Managing Committees (HCMCs), deliver health services in the institutions managed by HCMC, identify strengths as well as challenges perceived by HCMC members in the rural areas of Mokokchung district, Nagaland. The evaluation was made using input, process and output indicators. A doctor, the HCMC Chairman and one member from each of the three community health centers (CHC) and four primary health centers (PHC) were surveyed using a semi-structured questionnaire and an in-depth interview guide. Proportions for quantitative data were computed and key themes from the same were identified. Overall; the infrastructure, equipment and outpatient/inpatient service availability was satisfactory. There was a lack of funds and shortage of doctors, drugs as well as laboratory facilities. HCMCs were in place and carried out administrative activities. HCMCs felt ownership, mobilized community contributions and managed human resources. HCMC members had inadequate funds for their transport and training. They faced challenges in service delivery due to political interference and lack of adequate human, material, financial resources. Communitisation program was operational in the district. HCMC members felt the ownership of health facilities. Administrative, political support and adequate funds from the government are needed for effective functioning of HCMCs and optimal service delivery in public sector facilities.

  16. Referral of children seeking care at private health facilities in Uganda.

    Science.gov (United States)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

    2017-02-14

    In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.

  17. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS)

    DEFF Research Database (Denmark)

    Weiser, Prisca; Becker, Thomas; Losert, Carolin

    2009-01-01

    of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities.Meanwhile a multi-disciplinary network...... by promoting behaviour-based and/or environment-based interventions. METHODS AND DESIGN: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet...... consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well...

  18. Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

    Science.gov (United States)

    Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

    2014-11-01

    Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

  19. Eyelid closure at death

    Directory of Open Access Journals (Sweden)

    A D Macleod

    2009-01-01

    Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

  20. Structural Health Monitoring of Nuclear Spent Fuel Storage Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Lingyu

    2018-04-10

    Interim storage of spent nuclear fuel from reactor sites has gained additional importance and urgency for resolving waste-management-related technical issues. To ensure that nuclear power remains clean energy, monitoring has been identified by DOE as a high priority cross-cutting need, necessary to determine and predict the degradation state of the systems, structures, and components (SSCs) important to safety (ITS). Therefore, nondestructive structural condition monitoring becomes a need to be installed on existing or to be integrated into future storage system to quantify the state of health or to guarantee the safe operation of nuclear power plants (NPPs) during their extended life span. In this project, the lead university and the collaborating national laboratory teamed to develop a nuclear structural health monitoring (n-SHM) system based on in-situ piezoelectric sensing technologies that can monitor structural degradation and aging for nuclear spent fuel DCSS and similar structures. We also aimed to identify and quantify possible influences of nuclear spent fuel environment (temperature and radiation) to the piezoelectric sensor system and come up with adequate solutions and guidelines therefore. We have therefore developed analytical model for piezoelectric based n-SHM methods, with considerations of temperature and irradiation influence on the model of sensing and algorithms in acoustic emission (AE), guided ultrasonic waves (GUW), and electromechanical impedance spectroscopy (EMIS). On the other side, experimentally the temperature and irradiation influence on the piezoelectric sensors and sensing capabilities were investigated. Both short-term and long-term irradiation investigation with our collaborating national laboratory were performed. Moreover, we developed multi-modal sensing, validated in laboratory setup, and conducted the testing on the We performed multi-modal sensing development, verification and validation tests on very complex structures

  1. Cervical cancer screening through human papillomavirus testing in community health campaigns versus health facilities in rural western Kenya.

    Science.gov (United States)

    Huchko, Megan J; Ibrahim, Saduma; Blat, Cinthia; Cohen, Craig R; Smith, Jennifer S; Hiatt, Robert A; Bukusi, Elizabeth

    2018-04-01

    To determine the effectiveness of community health campaigns (CHCs) as a strategy for human papillomavirus (HPV)-based cervical cancer screening in rural western Kenya. Between January and November 2016, a cluster-randomized trial was carried out in 12 communities in western Kenya to investigate high-risk HPV testing offered via self-collection to women aged 25-65 years in CHCs versus government health facilities. Outcome measures were the total number of women accessing cervical cancer screening and the proportion of HPV-positive women accessing treatment. In total, 4944 women underwent HPV-based cervical cancer screening in CHCs (n=2898) or health facilities (n=2046). Screening uptake as a proportion of total eligible women in the population was greater in communities assigned to CHCs (60.0% vs 37.0%, P<0.001). Rates of treatment acquisition were low in both arms (CHCs 39.2%; health facilities 31.5%; P=0.408). Cervical cancer screening using HPV testing of self-collected samples reached a larger proportion of women when offered through periodic CHCs compared with health facilities. The community-based model is a promising strategy for cervical cancer prevention. Lessons learned from this trial can be used to identify ways of maximizing the impact of such strategies through greater community participation and improved linkage to treatment. ClinicalTrials.gov registration: NCT02124252. © 2017 International Federation of Gynecology and Obstetrics.

  2. Evaluating malaria case management at public health facilities in two provinces in Angola.

    Science.gov (United States)

    Plucinski, Mateusz M; Ferreira, Manzambi; Ferreira, Carolina Miguel; Burns, Jordan; Gaparayi, Patrick; João, Lubaki; da Costa, Olinda; Gill, Parambir; Samutondo, Claudete; Quivinja, Joltim; Mbounga, Eliane; de León, Gabriel Ponce; Halsey, Eric S; Dimbu, Pedro Rafael; Fortes, Filomeno

    2017-05-03

    Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in

  3. Recreational facilities: a guide to recreational facilities in the East Coast Area Health Board

    LENUS (Irish Health Repository)

    2012-02-01

    OBJECTIVE: To determine whether persons with generalized joint hypermobility have an increased risk of lower limb joint injury during sport. DATA SOURCES: PubMed, CINAHL, EMBASE, and SportDiscus were searched through February 2009, without language restrictions, using terms related to risk; hip, ankle, and knee injuries; and joint instability. Reference lists of included studies and relevant reviews were searched by hand. STUDY SELECTION: Selection criteria were peer-reviewed studies with a prospective design that used an objective scale to measure generalized joint hypermobility; the participants were engaged in sport activity, and the injury data were quantitative and based on diagnosis by a health professional, were self-reported, or resulted in time lost to athletic participation. The studies were screened by 1 researcher and checked by a second. Study methods were independently assessed by 2 investigators using the 6-point scale for prognostic studies developed by Pengel. Disagreements were resolved through discussion. Of 4841 studies identified, 18 met inclusion criteria. Of these, 8 were included in random-effects meta-analyses. DATA EXTRACTION: The data extracted by 2 reviewers included participant and sport characteristics and details of joint hypermobility and injury measurements. More detailed data for 4 investigations were obtained from the study authors. Where possible, hypermobility was defined as >\\/=4 of 9 points on the British Society of Rheumatology Scale (BSRS). MAIN RESULTS: Lower limb joint injuries (3 studies, 1047 participants) occurred in 14% of participants. Using the BSRS of joint hypermobility, any lower limb injury was not associated with hypermobility [odds ratio (OR), 1.43; 95% confidence interval (CI), 0.56-3.67]. Using the original authors\\' definitions, hypermobility was associated with risk of knee joint injuries (OR, 2.62; 95% CI, 1.04-6.58) in 5 studies. In 4 studies in which the BSRS could be used (1167 participants; incidence

  4. Hanford Patrol Academy demolition sites closure plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-30

    The Hanford Site is owned by the U.S. Government and operated by the U.S. Department of Energy, Richland Operations Office. Westinghouse Hanford Company is a major contractor to the U.S. Department of Energy, Richland Operations Office and serves as co-operator of the Hanford Patrol Academy Demolition Sites, the unit addressed in this paper. This document consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3 (Revision 4), and a closure plan for the site. An explanation of the Part A Form 3 submitted with this closure plan is provided at the beginning of the Part A section. This Hanford Patrol Academy Demolition Sites Closure Plan submittal contains information current as of December 15, 1994.

  5. The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Tura Gurmesa

    2013-01-01

    Full Text Available Abstract Background Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality. Methods The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. Results A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87 for health facility delivery as compared to home delivery. Conclusion Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are

  6. Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya.

    Science.gov (United States)

    Karanja, Sarah; Gichuki, Richard; Igunza, Patrick; Muhula, Samuel; Ofware, Peter; Lesiamon, Josephine; Leshore, Lepantas; Kyomuhangi-Igbodipe, Lenny Bazira; Nyagero, Josephat; Binkin, Nancy; Ojakaa, David

    2018-01-03

    In response to poor maternal, newborn, and child health indicators in Magadi sub-county, the "Boma" model was launched to promote health facility delivery by establishing community health units and training community health volunteers (CHVs) and traditional birth attendants (TBAs) as safe motherhood promoters. As a result, health facility delivery increased from 14% to 24%, still considerably below the national average (61%). We therefore conducted this study to determine factors influencing health facility delivery and describe barriers and motivators to the same. A mixed methods cross-sectional study involving a survey with 200 women who had delivered in the last 24 months, 3 focus group discussions with health providers, chiefs and CHVs and 26 in-depth interviews with mothers, key decision influencers and TBAs. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) using logistic regression were calculated to identify predictive factors for health facility delivery. Thematic analysis was done to describe barriers and motivators to the same. Of the women interviewed, 39% delivered at the health facility. Factors positively associated with health facility deliveries included belonging to the highest wealth quintiles [aOR 4.9 (95%CI 1.5-16.5)], currently not married [aOR 2.4 (95%CI 1.1-5.4)] and living near the health facility [aOR 2.2 (95%CI 1.1 = 4.4)]. High parity [aOR 0.7 (95%CI 0.5-0.9)] was negatively associated with health facility delivery. Barriers to health facility delivery included women not being final decision makers on place of birth, lack of a birth plan, gender of health provider, unfamiliar birthing position, disrespect and/or abuse, distance, attitude of health providers and lack of essential drugs and supplies. Motivators included proximity to health facility, mother's health condition, integration of TBAs into the health system, and health education/advice received. Belonging to the highest wealth quintile, currently not married and

  7. Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

    Science.gov (United States)

    Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue

    2018-02-06

    Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78

  8. Medical equipment in government health facilities: missed opportunities.

    Science.gov (United States)

    Pardeshi, Geeta S

    2005-01-01

    The availability and optimal utilization of medical equipment is important for improving the quality of health services. Significant investments are made for the purchase, maintenance and repair of medical equipment. Inadequate management of these equipment will result in financial losses and deprive the public of the intended benefits. This analysis is based on the conceptual framework drawn from the WHO recommended- lifecycle of medical equipment. (1) To identify the problems in different stages of the life cycle. (2) To assess its financial implications and effect on service delivery. Analysis of secondary data from the latest Comptroller and Auditor General (CAG) Reports for the states in India. The study variables were category of equipment, financial implications and problems in the stages of life cycle. Calculation of proportions. A total of forty instances mentioning problems in the first phase of the life cycle of medical equipment were noted in 12 state reports. The equipment from the radiology department (15), equipment in the wards (5), laboratory (3) and operation theatres (4) were the ones most frequently implicated. In a majority of cases the financial implications amounted to twenty-five lakhs. The financial implications were in the form of extra expenditure, unfruitful expenditure or locking of funds. In 25 cases the equipment could not be put to use because of non-availability of trained staff and inadequate infrastructural support. Careful procurement, incoming inspection, successful installation and synchronization of qualified trained staff and infrastructural support will ensure timely onset of use of the equipment.

  9. Family planning and reproductive health supply stockouts: problems and remedies for faith-based health facilities in Africa

    Directory of Open Access Journals (Sweden)

    Amy M. Metzger

    2017-01-01

    Full Text Available Background and aims: Faith-based organizations (FBOs provide a substantial portion of the health care services in many African countries. FBO facilities do consider family planning and reproductive health services as essential to reducing maternal and child mortality, and to the growth of healthy families. Many health facilities, however, struggle to maintain adequate stocks of reproductive health (RH supplies because of the various RH supply chains and funding sources, which often operate separately from other medicines and supplies. The purpose of this study is to identify the types of supply chain systems used by African faith-based health facilities to acquire reproductive health products (clotrimazole, combined oral contraceptive pills, contraceptive implants, CycleBeads®, emergency contraception, Erythromycin, female condoms, injectable contraceptives, intra-uterine contraceptive devices, magnesium sulfate, male condoms, Methyldopa, Misoprostol, Nifedpine, Oxytocin, and Progestin-only pills, to describe their problems and challenges, and to identify possible corrective actions. Methods: Through email surveys, phone interviews, and on-site visits, we studied the supply chains of 46 faith-based health facilities in 13 African countries. Sixteen RH commodities, including contraceptives, were selected as indicators. Results: Of the 46 facilities surveyed, 55 percent faced stockouts of one or more products in the three months prior to the survey. Stockouts were less common for contraceptives than for other RH products. Significant strengths of the FBO supply chain included creativity in finding other sources of commodities in the face of stockouts, staff designated to monitor quality of the commodities, high capacity for storage, low incidence of expired products, few instances of poor quality, and strong financial sustainability mechanisms, often including patient fees. Weaknesses included unreliable commodity sources and power supplies, long

  10. Gender equality and childbirth in a health facility: Nigeria and MDG5.

    Science.gov (United States)

    Singh, Kavita; Bloom, Shelah; Haney, Erica; Olorunsaiye, Comfort; Brodish, Paul

    2012-09-01

    This paper examined how addressing gender equality can lead to reductions in maternal mortality in Nigeria through an increased use of facility delivery. Because the majority of maternal complications cannot be predicted and often arise suddenly during labor, delivery and the immediate postpartum period, childbirth in a health facility is key to reducing maternal mortality. This paper used data from the 2008 Nigeria Demographic and Health Survey (DHS) to examine associations of gender measures on the utilization of facility delivery after controlling for socio-demographic factors. Four gender equality measures were studied: household decision-making, financial decision-making, attitudes towards wife beating, and attitudes regarding a wife's ability to refuse sex. Results found older, more educated, wealthier, urban, and working women were more likely to have a facility delivery than their counterparts. In addition ethnicity was a significant variable indicating the importance of cultural and regional diversity. Notably, after controlling for the socioeconomic variables, two of the gender equality variables were significant: household decision-making and attitudes regarding a wife's ability to refuse sex. In resource-poor settings such as Nigeria, women with more decision-making autonomy are likely better able to advocate for and access a health facility for childbirth. Thus programs and policies that focus on gender in addition to focusing on education and poverty have the potential to reduce maternal mortality even further.

  11. CLOSURE OF A DIOXIN INCINERATION FACILITY

    Science.gov (United States)

    The U.S. Environmental Protection Agency Mobile Incineration System, whihc was operated at the Denney Farm site in southwestern Miissouri between October 1985 and June 1989, treated almost six million kilograms of dioxin-contaminated wastes from eight area sites. At the conclusi...

  12. Scope and closures

    CERN Document Server

    Simpson, Kyle

    2014-01-01

    No matter how much experience you have with JavaScript, odds are you don’t fully understand the language. This concise yet in-depth guide takes you inside scope and closures, two core concepts you need to know to become a more efficient and effective JavaScript programmer. You’ll learn how and why they work, and how an understanding of closures can be a powerful part of your development skillset.

  13. Environmental Assessment for the Health Protection Instrument Calibration Facility at the Savannah River Site

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    The purpose of this Environmental Assessment (EA) is to review the possible environmental consequences associated with the construction and operation of a Health Protection Instrument Calibration Facility on the Savannah River Site (SRS). The proposed replacement calibration facility would be located in B Area of SRS and would replace an inadequate existing facility currently located within A Area of SRS (Building 736-A). The new facility would provide laboratories, offices, test equipment and the support space necessary for the SRS Radiation Monitoring Instrument Calibration Program to comply with DOE Orders 5480.4 (Environmental Protection, Safety and Health Protection Standards) and 5480.11 (Radiation Protection for Occupational Workers). The proposed facility would serve as the central site source for the evaluation, selection, inspection, testing, calibration, and maintenance of all SRS radiation monitoring instrumentation. The proposed facility would be constructed on a currently undeveloped portion in B Area of SRS. The exact plot associated with the proposed action is a 1.2 hectare (3 acre) tract of land located on the west side of SRS Road No. 2. The proposed facility would lie approximately 4.4 km (2.75 mi) from the nearest SRS site boundary. The proposed facility would also lie within the confines of the existing B Area, and SRS safeguards and security systems. Archaeological, ecological, and land use reviews have been conducted in connection with the use of this proposed plot of land, and a detailed discussion of these reviews is contained herein. Socioeconomic, operational, and accident analyses were also examined in relation to the proposed project and the findings from these reviews are also contained in this EA.

  14. Environmental Assessment for the Health Protection Instrument Calibration Facility at the Savannah River Site

    International Nuclear Information System (INIS)

    1993-08-01

    The purpose of this Environmental Assessment (EA) is to review the possible environmental consequences associated with the construction and operation of a Health Protection Instrument Calibration Facility on the Savannah River Site (SRS). The proposed replacement calibration facility would be located in B Area of SRS and would replace an inadequate existing facility currently located within A Area of SRS (Building 736-A). The new facility would provide laboratories, offices, test equipment and the support space necessary for the SRS Radiation Monitoring Instrument Calibration Program to comply with DOE Orders 5480.4 (Environmental Protection, Safety and Health Protection Standards) and 5480.11 (Radiation Protection for Occupational Workers). The proposed facility would serve as the central site source for the evaluation, selection, inspection, testing, calibration, and maintenance of all SRS radiation monitoring instrumentation. The proposed facility would be constructed on a currently undeveloped portion in B Area of SRS. The exact plot associated with the proposed action is a 1.2 hectare (3 acre) tract of land located on the west side of SRS Road No. 2. The proposed facility would lie approximately 4.4 km (2.75 mi) from the nearest SRS site boundary. The proposed facility would also lie within the confines of the existing B Area, and SRS safeguards and security systems. Archaeological, ecological, and land use reviews have been conducted in connection with the use of this proposed plot of land, and a detailed discussion of these reviews is contained herein. Socioeconomic, operational, and accident analyses were also examined in relation to the proposed project and the findings from these reviews are also contained in this EA

  15. Review of attacks on health care facilities in six conflicts of the past three decades.

    Science.gov (United States)

    Briody, Carolyn; Rubenstein, Leonard; Roberts, Les; Penney, Eamon; Keenan, William; Horbar, Jeffrey

    2018-01-01

    In the ongoing conflicts of Syria and Yemen, there have been widespread reports of attacks on health care facilities and personnel. Tabulated evidence does suggest hospital bombings in Syria and Yemen are far higher than reported in other conflicts but it is unclear if this is a reporting artefact. This article examines attacks on health care facilities in conflicts in six middle- to high- income countries that have occurred over the past three decades to try and determine if attacks have become more common, and to assess the different methods used to collect data on attacks. The six conflicts reviewed are Yemen (2015-Present), Syria (2011- Present), Iraq (2003-2011), Chechnya (1999-2000), Kosovo (1998-1999), and Bosnia and Herzegovina (1992-1995). We attempted to get the highest quality source(s) with summary data of the number of facilities attacked for each of the conflicts. The only conflict that did not have summary data was the conflict in Iraq. In this case, we tallied individual reported events of attacks on health care. Physicians for Human Rights (PHR) reported attacks on 315 facilities (4.38 per month) in Syria over a 7-year period, while the Monitoring Violence against Health Care (MVH) tool launched later by the World Health Organization (WHO) Turkey Health Cluster reported attacks on 135 facilities (9.64 per month) over a 14-month period. Yemen had a reported 93 attacks (4.65 per month), Iraq 12 (0.12 per month), Chechnya > 24 (2.4 per month), Kosovo > 100 (6.67 per month), and Bosnia 21 (0.41 per month). Methodologies to collect data, and definitions of both facilities and attacks varied widely across sources. The number of reported facilities attacked is by far the greatest in Syria, suggesting that this phenomenon has increased compared to earlier conflicts. However, data on attacks of facilities was incomplete for all of the conflicts examined, methodologies varied widely, and in some cases, attacks were not defined at all. A global

  16. Repository Safety Strategy: Strategy for Protecting Public Health and Safety after Closure of a Yucca Mountain Repository, Rev. 1

    Energy Technology Data Exchange (ETDEWEB)

    DOE

    1998-01-01

    The updated Strategy to Protect Public Health and Safety explains the roles that the natural and engineered systems are expected to play in achieving the objectives of a potential repository system at Yucca Mountain. These objectives are to contain the radionuclides within the waste packages for thousands of years, and to ensure that annual doses to a person living near the site will be acceptably low. This strategy maintains the key assumption of the Site Characterization Plan (DOE 1988) strategy that the potential repository level (horizon) will remain unsaturated. Thus, the strategy continues to rely on the natural attributes of the unsaturated zone for primary protection by providing a setting where waste packages assisted by other engineered barriers are expected to contain wastes for thousands of years. As in the Site Characterization Plan (DOE 1988) strategy, the natural system from the walls of the underground openings (drifts) to the human environment is expected to provide additional defense by reducing the concentrations of any radionuclides released from the waste packages. The updated Strategy to Protect Public Health and Safety is the framework for the integration of site information, repository design and assessment of postclosure performance to develop a safety case for the viability assessment and a subsequent license application. Current site information and a reference design are used to develop a quantitative assessment of performance to be compared with a performance measure. Four key attributes of an unsaturated repository system that are critical to meeting the objectives: (1) Limited water contacting the waste packages; (2) Long waste package lifetime; (3) Slow rate of release of radionuclides from the waste form; and (4) Concentration reduction during transport through engineered and natural barriers.

  17. Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

    OpenAIRE

    Steven F. Koch; Jeffrey S. Racine

    2013-01-01

    We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relat...

  18. [3D printing in health care facilities: What legislation in France?].

    Science.gov (United States)

    Montmartin, M; Meyer, C; Euvrard, E; Pazart, L; Weber, E; Benassarou, M

    2015-11-01

    Health care facilities more and more use 3D printing, including making their own medical devices (MDs). However, production and marketing of MDs are regulated. The goal of our work was to clarify what is the current French regulation that should be applied concerning the production of custom-made MDs produced by 3D printing in a health care facility. MDs consist of all devices used for diagnosis, prevention, or treatment of diseases in patients. Prototypes and anatomic models are not considered as MDs and no specific laws apply to them. Cutting guides, splints, osteosynthesis plates or prosthesis are MDs. In order to become a MD manufacturer in France, a health care facility has to follow the requirements of the 93/42/CEE directive. In addition, custom-made 3D-printed MDs must follow the annex VIII of the directive. This needs the writing of a declaration of conformity and the respect of the essential requirements (proving that a MD is secure and conform to what is expected), the procedure has to be qualified, a risk analysis and a control of the biocompatibility of the material have to be fulfilled. The documents proving that these rules have been respected have to be available. Becoming a regulatory manufacturer of MD in France is possible for a health care facility but the specifications have to be respected. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Comparison of patient referral processes between rural and urban health facilities in Liberia

    Directory of Open Access Journals (Sweden)

    J. Kim*

    2013-12-01

    Conclusions: Patient referral systems in Liberia are relatively unsystematic. While formal and informal mechanisms for referrals exist at both rural and urban health facilities, establishing guidelines for referral care practices and transportation strategies tailored to each of these settings will help to strengthen the healthcare system as a whole.

  20. How to Investigate Drug Use in Health Facilities. Selected Drug Use ...

    African Journals Online (AJOL)

    This short WHO manual outlines methods for evaluating drug use indicators in health facilities. The broad areas of ... Washington: American Psychiatric Press, Inc. 1991. ISBN 0-88048-114-5. This book is ... discussion of different symptom categories using the DSM. (Diagnostic Statistical Manual) as a base. The definition of.

  1. Developing a user-perception assessment tool for health facilities in South Africa

    CSIR Research Space (South Africa)

    Saidi, M

    2007-06-01

    Full Text Available . The broader tool is envisaged to assess the performance of health facilities in areas of functionality, impact, and building durability and quality. The process will involve developing and testing the tool at a pilot hospital in the country...

  2. Safety in Elevators and Grain Handling Facilities. Module SH-27. Safety and Health.

    Science.gov (United States)

    Center for Occupational Research and Development, Inc., Waco, TX.

    This student module on safety in elevators and grain handling facilities is one of 50 modules concerned with job safety and health. Following the introduction, 15 objectives (each keyed to a page in the text) the student is expected to accomplish are listed (e.g., Explain how explosion suppression works). Then each objective is taught in detail,…

  3. 77 FR 21580 - Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for...

    Science.gov (United States)

    2012-04-10

    ... Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for Fiscal Year (FY) 2013 AGENCY...: In accordance with HUD regulations, this notice announces changes of the mortgage insurance premiums... mortgage. The mortgage insurance premiums to be in effect for FHA firm commitments issued or reissued in FY...

  4. A simultaneous facility location and vehicle routing problem arising in health care logistics in the Netherlands

    NARCIS (Netherlands)

    Veenstra, Marjolein; Roodbergen, Kees Jan; Coelho, Leandro C.; Zhu, Stuart X.

    2018-01-01

    This paper introduces a simultaneous facility location and vehicle routing problem that arises in health care logistics in the Netherlands. In this problem, the delivery of medication from a local pharmacy can occur via lockers, from where patients that are within the coverage distance of a locker

  5. The consequences of nuclear waste disposal facilities on public health and environment

    International Nuclear Information System (INIS)

    Rivasi, M.

    2000-01-01

    This report, from the French parliament office for the evaluation of scientifical and technological choices, makes a status of the effluents and waste stocks from different types of nuclear facilities and analyzes the consequences of these effluents and wastes on the public health and on the environment. Finally, it examines the necessary scientifical, technical and legal improvements. (J.S.)

  6. Factors affecting closure of a temporary stoma.

    Science.gov (United States)

    Taylor, Claire; Varma, Sarah

    2012-01-01

    The purpose of the study was to examine time to reversal of a temporary ostomy, reasons for delayed closure, and patient satisfaction with the scheduling of their closure and related hospital care. Cross-sectional, descriptive study. The target population comprised patients who underwent creation of a temporary ostomy and reversal surgery within one National Health System Hospital Trust in the United Kingdom. The population served by this Trust are ethnically and socioeconomically diverse, predominantly living in urban areas around Greater London. Sixty-one persons who met inclusion criteria were identified. A two-step analytical process was undertaken. First, a literature review examining incidence and causes of delayed stoma closure was undertaken. Second, a postal survey of all patients who had had their stoma closed in 2009 was conducted. Respondents were allowed 2 weeks to complete and return the questionnaire. The survey instrument was developed locally and subjected to content validation using ostomy patients, surgical and nursing colleagues. It consisted of 9 questions querying time from original surgery to closure, reasons for delaying closure surgery beyond 12 weeks, and satisfaction with care. Twenty-seven patients returned their questionnaires, indicating they consented to participate; a response rate of 44%. Half of the respondents (n = 14 [52%]) underwent closure surgery within 6 months of stoma formation; the remaining 48% waited more than 6 months (median: 6.5 months, range: 1.5-26 months). Thirteen patients (48%) reported a delay in receiving their stoma closure; the main reason cited was the need for a course of adjuvant postoperative chemotherapy. Three quarters of respondents (22 [74%]) were satisfied with the overall care they received. Findings from this study suggest that stoma closure may be associated with fewest complications if performed before 12 weeks.

  7. Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review.

    Science.gov (United States)

    Kruse, Clemens Scott; Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

    2017-09-29

    Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Overall, implementation of EHRs has been found to be effective in the few LTC

  8. Predictors for health facility delivery in Busia district of Uganda: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Anyait Agnes

    2012-11-01

    Full Text Available Abstract Background Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action. Methods In a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007 were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother’s autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of health facility delivery were identified by comparing women who delivered in health facilities to those who did not, using bivariate and binary logistic regression analysis. Results Eight independent predictors that favoured delivery in a health facility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2–6.3, previous difficult delivery (AOR 4.2, 95% CI 3.0–8.0, parity less than four (AOR 2.9, 95% CI 1.6–5.6, preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5–11.1 preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3–34.1, not having difficulty with transport (AOR 2.0, 95% CI 1.2–3.5, being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1–3.4 and depending on other people (e.g. spouse in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4–4.6. A model with these 8 variables had an overall correct classification of 81.4% (chi square = 230.3, P  Conclusions These data suggest that in order to increase health facility deliveries

  9. Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

    Science.gov (United States)

    Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

    2016-10-06

    Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery

  10. Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi.

    Science.gov (United States)

    Kabaghe, Alinune N; Phiri, Mphatso D; Phiri, Kamija S; van Vugt, Michèle

    2017-10-18

    Prompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children. A cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted. Health workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63-84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96-100%) RDT negative children, respectively. However, 24% (95% CI 13-37%) of children receiving artemisinin-lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51-69%) of children presented within 24 h of onset of child's symptoms. The survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.

  11. A STUDY ON STATUS OF CLIENT SATISFACTION IN PATIENTS ATTENDING GOVERNMENT HEALTH FACILITIES IN AGRA DISTRICT

    Directory of Open Access Journals (Sweden)

    D Anand

    2012-09-01

    Full Text Available Background: It is easier to evaluate the patient’s satisfaction towards the service than evaluate the quality of medical services that they receive. Patient satisfaction indicators remain stable over time as oppose to clinical indicators which will be changed with technology and pace of medical progress. Objectives: 1 To assess the level of satisfaction of patients attending government health facilities.2 To identify the area of low satisfaction at Government health facility. Methodology: Multistage sampling technique was used for selecting primary and secondary level health facilities. Patients were interviewed, when they were leaving health facility by using pretested, predesigned, semi-structured schedule. Results: A total of 600 clients were interviewed in this study and it was found that there was high level of satisfaction with signboard/display, courtesy and respect given by doctor, overall time duration given by doctor, skills of doctor, effectiveness of health services in solving problem, cost incurred on health services, and behavior of paramedical staff. Whereas comparatively low level of satisfaction was found regarding timings of OPD, registration procedure, waiting time, Cleanliness and comfort of waiting area and examination room, privacy measures and behavior of other non medical staff member.Major causes of dissatisfaction at primary level were Comfort and cleanliness of waiting area and service area, privacy measures, overall time duration given by doctor and behavior of supporting staff. However at higher i.e. secondary and tertiary level major causes found were inadequate OPD timing, mismanaged registration procedure and long waiting time to seek doctor. Conclusion: To raise level of patients satisfaction there should be capacity building,training and orientation programmes for health professonals.

  12. Assessing the Contributions of Private Health Facilities in a Pioneer Private-Public Partnership in Childhood Immunization in Nigeria

    Science.gov (United States)

    Oluoha, Chukwuemeka; Ahaneku, Hycienth

    2014-01-01

    The vision of Nigeria’s immunization program is to reach and sustain routine immunization coverage of greater than 90% for all vaccines by 2020. In order to achieve this, Abia state embarked on a unique private-public partnership (PPP) between private health facilities and the Abia state ministry of health. The aim of this partnership was to collaborate with private health facilities to provide free childhood immunization services in the state - the first of its kind in Nigeria. This is a retrospective study of the 2011 Abia state, Nigeria monthly immunization data. In the 4 local governments operating the PPP, 45% (79/175) of the health facilities that offered immunization services in 2011 were private health facilities and 55% (96/175) were public health facilities. However, 21% of the immunization services took place in private health facilities while 79% took place in public health facilities. Private health facilities were shown to have a modest contribution to immunization in the 4 local governments involved in the PPP. Efforts should be made to expand PPP in immunization nationally to improve immunization services in Nigeria. PMID:28299112

  13. Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon.

    Science.gov (United States)

    Mangham, Lindsay J; Cundill, Bonnie; Achonduh, Olivia A; Ambebila, Joel N; Lele, Albertine K; Metoh, Theresia N; Ndive, Sarah N; Ndong, Ignatius C; Nguela, Rachel L; Nji, Akindeh M; Orang-Ojong, Barnabas; Wiseman, Virginia; Pamen-Ngako, Joelle; Mbacham, Wilfred F

    2012-03-01

    To investigate the quality of malaria case management in Cameroon 5 years after the adoption of artemisinin-based combination therapy (ACT). Treatment patterns were examined in different types of facility, and the factors associated with being prescribed or receiving an ACT were investigated. A cross-sectional cluster survey was conducted among individuals of all ages who left public and private health facilities and medicine retailers in Cameroon and who reported seeking treatment for a fever. Prevalence of malaria was determined by rapid diagnostic tests (RDTs) in consenting patients attending the facilities and medicine retailers. Among the patients, 73% were prescribed or received an antimalarial, and 51% were prescribed or received an ACT. Treatment provided to patients significantly differed by type of facility: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers were prescribed or received an ACT (P = 0.023). The odds of a febrile patient being prescribed or receiving an ACT were significantly higher for patients who asked for an ACT (OR = 24.1, P < 0.001), were examined by the health worker (OR = 1.88, P = 0.021), had not previously sought an antimalarial for the illness (OR = 2.29, P = 0.001) and sought treatment at a public (OR = 3.55) or private facility (OR = 1.99, P = 0.003). Malaria was confirmed in 29% of patients and 70% of patients with a negative result were prescribed or received an antimalarial. Malaria case management could be improved. Symptomatic diagnosis is inefficient because two-thirds of febrile patients do not have malaria. Government plans to extend malaria testing should promote rational use of ACT; though, the introduction of rapid diagnostic testing needs to be accompanied by updated clinical guidelines that provide clear guidance for the treatment of patients with negative test results. © 2011 Blackwell Publishing Ltd.

  14. Birth in a health facility--inequalities among the Ethiopian women: results from repeated national surveys.

    Directory of Open Access Journals (Sweden)

    Elias Ali Yesuf

    Full Text Available BACKGROUND: Uptake of health facilities for delivery care in Ethiopia has not been examined in the light of equality. We investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal education. METHODS: This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was analyzed using logistic regressions to estimate the weighted association between birth in a health facility and study's predictors. RESULTS: Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain low (5.4%,2000 and 11.8%,2011. Compared with women from rural places, women from urban areas had independent OR of a health facility delivery of 4.9 (95% CI: 3.4, 7.0, 5.0 (95% CI: 3.6, 6.9, and 4.6 (95% CI: 3.5, 6.0 in 2000, 2005, and 2011, respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively. Women of the upper economic quintile had 3.0-7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile, with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a health facility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and Somali getting relatively worse over time. CONCLUSIONS: The disparity related to urbanity or education in the use of health facility for birth in Ethiopia is staggering. There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between economic strata except for the richest households.

  15. Availability of medicines in public sector health facilities of two North Indian States.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Tripathy, Jaya Prasad; Kumar, Rajesh

    2015-12-23

    Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities. The present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines -92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH). Overall availability of medicines was 45.2% and 51.1% in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60% in both the states whereas for anti-diabetics it was 44% and 47% in Punjab and Haryana respectively. Atleast one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less

  16. The Role of Distance and Quality on Facility Selection for Maternal and Child Health Services in Urban Kenya.

    Science.gov (United States)

    Escamilla, Veronica; Calhoun, Lisa; Winston, Jennifer; Speizer, Ilene S

    2018-02-01

    Universal access to health care requires service availability and accessibility for those most in need of maternal and child health services. Women often bypass facilities closest to home due to poor quality. Few studies have directly linked individuals to facilities where they sought maternal and child health services and examined the role of distance and quality on this facility choice. Using endline data from a longitudinal survey from a sample of women in five cities in Kenya, we examine the role of distance and quality on facility selection for women using delivery, facility-based contraceptives, and child health services. A survey of public and private facilities offering reproductive health services was also conducted. Distances were measured between household cluster location and both the nearest facility and facility where women sought care. A quality index score representing facility infrastructure, staff, and supply characteristics was assigned to each facility. We use descriptive statistics to compare distance and quality between the nearest available facility and visited facility among women who bypassed the nearest facility. Facility distance and quality comparisons were also stratified by poverty status. Logistic regression models were used to measure associations between the quality and distance to the nearest facility and bypassing for each outcome. The majority of women bypassed the nearest facility regardless of service sought. Women bypassing for delivery traveled the furthest and had the fewest facility options near their residential cluster. Poor women bypassing for delivery traveled 4.5 km further than non-poor women. Among women who bypassed, two thirds seeking delivery and approximately 46% seeking facility-based contraception or child health services bypassed to a public hospital. Both poor and non-poor women bypassed to higher quality facilities. Our findings suggest that women in five cities in Kenya prefer public hospitals and are

  17. Keeping health facilities safe: one way of strengthening the interaction between disease-specific programmes and health systems.

    Science.gov (United States)

    Harries, Anthony D; Zachariah, Rony; Tayler-Smith, Katie; Schouten, Erik J; Chimbwandira, Frank; Van Damme, Wim; El-Sadr, Wafaa M

    2010-12-01

    The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground. Taking the theme 'What would entice HIV- and tuberculosis (TB)-programme managers to sit around the table on a Monday morning with health system experts', this viewpoint focuses on infection control and health facility safety as an important and highly relevant practical topic for both disease-specific programmes and health system strengthening. Our attentions, and the examples and lessons we draw on, are largely aimed at sub-Saharan Africa where the great burden of TB and HIV ⁄ AIDS resides, although the principles we outline would apply to other parts of the world as well. Health care infections, caused for example by poor hand hygiene, inadequate testing of donated blood, unsafe disposal of needles and syringes, poorly sterilized medical and surgical equipment and lack of adequate airborne infection control procedures, are responsible for a considerable burden of illness amongst patients and health care personnel, especially in resource-poor countries. Effective infection control in a district hospital requires that all the components of a health system function well: governance and stewardship, financing,infrastructure, procurement and supply chain management, human resources, health information systems, service delivery and finally supervision. We argue in this article that proper attention to infection control and an emphasis on safe health facilities is a concrete first step towards strengthening the interaction between disease-specific programmes and health systems where it really matters – for patients who are sick and for the health care workforce who provide

  18. Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

    Science.gov (United States)

    Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet

    2017-05-01

    Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

  19. Health facilities safety in natural disasters: experiences and challenges from South East Europe.

    Science.gov (United States)

    Radovic, Vesela; Vitale, Ksenija; Tchounwou, Paul B

    2012-05-01

    The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and health facilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of health facilities and people. Strategic measures that should be taken in future to provide better safety for health facilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.

  20. Health Facilities Safety in Natural Disasters: Experiences and Challenges from South East Europe

    Directory of Open Access Journals (Sweden)

    Vesela Radovic

    2012-05-01

    Full Text Available The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and health facilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of health facilities and people. Strategic measures that should be taken in future to provide better safety for health facilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.

  1. Use of health services by residents at a seniors-only living facility

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    Elen Ferraz Teston

    2013-10-01

    Full Text Available The objective of the study was to compare the use of medical and dental services by seniors residing at a seniors-only living facility and in the general community. It was a quantitative study, among 50 residents of the living facility and 173 in the general community. The data were collected between November 2011 and February 2012 through a questionnaire, and subjected to statistical analysis. Performance of clinical exams and satisfaction with health services was greater among seniors living in the general community; however, physical therapy treatment was more common among those living in the facility. The use of medical and dental services showed a statistically significant difference. The seniors in both groups need oral health monitoring and those living in the facility also require coverage by the Family Health Strategy. The presence of professionals with the right profile to adequately serve residents and the network of available services are determining factors for the success of this new housing policy.

  2. Women's use of private and government health facilities for childbirth in Nairobi's informal settlements.

    Science.gov (United States)

    Bazant, Eva S; Koenig, Michael A; Fotso, Jean-Christophe; Mills, Samuel

    2009-03-01

    The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home.

  3. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors. PMID:22551645

  4. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Directory of Open Access Journals (Sweden)

    Magnavita Nicola

    2012-05-01

    Full Text Available Abstract Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form for reporting violent incidents, the DCS (demand/control/support model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

  5. Process evaluation of communitisation programme in public sector health facilities, Mokokchung district, Nagaland, 2015

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    Aonungdok Tushi

    2017-01-01

    Full Text Available Background: Public sector health facilities were poorly managed due to a history of conflict in Nagaland, India. Government of Nagaland introduced “Nagaland Communitisation of Public Institutions and Services Act” in 2002. Main objectives of the evaluation were to review the functioning of Health Center Managing Committees (HCMCs, deliver health services in the institutions managed by HCMC, identify strengths as well as challenges perceived by HCMC members in the rural areas of Mokokchung district, Nagaland. Materials and Methods: The evaluation was made using input, process and output indicators. A doctor, the HCMC Chairman and one member from each of the three community health centers (CHC and four primary health centers (PHC were surveyed using a semi-structured questionnaire and an in-depth interview guide. Proportions for quantitative data were computed and key themes from the same were identified. Results: Overall; the infrastructure, equipment and outpatient/inpatient service availability was satisfactory. There was a lack of funds and shortage of doctors, drugs as well as laboratory facilities. HCMCs were in place and carried out administrative activities. HCMCs felt ownership, mobilized community contributions and managed human resources. HCMC members had inadequate funds for their transport and training. They faced challenges in service delivery due to political interference and lack of adequate human, material, financial resources. Conclusions: Communitisation program was operational in the district. HCMC members felt the ownership of health facilities. Administrative, political support and adequate funds from the government are needed for effective functioning of HCMCs and optimal service delivery in public sector facilities.

  6. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study

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    Sychareun Vanphanom

    2012-08-01

    Full Text Available Abstract Background Maternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. Methods A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. Results Obstacles to giving birth at health facilities included: (1 Distance to the health facilities and difficulties and costs of getting there; (2 Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3 The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4 The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself. Conclusion This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and

  7. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study

    Science.gov (United States)

    2012-01-01

    Background Maternal mortality among poor rural women in the Lao People’s Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. Methods A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. Results Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a “hot bed” after delivery. The decision about where to give birth was commonly made by the woman’s husband, mother, mother-in-law or other relatives in consultation with the woman herself. Conclusion This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR’s high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be

  8. Heat stress and inadequate sanitary facilities at workplaces – an occupational health concern for women?

    Science.gov (United States)

    Venugopal, Vidhya; Rekha, Shanmugam; Manikandan, Krishnamoorthy; Latha, Perumal Kamalakkannan; Vennila, Viswanathan; Ganesan, Nalini; Kumaravel, Perumal; Chinnadurai, Stephen Jeremiah

    2016-01-01

    Background Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. Objective The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. Design A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014–2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. Results Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=−2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ2=4.03, p=0.0444), and prevalence of genitourinary issues (χ2=42.92, p=0.0005×10−7) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. Conclusions The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to

  9. Heat stress and inadequate sanitary facilities at workplaces – an occupational health concern for women?

    Directory of Open Access Journals (Sweden)

    Vidhya Venugopal

    2016-09-01

    Full Text Available Background: Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. Objective: The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. Design: A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014–2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT, sweat rate (SwR, and urine specific gravity (USG were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. Results: Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=−2.3879, p=0.0192, inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ2=4.03, p=0.0444, and prevalence of genitourinary issues (χ2=42.92, p=0.0005×10−7 reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. Conclusions: The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the

  10. Heat stress and inadequate sanitary facilities at workplaces - an occupational health concern for women?

    Science.gov (United States)

    Venugopal, Vidhya; Rekha, Shanmugam; Manikandan, Krishnamoorthy; Latha, Perumal Kamalakkannan; Vennila, Viswanathan; Ganesan, Nalini; Kumaravel, Perumal; Chinnadurai, Stephen Jeremiah

    2016-01-01

    Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces. The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers. A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014-2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace. Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=-2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ (2)=4.03, p=0.0444), and prevalence of genitourinary issues (χ (2)=42.92, p=0.0005×10(-7)) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers. The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to empower women, avert further health risks, and

  11. mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

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    Bukola Samuel Owolabi

    2018-01-01

    Full Text Available Objectives: Mobile health (mHealth is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1% had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4% were aware of the use of mobile phones in health-care delivery. Only three (27.3% (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5% had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

  12. External quality assessment of malaria microscopy diagnosis in selected health facilities in Western Oromia, Ethiopia.

    Science.gov (United States)

    Sori, Getachew; Zewdie, Olifan; Tadele, Geletta; Samuel, Abdi

    2018-06-18

    Accurate early diagnosis and prompt treatment are one of the key strategies to control and prevent malaria disease. External quality assessment is the most effective method for evaluation of the quality of malaria microscopy diagnosis. The aim of this study was to assess the quality of malaria microscopy diagnosis and its associated factors in selected public health facility laboratories in East Wollega Zone, Western Ethiopia. Facility-based cross-sectional study design was conducted in 30 randomly selected public health facility laboratories from November 2014 to January 2015 in East Wollega Zone, Western Ethiopia. Ten validated stained malaria panel slides with known Plasmodium species, developmental stage and parasite density were distributed. Data were captured; cleaned and analyzed using SPSS version 20 statistical software-multivariate logistic regressions and the agreement in reading between the peripheral diagnostic centers and the reference laboratory were done using kappa statistics. A total of 30 health facility laboratories were involved in the study and the overall quality of malaria microscopy diagnosis was poor (62.3%). The associated predictors of quality in this diagnosis were in-service training [(AOR = 16, 95% CI (1.3, 1.96)], smearing quality [(AOR = 24, 95% CI (1.8, 3.13)], staining quality [(AOR = 15, 95% CI (2.35, 8.61), parasite detection [(AOR = 9, 95% CI (1.1, 8.52)] and identification skills [(AOR = 8.6, 95% CI (1.21, 1.63)]. Eighteen (60%) of health facility laboratories had in-service trained laboratory professionals on malaria microscopy diagnosis. Overall quality of malaria microscopy diagnosis was poor and a significant gap in this service was observed that could impact on its diagnostic services.

  13. [Food and beverages available in automatic food dispensers in health care facilities of the Portugal North Health Region].

    Science.gov (United States)

    Rodrigues, Filipa Gomes; Ramos, Elisabete; Freitas, Mário; Neto, Maria

    2010-01-01

    Patients and health staff frequently need to stay in health care facilities for quite a long time. Therefore, it's necessary to create the conditions that allow the ingestion of food during those periods, namely through the existence of automatic food dispensers. However, the available food and beverages might not always be compatible with a healthy diet. The aim of this work was to evaluate if the food and beverages available in automatic food dispensers in public Ambulatory Care Facilities (ACF) and Hospitals of the Portugal North Health Region were contributing to a healthy diet, during the year of 2007. A questionnaire was elaborated and sent to the Coordinators of the Health Sub-Regions and to the Hospital Administrators. The questionnaire requested information about the existence of automatic food dispensers in the several departments of each health care facility, as well as which food and beverages were available and most sold. Afterwards, the pre-processing of the results involved the classification of the food and beverages in three categories: recommended, sometimes recommended and not recommended. The questionnaire reply ratio was 71% in ACF and 83% in Hospitals. Automatic food dispensers were available in all the Hospitals and 86.5% of ACF. It wasn't possible to acquire food in 37% of the health facility departments. These departments were all located in ACF. The more frequently available beverages in departments with automatic food dispensers were coffee, still water, tea, juices and nectars and soft drinks. Still water, coffee, yogurt, juices and nectars and soft drinks were reported as the most sold. The more frequently avaliable food items were chocolate, recommended cookies, not recommended cakes, recommended sandwiches and sometimes recommended croissants. The food items reported as being the most sold were recommended sandwiches, chocolate, recommended cookies, sometimes recommended croissants and not recommended cookies. The beverages in the

  14. Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

    Energy Technology Data Exchange (ETDEWEB)

    Farnham, Irene [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2016-08-01

    This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impacted groundwater

  15. Underground Test Area (UGTA) Closure Report for Corrective Action Unit 98: Frenchman Flat Nevada National Security Site, Nevada, Revision 1 ROTC-1

    International Nuclear Information System (INIS)

    Farnham, Irene

    2016-01-01

    This Closure Report (CR) has been prepared for Corrective Action Unit (CAU) 98, Frenchman Flat, Nevada National Security Site (NNSS), Nevada. The Frenchman Flat CAU was the site of 10 underground nuclear tests, some of which have impacted groundwater near the tests. This work was performed as part of the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) Underground Test Area (UGTA) Activity in accordance with the Federal Facility Agreement and Consent Order (FFACO). This CR describes the selected corrective action to be implemented during closure to protect human health and the environment from the impacted groundwater

  16. Challenges that Hinder Parturients to Deliver in Health Facilities: A Qualitative Analysis in Two Districts of Indonesia

    Directory of Open Access Journals (Sweden)

    Sudirman Nasir

    2016-12-01

    Full Text Available Background: There are many challenges women face to be able to give birth in health facilities in many parts of Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other community members on potential barriers faced by women to deliver in health facilities in two districts within The Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages in Cianjur, in the West Java province. The participants included village midwives, Posyandu kader (village health volunteers, traditional birth attendants (TBAs, mothers, men, village heads and district health officials. Results: The main findings were mostly similar in the two study areas. However, there were some key differences. Preference for TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations between midwives and TBAs, and responsiveness to traditional practices within health facilities and effective health promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in both study areas.

  17. 300 Area waste acid treatment system closure plan

    International Nuclear Information System (INIS)

    LUKE, S.N.

    1999-01-01

    The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999

  18. 300 Area waste acid treatment system closure plan

    Energy Technology Data Exchange (ETDEWEB)

    LUKE, S.N.

    1999-05-17

    The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.

  19. Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities.

    Science.gov (United States)

    Kim, Joyce J; Basu, Mohua; Plantinga, Laura; Pastan, Stephen O; Mohan, Sumit; Smith, Kayla; Melanson, Taylor; Escoffery, Cam; Patzer, Rachel E

    2018-05-07

    Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness. We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities ( n =655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Awareness of national racial disparity in waitlisting was defined as responding "yes" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The secondary outcome was providers' perceptions of racial difference in waitlisting at their own facilities. Among 655 providers surveyed, 19% were aware of the national racial disparity in waitlisting: 50% (57 of 113) of medical directors, 11% (35 of 327) of nurse managers, and 16% (35 of 215) of other providers. In analyses adjusted for provider and facility characteristics, nurse managers (versus medical directors; odds ratio, 7.33; 95% confidence interval, 3.35 to 16.0) and white providers (versus black providers; odds ratio, 2.64; 95% confidence interval, 1.39 to 5.02) were more likely to be unaware of a national racial disparity in waitlisting. Facilities in the South (versus the Northeast; odds ratio, 3.05; 95% confidence interval, 1.04 to 8.94) and facilities with a low percentage of blacks (versus a high percentage of blacks; odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39) were more likely to be unaware. One quarter of facilities had >5% racial difference in waitlisting within their own facilities, but only 5% were aware of the disparity. Among a limited sample of dialysis facilities with low

  20. Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study.

    Science.gov (United States)

    Helova, Anna; Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

    2017-03-01

    Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

  1. Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions.

    Science.gov (United States)

    Essendi, Hildah; Johnson, Fiifi Amoako; Madise, Nyovani; Matthews, Zoe; Falkingham, Jane; Bahaj, Abubakr S; James, Patrick; Blunden, Luke

    2015-11-09

    The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas. This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities. The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations. The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

  2. Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

    Science.gov (United States)

    Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

    2014-10-01

    We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

  3. Webinar Presentation: Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time

    Science.gov (United States)

    This presentation, Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome.

  4. Closure of a mixed waste landfill: Lessons learned

    International Nuclear Information System (INIS)

    Phifer, M.A.

    1990-01-01

    Much experience has been gained during the closure of the Mixed Waste Management Facility (MWMF) at the Savannah River Site (SRS) and many lessons were learned. This knowledge was applied to other closures at SRS yielding decreased costs, schedule enhancement, and increased overall project efficiency. The next major area of experience to be gained at SRS in the field of waste site closures will be in the upkeep, maintenance, and monitoring of clay caps. Further test programs will be required to address these requirements

  5. The Role of Health Extension Workers in Linking Pregnant Women With Health Facilities for Delivery in Rural and Pastoralist Areas of Ethiopia.

    Science.gov (United States)

    Jackson, Ruth; Hailemariam, Assefa

    2016-09-01

    Women's preference to give birth at home is deeply embedded in Ethiopian culture. Many women only go to health facilities if they have complications during birth. Health Extension Workers (HEWs) have been deployed to improve the utilization of maternal health services by bridging the gap between communities and health facilities. This study examined the barriers and facilitators for HEWs as they refer women to mid-level health facilities for birth. A qualitative study was conducted in three regions: Afar Region, Southern Nations Nationalities and People's Region and Tigray Region between March to December 2014. Interviews and focus group discussions were conducted with 45 HEWs, 14 women extension workers (employed by Afar Pastoralist Development Association, Afar Region) and 11 other health workers from health centers, hospitals or health offices. Data analysis was done based on collating the data and identifying key themes. Barriers to health facilities included distance, lack of transportation, sociocultural factors and disrespectful care. Facilitators for facility-based deliveries included liaising with Health Development Army (HDA) leaders to refer women before their expected due date or if labour starts at home; the introduction of ambulance services; and, provision of health services that are culturally more acceptable for women. HEWs can effectively refer more women to give birth in health facilities when the HDA is well established, when health staff provide respectful care, and when ambulance is available at any time.

  6. Tubular closure mechanism

    International Nuclear Information System (INIS)

    Kalen, D.D.; Mitchem, J.W.

    1982-01-01

    This invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holder used in nuclear reactors. The closure mechanism is composed of a latching member which includes a generally circular chamber with a plurality of elongated latches depending therefrom. The latching member circumscribes part of an actuator member which is disposed within the latching member so as to be axially movable. The axial movement of the actuator actuates positioning of the latches between positions in which the latches are locked and secured within the actuator member. Means, capable of being remotely manipulated, are provided to move the actuator in order to position the latches and load the articles within the tube

  7. Tank closure reducing grout

    International Nuclear Information System (INIS)

    Caldwell, T.B.

    1997-01-01

    A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel

  8. Role of information and communication technology in promoting oral health at residential aged care facilities.

    Science.gov (United States)

    Adebayo, Bola; Durey, Angela; Slack-Smith, Linda M

    2017-07-01

    Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents' oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.

  9. Bechtel Hanford, Inc./ERC team health and safety plan Environmental Restoration Disposal Facility operations

    International Nuclear Information System (INIS)

    Turney, S.R.

    1996-02-01

    A comprehensive safety and health program is essential for reducing work-related injuries and illnesses while maintaining a safe and health work environment. This document establishes Bechtel Hanford, Inc. (BHI)/Environmental Restoration Contractor (ERC) team requirements, policies, and procedures and provides preliminary guidance to the Environmental Restoration Disposal Facility (ERDF) subcontractor for use in preparing essential safety and health documents. This health and safety plan (HASP) defines potential safety and health issues associated with operating and maintaining the ERDF. A site-specific HASP shall be developed by the ERDF subcontractor and shall be implemented before operations and maintenance work can proceed. An activity hazard analysis (AHA) shall also be developed to provide procedures to identify, assess, and control hazards or potential incidents associated with specific operations and maintenance activities

  10. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  11. Ecologic assessment of closure options for Savannah River Plant waste sites: Task 38, AX-681812

    International Nuclear Information System (INIS)

    1987-01-01

    Ecologic assessment of closure options is one of several analyses being documented in the EIDs (along with analysis of relative potential health risks, accident risks, and costs). This information will serve as a basis for choosing the best option for closing a particular waste facility. This report presents the methodology adopted for SRP waste site ecological assessment, and the results of its application. The results of the ecologic assessment indicated that no impacts are expected for any of the closure options at eleven sites. Significant ecologic impacts are possible at the eight waste sites or groups of waste sites including the Radioactive Waste Burial Grounds, Old TNX Seepage Basin, CMP Pits, F-Area Seepage Basins, H-Area Seepage Basins, SRL Seepage Basins, R-Reactor Seepage Basins, and L-Area Oil and Chemical Basin. 104 refs., 22 figs., 241 tabs

  12. Involvement of the Public Health Authority in emergency planning and preparedness for nuclear facilities in Hungary

    International Nuclear Information System (INIS)

    Sztanyik, L.B.

    1986-01-01

    It is required by the Hungarian Atomic Energy Act and its enacting clause of 1980 that facilities established for the application of atomic energy be designed, constructed and operated in such a manner that abnormal operational occurrences can be avoided and unplanned exposures to radiation and radioactive substances can be prevented. The primary responsibility for planning and implementing emergency actions rests with the management of the operating organization. Thus one of the prerequisites of licensing the first nuclear power plant in Hungary was the preparation and submission for approval of an emergency plan by the operating organization. In addition to this, the council of the county where the power plant is located has also been obliged to prepare a complementary emergency plan, in co-operation with other regional and national authorities, for the prevention of consequences from an emergency that may extend beyond the site boundary of the plant. In preparing the complementary plan, the emergency plan of the facility had to be taken into account. Unlike most national authorities involved in nuclear matters, the Public Health Authority is involved in the preparation of plans for every kind of emergency in a nuclear facility, including even those whose consequences can probably be confined to the plant site. The paper discusses in detail the role and responsibility of the Public Health Authority in emergency planning and preparedness for nuclear facilities. (author)

  13. Wheelchair cleaning and disinfection in Canadian health care facilities: "That's wheelie gross!".

    Science.gov (United States)

    Gardner, Paula; Muller, Matthew P; Prior, Betty; So, Ken; Tooze, Jane; Eum, Linda; Kachur, Oksana

    2014-11-01

    Wheelchairs are complex equipment that come in close contact with individuals at increased risk of transmitting and acquiring antibiotic-resistant organisms and health care-associated infection. The purpose of this study was to determine the status of wheelchair cleaning and disinfection in Canadian health care facilities. Acute care hospitals (ACHs), chronic care hospitals (CCHs), and long-term care facilities (LTCFs) were contacted and the individual responsible for oversight of wheelchair cleaning and disinfection was identified. A structured interview was conducted that focused on current practices and concerns, barriers to effective wheelchair cleaning and disinfection, and potential solutions. Interviews were completed at 48 of the 54 facilities contacted (89%), including 18 ACHs, 16 CCHs, and 14 LTCFs. Most (n = 24) facilities had 50-200 in-house wheelchairs. Respondents were very concerned about wheelchair cleaning as an infection control issue. Specific concerns included the lack of reliable systems for tracking and identifying dirty and clean wheelchairs (71%, 34/48), failure to clean and disinfect wheelchairs between patients (52%, 25/48), difficulty cleaning cushions (42%, 20/48), lack of guidelines (35%, 27/48), continued use of visibly soiled wheelchairs (29%, 14/48) and lack of resources (25%, 12/48). Our results suggest that wheelchair cleaning and disinfection is not optimally performed at many Canadian hospitals and LTCFs. Specific guidance on wheelchair cleaning and disinfection is necessary. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

    Directory of Open Access Journals (Sweden)

    Nithra Kitreerawutiwong

    Full Text Available Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district health promotion hospitals (THPHs were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2.A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district health promotion hospitals (THPHs led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30, followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06. THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22.Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

  15. [EVALUATION OF THE EFFECTIVENESS OF ADDITIONAL PROFESSIONAL EDUCATION ON THE BASIS OF HEALTH CARE FACILITY].

    Science.gov (United States)

    Bohomaz, V M; Rymarenko, P V

    2014-01-01

    In this study we tested methods of facility learning of health care workers as part of a modern model of quality management of medical services. The statistical and qualitative analysis of the effectiveness of additional training in emergency medical care at the health facility using an adapted curriculum and special mannequins. Under the guidance of a certified instructor focus group of 53 doctors and junior medical specialists studied 22 hours. According to a survey of employees trained their level of selfassessment of knowledge and skills sigificantly increased. Also significantly increased the proportion of correct answers in a formalized testing both categories of workers. Using androgological learning model, mannequins simulators and training in small groups at work create the most favorable conditions for effective individual and group practical skills of emergency medicine.

  16. A 'mystery client' evaluation of adolescent sexual and reproductive health services in health facilities from two regions in Tanzania.

    Directory of Open Access Journals (Sweden)

    Zaina Mchome

    Full Text Available Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people's access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning. The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers' mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people's efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.

  17. Job Satisfactions of Nurses and Physicians Working in the Same Health Care Facility in Turkey

    OpenAIRE

    Züleyha Alper; Đlker Ercan; Güven Özkaya; Neriman Akansel

    2011-01-01

    Background: Job satisfaction is defined as the degree to which employees like or enjoy their jobs and the degreeof satisfaction is based on the importance placed upon this reward and benefit.Objective: Aim of this study was to determine the job satisfaction levels of nurses and physicians working in thesame health care facility, analyze the factors that may affect job satisfaction levels. This study was conducted asa descriptive study and was carried out in one Medical Care Center Northwester...

  18. Professional Closure Beyond State Authorization

    Directory of Open Access Journals (Sweden)

    Gitte Sommer Harrits

    2014-03-01

    Full Text Available For decades, the Weberian approach to the study of professions has been strong, emphasizing state authorization and market monopolies as constituting what is considered a profession. Originally, however, the Weberian conception of closure, or the ways in which a profession is constituted and made separate, was broader. This article suggests a revision of the closure concept, integrating insights from Pierre Bourdieu, and conceptualizing professional closure as the intersection of social, symbolic and legal closure. Based on this revision, this article demonstrates how to apply such a concept in empirical studies. This is done by exploring social, symbolic and legal closure across sixteen professional degree programs. The analyses show a tendency for some overlap between different forms of closure, with a somewhat divergent pattern for legal closure. Results support the argument that we need to study these processes as an intersection of different sources of closure, including capital, lifestyles and discourse

  19. Negative pressure wound treatment improves Acute Physiology and Chronic Health Evaluation II score in mediastinitis allowing a successful elective pectoralis muscle flap closure: six-year experience of a single protocol.

    Science.gov (United States)

    Salica, Andrea; Weltert, Luca; Scaffa, Raffaele; Guerrieri Wolf, Lorenzo; Nardella, Saverio; Bellisario, Alessandro; De Paulis, Ruggero

    2014-11-01

    Optimal management of poststernotomy mediastinitis is controversial. Negative pressure wound treatment improves wound environment and sternal stability with low surgical invasiveness. Our protocol was based on negative pressure followed by delayed surgical closure. The aim of this study was to provide the results at early follow-up and to identify the risk factors for adverse outcome. In 5400 cardiac procedures, 44 consecutive patients with mediastinitis were enrolled in the study. Mediastinitis treatment was based on urgent debridement and negative pressure as the first-line approach. After wound sterilization, chest closure was achieved by elective pectoralis muscle advancement flap. Each patient's hospital data were collected prospectively. Variables included patient demographics and clinical and biological data. Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated at the time of diagnosis and 48 hours after debridement. Focus outcome measures were mediastinitis-related death and need for reintervention after pectoralis muscle closure. El Oakley type I and type IIIA mediastinitis were the most frequent types (63.6%). Methicillin-resistant Staphylococcus aureus was present in 25 patients (56.8%). Mean APACHE II score was 19.4±4 at the time of diagnosis, and 30 patients (68.2%) required intensive care unit transfer before surgical debridement. APACHE II score improved 48 hours after wound debridement and negative pressure application (mean value, 19.4±4 vs 7.2±2; P=.005) independently of any other variables included in the study. One patient in septic shock at the time of diagnosis died (2.2%). Negative pressure promotes a significant improvement in clinical status according to APACHE II score and allows a successful elective surgical closure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  20. Measuring the quality of child health care at first-level facilities.

    Science.gov (United States)

    Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre

    2005-08-01

    Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

  1. Simulating school closure policies for cost effective pandemic decision making

    Directory of Open Access Journals (Sweden)

    Araz Ozgur M

    2012-06-01

    Full Text Available Abstract Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY threshold equal to the US per capita GDP ($46,000, we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP with the longest duration closure (24 weeks considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates. Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.

  2. Regional health care planning: a methodology to cluster facilities using community utilization patterns.

    Science.gov (United States)

    Delamater, Paul L; Shortridge, Ashton M; Messina, Joseph P

    2013-08-22

    Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

  3. MNC Subsidiary Closures

    DEFF Research Database (Denmark)

    Sofka, Wolfgang; Torres Preto, Miguel; de Faria, Pedro

    2014-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. In particular, we examine the extent to which the human capital that these employees acquired while employed by the MNC influences the wages they receive in their new jobs. We propose an employee...

  4. Friction or Closure

    DEFF Research Database (Denmark)

    Lundahl, Mikela

    2014-01-01

    Heritage is a discourse that aims at closure. It fixates the narrative of the past through the celebration of specific material (or sometimes immaterial non-) ob-jects. It organizes temporality and construct events and freezes time. How does this unfold in the case of the UNESCO World Heritage si...

  5. Mail Office annual closure

    CERN Multimedia

    2013-01-01

    On the occasion of the annual closure of CERN, there will be no mail distributed on Friday 20 December 2013 but mail will be collected in the morning. Nevertheless, you will still be able to bring your outgoing mail to Building 555-R-002 until 12 noon.  

  6. Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

    Science.gov (United States)

    Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

    2018-04-23

    This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  7. Ring closure in actin polymers

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, Supurna, E-mail: supurna@rri.res.in [Raman Research Institute, Bangalore 560080 (India); Chattopadhyay, Sebanti [Doon University, Dehradun 248001 (India)

    2017-03-18

    We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers. - Highlights: • Ring closure of biopolymers. • Worm like chain model. • Predictions for experiments.

  8. Stomal Closure: Strategies to Prevent Incisional Hernia

    Science.gov (United States)

    Harries, Rhiannon L.; Torkington, Jared

    2018-01-01

    Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias. PMID:29670882

  9. Closure of shallow underground injection wells

    International Nuclear Information System (INIS)

    Veil, J.A.; Grunewald, B.

    1993-01-01

    Shallow injection wells have long been used for disposing liquid wastes. Some of these wells have received hazardous or radioactive wastes. According to US Environmental Protection Agency (EPA) regulations, Class IV wells are those injection wells through which hazardous or radioactive wastes are injected into or above an underground source of drinking water (USDW). These wells must be closed. Generally Class V wells are injection wells through which fluids that do not contain hazardous or radioactive wastes are injected into or above a USDW. Class V wells that are responsible for violations of drinking water regulations or that pose a threat to human health must also be closed. Although EPA regulations require closure of certain types of shallow injection wells, they do not provide specific details on the closure process. This paper describes the regulatory background, DOE requirements, and the steps in a shallow injection well closure process: Identification of wells needing closure; monitoring and disposal of accumulated substances; filling and sealing of wells; and remediation. In addition, the paper describes a major national EPA shallow injection well enforcement initiative, including closure plan guidance for wells used to dispose of wastes from service station operations

  10. Stomal Closure: Strategies to Prevent Incisional Hernia

    Directory of Open Access Journals (Sweden)

    Rhiannon L. Harries

    2018-04-01

    Full Text Available Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.

  11. Baseline results of the first malaria indicator survey in Iran at the health facility level

    Directory of Open Access Journals (Sweden)

    Taghizadeh-Asl Rahim

    2011-10-01

    Full Text Available Abstract Background Malaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of Iran Methods In this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages were used to summarize the results and Chi square test was used to analyse data. Results All but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly. The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless

  12. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

    Science.gov (United States)

    Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

    2013-07-05

    Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive

  13. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  14. Physical Exposure to Seismic Hazards of Health Facilities in Mexico City, Mexico

    Science.gov (United States)

    Rodriguez, S. M.; Novelo Casanova, D.

    2010-12-01

    Although health facilities are essential infrastructure during disasters and emergencies, they are also usually highly vulnerable installations in the case of the occurrence of large and major earthquakes. Hospitals are one of the most complex critical facilities in modern cities and they are used as first response in emergency situations. The operability of a hospital must be maintained after the occurrence of a local strong earthquake in order to satisfy the need for medical care of the affected population. If a health facility is seriously damaged, it cannot fulfill its function when most is needed. In this case, hospitals become a casualty of the disaster. To identify the level of physical exposure of hospitals to seismic hazards in Mexico City, we analyzed their geographic location with respect to the seismic response of the different type of soils of the city from past earthquakes, mainly from the events that occurred on September 1985 (Ms= 8.0) and April 1989 (Ms= 6.9). Seismic wave amplification in this city is the result of the interaction of the incoming seismic waves with the soft and water saturated clay soils, on which a large part of Mexico City is built. The clay soils are remnants of the lake that existed in the Valley of Mexico and which has been drained gradually to accommodate the growing urban sprawl. Hospital facilities were converted from a simple database of names and locations into a map layer of resources. This resource layer was combined with other map layers showing areas of seismic microzonation in Mexico City. This overlay was then used to identify those hospitals that may be threatened by the occurrence of a large or major seismic event. We analyzed the public and private hospitals considered as main health facilities. Our results indicate that more than 50% of the hospitals are highly exposed to seismic hazards. Besides, in most of these health facilities we identified the lack of preventive measures and preparedness to reduce their

  15. CIRSE Vascular Closure Device Registry

    NARCIS (Netherlands)

    Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2011-01-01

    Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. The CIRSE registry of closure devices

  16. Crack closure, a literature study

    Science.gov (United States)

    Holmgren, M.

    1993-08-01

    In this report crack closure is treated. The state of the art is reviewed. Different empirical formulas for determining the crack closure are compared with each other, and their benefits are discussed. Experimental techniques for determining the crack closure stress are discussed, and some results from fatigue tests are also reported. Experimental data from the literature are reported.

  17. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    DEFF Research Database (Denmark)

    Ahiabu, Mary-Anne; Tersbøl, Britt Pinkowski; Biritwum, Richard

    2016-01-01

    with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support......Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality...... assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern...

  18. [Evaluation auditing of the quality of health care in accreditation of health facilities].

    Science.gov (United States)

    Paim, Chennyfer da Rosa Paino; Zucchi, Paola

    2011-01-01

    This article shows how many health insurance companies operating in the Greater São Paulo have been performing auditing of the quality of their health care services, professionals, and which criteria are being employed to do so. Because of the legislation decreeing that health insurance companies have legal co-responsibility for the health care services and National Health Agency control the health services National Health Agency, auditing evaluations have been implemented since then. The survey was based on electronic forms e-mailed to all health insurance companies operating in the Greater São Paulo. The sample consisted of 125 health insurance companies; 29 confirmed that had monitoring and evaluation processes; 26 performed auditing of their services regularly; from those, 20 used some type of form or protocol for technical visits; all evaluation physical and administrative structure and 22 included functional structure. Regarding the professionals audited 21 were nurses, 13 administrative assistants; 04 managers and 02 doctors. Regarding criteria for accreditation the following were highlighted: region analysis (96%), localization (88.88%) and cost (36%). We conclude that this type of auditing evaluation is rather innovative and is being gradually implemented by the health insurance companies, but is not a systematic process.

  19. Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness.

    Science.gov (United States)

    Bramesfeld, A; Stegbauer, C

    2016-10-01

    The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users' legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services' performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

  20. Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey.

    Science.gov (United States)

    Kyei-Onanjiri, Minerva; Carolan-Olah, Mary; Awoonor-Williams, John Koku; McCann, Terence V

    2018-03-15

    Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies. The aim of this study was to examine the availability of emergency obstetric care interventions in the Upper East Region of Ghana. A cross-sectional survey of 120 health facilities was undertaken. Status of emergency obstetric care was assessed through an interviewer administered questionnaire to directors/in-charge officers of maternity care units in selected facilities. Data were analysed using descriptive statistics. Eighty per cent of health facilities did not meet the criteria for provision of emergency obstetric care. Comparatively, private health facilities generally provided EmOC interventions less frequently than public health facilities. Other challenges identified include inadequate skill mix of maternity health personnel, poor referral processes, a lack of reliable communication systems and poor emergency transport systems. Multiple factors combine to limit women's access to a range of essential maternal health services. The availability of EmOC interventions was found to be low across the region; however, EmOC facilities could be increased by nearly one-third through modest investments in some existing facilities. Also, the key challenges identified in this study can be improved by enhancing pre-existing health system structures such as Community-based Health Planning and Services (CHPS), training more midwifery personnel, strengthening in-service training and implementation of referral audits as part of health service

  1. Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Naoko Kozuki

    Full Text Available This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing

  2. Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

    Science.gov (United States)

    Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

    2017-01-01

    This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and

  3. Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

    Science.gov (United States)

    Abeje, Tadiye; Negera, Edessa; Kebede, Eshetu; Hailu, Tsegaye; Hassen, Ismaile; Lema, Tsehainesh; Yamuah, Lawrence; Shiguti, Birru; Fenta, Melkamu; Negasa, Megersa; Beyene, Demissew; Bobosha, Kidist; Aseffa, Abraham

    2016-04-07

    Leprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76% of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States. A cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers' attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom's cut off point was used to describe the knowledge and practical skills of the respondents while Likert's scale was used for attitude assessment. A total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4%), health officers and nurses with Bachelor degree in Science (27%), clinical nurses with diploma (66%) and health assistants (2.8%). The median age of the respondents was 26.0 years and females made up of 45%. Generally the knowledge and skills of the respondents were found to be poor while attitude

  4. Health workers' perceptions of private-not-for-profit health facilities' organizational culture and its influence on retention in Uganda.

    Science.gov (United States)

    Shumba, Constance Sibongile; Kielmann, Karina; Witter, Sophie

    2017-12-06

    An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs' working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention. Thirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi-structured topic guide. Interview transcripts were analysed using thematic content analysis. Interviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management. The findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.

  5. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; Van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.P.; Rinke de Wit, T.F.

    2015-01-01

    Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  6. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

    2015-01-01

    Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  7. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.; Rinke de Wit, T.F.

    2015-01-01

    Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  8. DOE standard: Integration of environment, safety, and health into facility disposition activities. Volume 2: Appendices

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-05-01

    This volume contains the appendices that provide additional environment, safety, and health (ES and H) information to complement Volume 1 of this Standard. Appendix A provides a set of candidate DOE ES and H directives and external regulations, organized by hazard types that may be used to identify potentially applicable directives to a specific facility disposition activity. Appendix B offers examples and lessons learned that illustrate implementation of ES and H approaches discussed in Section 3 of Volume 1. Appendix C contains ISMS performance expectations to guide a project team in developing and implementing an effective ISMS and in developing specific performance criteria for use in facility disposition. Appendix D provides guidance for identifying potential Applicable or Relevant and Appropriate Requirements (ARARs) when decommissioning facilities fall under the Comprehensive Environmental Response, Compensation, Liability Act (CERCLA) process. Appendix E discusses ES and H considerations for dispositioning facilities by privatization. Appendix F is an overview of the WSS process. Appendix G provides a copy of two DOE Office of Nuclear Safety Policy and Standards memoranda that form the bases for some of the guidance discussed within the Standard. Appendix H gives information on available hazard analysis techniques and references. Appendix I provides a supplemental discussion to Sections 3.3.4, Hazard Baseline Documentation, and 3.3.6, Environmental Permits. Appendix J presents a sample readiness evaluation checklist.

  9. DOE standard: Integration of environment, safety, and health into facility disposition activities. Volume 2: Appendices

    International Nuclear Information System (INIS)

    1998-05-01

    This volume contains the appendices that provide additional environment, safety, and health (ES and H) information to complement Volume 1 of this Standard. Appendix A provides a set of candidate DOE ES and H directives and external regulations, organized by hazard types that may be used to identify potentially applicable directives to a specific facility disposition activity. Appendix B offers examples and lessons learned that illustrate implementation of ES and H approaches discussed in Section 3 of Volume 1. Appendix C contains ISMS performance expectations to guide a project team in developing and implementing an effective ISMS and in developing specific performance criteria for use in facility disposition. Appendix D provides guidance for identifying potential Applicable or Relevant and Appropriate Requirements (ARARs) when decommissioning facilities fall under the Comprehensive Environmental Response, Compensation, Liability Act (CERCLA) process. Appendix E discusses ES and H considerations for dispositioning facilities by privatization. Appendix F is an overview of the WSS process. Appendix G provides a copy of two DOE Office of Nuclear Safety Policy and Standards memoranda that form the bases for some of the guidance discussed within the Standard. Appendix H gives information on available hazard analysis techniques and references. Appendix I provides a supplemental discussion to Sections 3.3.4, Hazard Baseline Documentation, and 3.3.6, Environmental Permits. Appendix J presents a sample readiness evaluation checklist

  10. Evaluation of a novel trocar-site closure and comparison with a standard Carter-Thomason closure device.

    Science.gov (United States)

    del Junco, Michael; Okhunov, Zhamshid; Juncal, Samuel; Yoon, Renai; Landman, Jaime

    2014-07-01

    The aim of this study was to evaluate and compare a novel trocars-site closure device, the WECK EFx™ Endo Fascial Closure System (EFx) with the Carter-Thomason CloseSure System® (CT) for the closure of laparoscopic trocar site defects created by a 12-mm dilating trocar. We created standardized laparoscopic trocars-site abdominal wall defects in cadaver models using a standard 12-mm laparoscopic dilating trocar. Trocar defects were closed in a randomized fashion using one of the two closure systems. We recorded time and number of attempts needed for complete defect closure. In addition, we recorded the ability to maintain pneumoperitoneum, endoscopic visualization, safety, security, and facility based on the surgeon's subjective evaluations. We compared outcomes for the EFx and CT closure systems. We created 72 standardized laparoscopic trocars-site abdominal wall defects. The mean time needed for complete defect closure was 98.53 seconds (±28.9) for the EFx compared with 133.61 seconds (±54.61) for the CT (Psafety were 2.92 for EFx vs 2.19 for CT (Pvs 1.83 for EFx and CT, respectively (Pvs 2.33 for CT (P=0.022). No significant difference was observed between the EFx and the CT systems for endoscopic visualization (2.28 vs 2.50, P=0.080). In this in vitro cadaver trial, the EFx was superior in terms of time needed to complete defect closure, safety, and facility. CT was superior in terms of maintenance of pneumoperitoneum. Both systems were equal in the number of attempts needed to complete the defect closure and endoscopic visualization.

  11. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana.

    Science.gov (United States)

    Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

    2016-09-21

    Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

  12. Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case Study of Mama Lucy Kibaki Hosptal

    Science.gov (United States)

    Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M.

    2015-01-01

    Health service delivery is a key pillar of the health system management .The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers . Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014 .The key informants were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview guide and focused

  13. Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case Study of Mama Lucy Kibaki Hospital.

    Science.gov (United States)

    Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M

    2015-03-25

    Health service delivery is a key pillar of the health system management. The World Health Organization recently emphasized the need to develop adolescent -friendly health services to improve the care provided to young people throughout the world. However, there is limited peer reviewed literature on this subject therefore necessitating assessment of whether the existing health facilities are prepared to implement the adolescent friendly health services. Adolescent friendly health services remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. After International Conference on Population and Development in 1994, countries started implementing adolescent friendly health services. The Government of Kenya together with partners in an attempt to address the health challenges came up with the Adolescent package of care (APOC) in 2013 whose guidelines were finalized in November 2014 and released for use by service providers . Despite this package of care, there is still ineffective staff capacity in relation to skills and knowledge gap of health professionals, training needs, health resources as well as health system factors that can affect implementation of AFHS. The study explored ways of mitigating or addressing the barriers to implementation of these services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 348 health care providers and 472 adolescents in Mam Lucy Kibaki Hospital from 3rd May 2014 to 16 June 2014. The key informants were mainly nurses, clinical officers and Medical doctors who were working at the health service delivery area at the time of study and were interviewed using an interview guide. The managers at the hospital were interviewed using an in-depth interview guide while the adolescents were interviewed through interview guide and focused

  14. Multilevel examination of facility characteristics, social integration, and health for older adults living in nursing homes.

    Science.gov (United States)

    Leedahl, Skye N; Chapin, Rosemary K; Little, Todd D

    2015-01-01

    Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes. Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff. The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes. To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia

    Directory of Open Access Journals (Sweden)

    Alessandra N. Bazzano

    2016-12-01

    Full Text Available Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming.

  16. Nursing Administrators' Views on Oral Health in Long-Term Care Facilities: An exploratory study.

    Science.gov (United States)

    Urata, Janelle Y; Couch, Elizabeth T; Walsh, Margaret M; Rowe, Dorothy J

    2018-04-01

    Purpose: To explore the knowledge, attitudes, and practices of supervising nurse administrators (SNAs) regarding the oral care provided to long-term care facility (LTCF) residents and the role of dental professionals in those facilities. Methods: The investigators of this study partnered with the National Association of Nursing Administrators to send this cross-sectional study consisting of a 35-item electronic survey to its members whose email addresses were in their database. Online software tabulated responses and calculated frequencies (percentages) of responses for each survey item. Results: Of the 2,359 potential participants, 171 (n=171) completed the survey for a 7% response rate. Only 25% of the respondents were familiar with the expertise of dental hygienists (DHs), however once informed, the majority were interested in having DHs perform oral health staff trainings, oral screenings, and dental referrals and initiate fluoride varnish programs. Most respondents correctly answered the oral health-related knowledge items, understood that oral health is important to general health, but reported that the LTCF residents' oral health was only "good" or "fair." Fewer than half, (48%) of the SNAs were "very satisfied" with the quality of oral care provided to the residents. While more than half reported that they had no dentist on staff or on-site dental equipment, 77% reported that they would consider on-site mobile oral care services. Oral health training for staff was provided primarily by registered nurses, however only 32% reported including identification of dental caries as part of the in-service training. Conclusion: This exploratory study lays the foundation for more extensive research investigating various strategies to improve the oral health of LTCF residents, including increased collaboration between DHs and SNAs. Copyright © 2018 The American Dental Hygienists’ Association.

  17. Social and cultural dimensions of hygiene in Cambodian health care facilities

    Directory of Open Access Journals (Sweden)

    Faurand-Tournaire Anne-Laure

    2011-02-01

    Full Text Available Abstract Background The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. Methods We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors and with patients who attended the study health facilities. Results Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1 informal and formal social rapports in hospitals, (2 major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Conclusion Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.

  18. Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review.

    Science.gov (United States)

    Neo, Jun Rong Jeffrey; Sagha-Zadeh, Rana; Vielemeyer, Ole; Franklin, Ella

    2016-06-01

    Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc

  19. The Rising Rate of Rural Hospital Closures.

    Science.gov (United States)

    Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

    2016-01-01

    Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

  20. The Oral Health Care Manager in a Patient-Centered Health Facility.

    Science.gov (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

    2016-06-01

    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A study on closure performance in geological disposal of high-level radioactive waste (H14)

    International Nuclear Information System (INIS)

    Sugita, Yutaka; Kawakami, Susumu; Yui, Mikazu; Makino, Hitoshi; Sawada, Atsushi; Kurihara, Yuji; Mihara, Morihiro

    2003-04-01

    Regarding closure technology of underground facilities in geological disposal of the HLW in H12 report, the fundamental concept that closure technology has no impact against the engineered barrier system (EBS) was described. Performance Assessment (PA) has been performed without considering of the barrier function of closure elements. Following H12 report, the various in-situ data of the closure elements (ex. plug, backfill) have been obtained. Therefore, we considered that the PA of the EBS considering the expecting performance of the closure elements from the view points of both the engineering technology and the PA should be examined. First, the characteristics of rock mass and the function of the closure elements were summarized. Then, the closure scenario was developed preliminarily based on hydrological analysis between a hydraulic fracture and a disposal panel, the fault tree analysis, and so on. (author)

  2. Small Water Enterprise in Rural Rwanda: Business Development and Year-One Performance Evaluation of Nine Water Kiosks at Health Care Facilities.

    Science.gov (United States)

    Huttinger, Alexandra; Brunson, Laura; Moe, Christine L; Roha, Kristin; Ngirimpuhwe, Providence; Mfura, Leodomir; Kayigamba, Felix; Ciza, Philbert; Dreibelbis, Robert

    2017-12-16

    Small water enterprises (SWEs) have lower capital expenditures than centralized systems, offering decentralized solutions for rural markets. This study evaluated SWEs in rural Rwanda, where nine health care facilities (HCF) owned and operated water kiosks supplying water from onsite water treatment systems (WTS). SWEs were monitored for 12 months. Spearman's Rank Correlation Coefficient (r s ) was used to evaluate correlations between demand for kiosk water and community characteristics, and between kiosk profit and factors influencing the cost model. On average, SWEs distributed 15,300 L/month. One SWE ran at a loss, four had profit margins of ≤10% and four had profit margins of 45-75%. Factors influencing SWE performance were intermittent water supply (87% of SWE closures were due to water shortage), consumer demand (demand was high where populations already used improved water sources (r s = 0.81, p = 0.02)), price sensitivity (demand was lower where SWEs had high prices (r s = -0.65, p = 0.08)), and production cost (water utility tariffs negatively impacted SWE profits (r s = -0.52, p Future research is needed to assess the extent to which kiosk revenue can support ongoing operational costs of WTS and kiosks both at HCF and in other contexts.

  3. Small Water Enterprise in Rural Rwanda: Business Development and Year-One Performance Evaluation of Nine Water Kiosks at Health Care Facilities

    Directory of Open Access Journals (Sweden)

    Alexandra Huttinger

    2017-12-01

    Full Text Available Small water enterprises (SWEs have lower capital expenditures than centralized systems, offering decentralized solutions for rural markets. This study evaluated SWEs in rural Rwanda, where nine health care facilities (HCF owned and operated water kiosks supplying water from onsite water treatment systems (WTS. SWEs were monitored for 12 months. Spearman’s Rank Correlation Coefficient (rs was used to evaluate correlations between demand for kiosk water and community characteristics, and between kiosk profit and factors influencing the cost model. On average, SWEs distributed 15,300 L/month. One SWE ran at a loss, four had profit margins of ≤10% and four had profit margins of 45–75%. Factors influencing SWE performance were intermittent water supply (87% of SWE closures were due to water shortage, consumer demand (demand was high where populations already used improved water sources (rs = 0.81, p = 0.02, price sensitivity (demand was lower where SWEs had high prices (rs = −0.65, p = 0.08, and production cost (water utility tariffs negatively impacted SWE profits (rs = −0.52, p < 0.01. Sustainability was more favorable in circumstances where recovery of capital expenditures was not expected, and the demand for treated water was sufficient to fund operational expenditures. Future research is needed to assess the extent to which kiosk revenue can support ongoing operational costs of WTS and kiosks both at HCF and in other contexts.

  4. Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees.

    Science.gov (United States)

    Lodenstein, Elsbet; Mafuta, Eric; Kpatchavi, Adolphe C; Servais, Jean; Dieleman, Marjolein; Broerse, Jacqueline E W; Barry, Alpha Amadou Bano; Mambu, Thérèse M N; Toonen, Jurrien

    2017-06-13

    Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the (past) presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities. Most HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC members does not seem to affect HFC engagement in social accountability. Most HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and

  5. 203: THE RELATIONSHIP BETWEEN LEADERSHIP STYLES AND HEALTH WORKER MOTIVATION, TEAMWORK AND JOB SATISFACTION IN HEALTH FACILITIES IN UGANDA

    Science.gov (United States)

    Musinguzi, Conrad; Rutebemberwa, Elizeus; Namale, Leticia; Dahal, Aruna

    2017-01-01

    Background and aims Some studies have shown that poor leadership is associated with lack of effective teamwork and a demotivated workforce leading to poor service delivery. There is scanty data in Uganda on how leadership styles relate to service delivery. This study was done to identify the leadership style in health facilities in Uganda and their relationship with health workers' motivation, job satisfaction and teamwork. Methods A cross-sectional study was conducted in eastern, Rwenzori and west Nile regions of Uganda in November 2015 using self-administered questionnaires distributed and picked the same day from 564 health workers in 270 health facilities. These questionnaires collected information on the health workers' perception of leadership styles of their facility in-charges, their level of motivation and job satisfaction; and the level of team work. Factor analysis was used to identify and confirm latent variables for constructs on leadership styles, motivation, job satisfaction and team work. Relationships were assessed using Pearson correlation. Results A total of 368/564 (64.3%) health workers indicated that transformational leadership was frequent or fairly often, while for transactional leadership it was 304/564 (54.4%) and laissez faire, it was 64/564 (11.4%). There was high correlation between transformational leadership with job satisfaction (r=0.31) and team work (r=0.47) and less correlation with motivation (r=0.18). Transactional leadership was highly correlated with teamwork (r=0.45) but low correlation with motivation (r=0.20) and job satisfaction (r=0.25). Laissez was negatively correlated with motivation at (r=−0.0002), job satisfaction (r=−0.21) and team work (r=−0.19). Conclusion Health workers who perceived their leaders to display transformational leadership had a strong likelihood of being satisfied with their jobs and working in teams. However, those who perceived their in-charges as having a laissez faire leadership style were

  6. When More is Less: The Case of Disconnected Information Systems in Indonesian Public Health Facilities

    Science.gov (United States)

    Wahid, Fathul; Teduh Dirgahayu, Raden; Hamzah, Almed; Setiaji, Hari

    2018-03-01

    The clear majority of previous studies have found that the absence of information systems to properly manage data is one of the main challenges in improving public health management. The present study offers an alternate perspective, revealing other emerging problems in cases where there are many information systems in place but without sufficient orchestration. The national government of Indonesia has been coercive in its implementation of various information systems without involving users at public health facilities, which has created many problems on the ground. The problems identified relate to the quality of the disconnected information systems currently in use, the lack of human resource development, unclear procedures, uncoordinated reports and the absence of an incentive scheme. The present study also highlights some practical implications, including the use of a more holistic perspective in designing and developing an integrated public health information infrastructure.

  7. Adopting and implementing nutrition guidelines in recreational facilities: tensions between public health and corporate profitability.

    Science.gov (United States)

    Olstad, Dana Lee; Raine, Kim D; McCargar, Linda J

    2013-05-01

    Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities. In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis. Food services in recreational facilities. Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters). Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete. Public-private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

  8. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  9. Newborn care practices at home and in health facilities in 4 regions of Ethiopia.

    Science.gov (United States)

    Callaghan-Koru, Jennifer A; Seifu, Abiy; Tholandi, Maya; de Graft-Johnson, Joseph; Daniel, Ephrem; Rawlins, Barbara; Worku, Bogale; Baqui, Abdullah H

    2013-12-01

    Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered

  10. High prevalence of workplace violence among nurses working at public health facilities in Southern Ethiopia.

    Science.gov (United States)

    Fute, Mathewos; Mengesha, Zelalem Birhanu; Wakgari, Negash; Tessema, Gizachew Assefa

    2015-01-01

    The rising rate of workplace violence in health care facilities has become a major problem for health care providers including nurses. However, evidences are lacking in Ethiopia particularly in the study area. The aim of this study is to assess the prevalence and associated factors of workplace violence among nurses working at health care facilities in Hawassa City Administration, Southern Ethiopia. An institution-based cross-sectional study was conducted on 660 randomly selected nurses working at public health facilities in Hawassa City Administration in April 2014. A pre-tested and structured questionnaire was used to collect the data. Data were entered using EPI-Info and exported to SPSS for further analysis. Descriptive statistics were done. Logistic regression analyses were used to see the association between different variables and the outcome variable. Odds ratios with 95% Confidence Interval (CI) were computed to determine the presence and strength of the association. In this study, the prevalence of workplace violence was 29.9% [95% CI: 26.5, 33.5)] of which physical violence accounted for 36 (18.22%), verbal abuse for 172 (89.58%) and sexual harassment for 25 (13.02%). Female sex [AOR=2.00, 95% CI: (1.28, 2.39)], short work experience [AOR=8.86, 95% CI: (3.47, 22.64)], age group of 22-25 [AOR=4.17, 95% CI: (2.46, 7.08)], age group of (26-35) [AOR=1.9, 95% CI (1.16, 3.1)], work in emergency [(AOR=4.28, 95% CI: (1.39, 4.34)] and work in the Inpatient Department [(AOR=2.11, 95% CI: (1.98, 2.64)] were the factors positively associated with workplace violence. A significant proportion of nurses faced violence while providing care at in public health facilities. Being female, younger age, short work experience, and assignment in emergency and inpatient departments were positively associated with workplace violence. Policy makers and stakeholders should focus on workplace violence prevention strategies.

  11. University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

    Directory of Open Access Journals (Sweden)

    Mokgobadibe V. Ntsiea

    2017-06-01

    Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

  12. RELAP-7 Closure Correlations

    Energy Technology Data Exchange (ETDEWEB)

    Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-04-01

    The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

  13. Urethrovaginal fistula closure.

    Science.gov (United States)

    Clifton, Marisa M; Goldman, Howard B

    2017-01-01

    In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.

  14. Induced abortion and associated factors in health facilities of Guraghe zone, southern Ethiopia.

    Science.gov (United States)

    Tesfaye, Gezahegn; Hambisa, Mitiku Teshome; Semahegn, Agumasie

    2014-01-01

    Unsafe abortion is one of the major medical and public health problems in developing countries including Ethiopia. However, there is a lack of up-to-date and reliable information on induced abortion distribution and its determinant factors in the country. This study was intended to assess induced abortion and associated factors in health facilities of Guraghe zone, Southern Ethiopia. Institution based cross-sectional study was conducted in eight health facilities in Guraghe zone. Client exit interview was conducted on 400 patients using a structured questionnaire. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with induced abortion. Out of 400 women, 75.5% responded that the current pregnancy that ended in abortion is unwanted. However, only 12.3% of the respondents have admitted interference to the current pregnancy. Having more than four pregnancies (AOR = 4.28, CI: (1.24-14.71)), age of 30-34 years (AOR = 0.15, CI: (0.04-0.55)), primary education (AOR = 0.26, CI: (0.13-0.88)), and wanted pregnancy (AOR = 0.44, CI: (0.14-0.65)) were found to have association with induced abortion. The study revealed high level of induced abortion which is underpinned by high magnitude of unwanted pregnancy. There is requirement for widespread expansion of increased access to high quality family planning service and post-abortion care.

  15. Guidance for closure of existing DOE LLW disposal sites

    International Nuclear Information System (INIS)

    Blanchfield, L.

    1987-01-01

    During FY 1986, a closure guidance document was developed. The purpose of this document is to provide guidance in support of DOE Order 5820.2 to site operating contractors for the stabilization and closure of existing low-level waste (LLW) shallow land disposal sites at US Department of Energy (DOE) facilities. Guidance is provided to aid operators in placing existing LLW sites in a closed conditions, i.e., a condition in which a nonoperational site meets postclosure performance requirements and can be shown, within a high degree of confidence, to perform as anticipated in the future, under the most cost-effective maintenance approach. Guidance is based on the philosophy that closure should be planned and performed using a systems approach. Plans for FY 1987 call for revision of the document to incorporate more information on closure of LLW sites also containing radioactive mixed waste and/or transuranic waste. 4 references, 3 figures, 2 tables

  16. Utility of health facility-based malaria data for malaria surveillance.

    Directory of Open Access Journals (Sweden)

    Yaw A Afrane

    Full Text Available Currently, intensive malaria control programs are being implemented in Africa to reduce the malaria burden. Clinical malaria data from hospitals are valuable for monitoring trends in malaria morbidity and for evaluating the impacts of these interventions. However, the reliability of hospital-based data for true malaria incidence is often questioned because of diagnosis accuracy issues and variation in access to healthcare facilities among sub-groups of the population. This study investigated how diagnosis and treatment practices of malaria cases in hospitals affect reliability of hospital malaria data.The study was undertaken in health facilities in western Kenya. A total of 3,569 blood smears were analyzed after being collected from patients who were requested by clinicians to go to the hospital's laboratory for malaria testing. We applied several quality control measures for clinical malaria diagnosis. We compared our slide reading results with those from the hospital technicians. Among the 3,390 patients whose diagnoses were analyzed, only 36% had clinical malaria defined as presence of any level of parasitaemia and fever. Sensitivity and specificity of clinicians' diagnoses were 60.1% (95% CI: 61.1-67.5 and 75.0% (95% CI: 30.8-35.7, respectively. Among the 980 patients presumptively treated with an anti-malarial by the clinicians without laboratory diagnosis, only 47% had clinical malaria.These findings revealed substantial over-prescription of anti-malarials and misdiagnosis of clinical malaria. More than half of the febrile cases were not truly clinical malaria, but were wrongly diagnosed and treated as such. Deficiency in malaria diagnosis makes health facility data unreliable for monitoring trends in malaria morbidity and for evaluating impacts of malaria interventions. Improving malaria diagnosis should be a top priority in rural African health centers.

  17. The influence of facility design and human resource management on health care professionals.

    Science.gov (United States)

    Sadatsafavi, Hessam; Walewski, John; Shepley, Mardelle M

    2015-01-01

    Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels

  18. LDS hospital, a facility of Intermountain Health Care, Salt Lake City, Utah.

    Science.gov (United States)

    Peck, M; Nelson, N; Buxton, R; Bushnell, J; Dahle, M; Rosebrock, B; Ashton, C A

    1997-01-01

    On-line documentation by nurses and a comprehensive text management system are functional in several facilities of intermountain Health Care (IHC). The following articles detail factors in the design and implementation of this computerized network as experienced at LDS Hospital, part of the IHC system. Areas discussed are the system's applications for medical decision support, communication, patient classification, nurse staffing versus cost, emergency department usage, patient problem/event recording, clinical outcomes, and text publication. Users express satisfaction with the time saving, consistency of reporting, and cohesiveness of these applications.

  19. Animal-assisted interventions: A national survey of health and safety policies in hospitals, eldercare facilities, and therapy animal organizations.

    Science.gov (United States)

    Linder, Deborah E; Siebens, Hannah C; Mueller, Megan K; Gibbs, Debra M; Freeman, Lisa M

    2017-08-01

    Animal-assisted intervention (AAI) programs are increasing in popularity, but it is unknown to what extent therapy animal organizations that provide AAI and the hospitals and eldercare facilities they work with implement effective animal health and safety policies to ensure safety of both animals and humans. Our study objective was to survey hospitals, eldercare facilities, and therapy animal organizations on their AAI policies and procedures. A survey of United States hospitals, eldercare facilities, and therapy animal organizations was administered to assess existing health and safety policies related to AAI programs. Forty-five eldercare facilities, 45 hospitals, and 27 therapy animal organizations were surveyed. Health and safety policies varied widely and potentially compromised human and animal safety. For example, 70% of therapy animal organizations potentially put patients at risk by allowing therapy animals eating raw meat diets to visit facilities. In general, hospitals had stricter requirements than eldercare facilities. This information suggests that there are gaps between the policies of facilities and therapy animal organizations compared with recent guidelines for animal visitation in hospitals. Facilities with AAI programs need to review their policies to address recent AAI guidelines to ensure the safety of animals and humans involved. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Revolving drug funds at front-line health facilities in Vientiane, Lao PDR.

    Science.gov (United States)

    Murakami, H; Phommasack, B; Oula, R; Sinxomphou, S

    2001-03-01

    Pharmaceutical cost recovery programmes, which have been mainly implemented in Africa, are gradually spreading to Southeast Asian countries that formerly belonged to the socialist bloc. This report describes the economic and operational realities of revolving drug funds (RDFs) at district hospitals and health centres in the capital of the Lao PDR by reviewing research conducted by the implementing department. People in the municipality spent an average of US$11 on drugs in 1996. The RDFs comprised only 3% of the total yearly drug sales in the municipality, whereas private pharmacies accounted for 75%. The RDFs were forced to operate in conjunction with the remaining government drug endowment and the thriving private pharmacies. This scheme has provided a stable supply of essential drugs. The assurance of drug availability at the front-line health facilities has resulted in increased utilization of the facilities despite the introduction of a drug fee. The cost recovery rate was 107% at health centres and 108% at district hospitals in two monitored districts during the 10 months from November 1997. Decentralized financial management was essential for cost recovery, allowing timely adjustment of selling prices as purchase prices rapidly inflated after the Asian economic crisis. The health staff observed that the people perceived drugs as everyday commodities that they should buy and take based on self-diagnosis and personal preference. Adaptation of the public health authorities to market-oriented thinking along with the establishment of pharmaceutical cost recovery occurred with few problems. However, both financial and operational management capacity at the municipal level pose a major challenge to policy clarification and scheme setting, especially in procurement, control of prescribing practices and the integration of drug dispensing with other components of quality clinical care.

  1. The Fernald Closure Project: Lessons Learned

    International Nuclear Information System (INIS)

    Murphy, Cornelius M.; Carr, Dennis

    2008-01-01

    For nearly 37 years, the U.S. Department of Energy site at Fernald - near Cincinnati, Ohio - produced 230,000 metric tons (250,000 short tons) of high-purity, low-enriched uranium for the U.S. Defense Program, generating more than 5.4 million metric tons (6 million short tons) of liquid and solid waste as it carried out its Cold War mission. The facility was shut down in 1989 and clean up began in 1992, when Fluor won the contract to clean up the site. Cleaning up Fernald and returning it to the people of Ohio was a $4.4 billion mega environmental-remediation project that was completed in October 2006. Project evolved through four phases: - Conducting remedial-investigation studies to determine the extent of damage to the environment and groundwater at, and adjacent to, the production facilities; - Selecting cleanup criteria - final end states that had to be met that protect human health and the environment; - Selecting and implementing the remedial actions to meet the cleanup goals; - Executing the work in a safe, compliant and cost-effective manner. In the early stages of the project, there were strained relationships - in fact total distrust - between the local community and the DOE as a result of aquifer contamination and potential health effects to the workers and local residents. To engage citizens and interested stakeholders groups in the decision-making process, the DOE and Fluor developed a public-participation strategy to open the channels of communication with the various parties: site leadership, technical staff and regulators. This approach proved invaluable to the success of the project, which has become a model for future environmental remediation projects. This paper will summarize the history and shares lessons learned: the completion of the uranium-production mission to the implementation of the Records of Decision defining the cleanup standards and the remedies achieved. Lessons learned fall into ten categories: - Regulatory approach with end

  2. Public perception of odour and environmental pollution attributed to MSW treatment and disposal facilities: A case study

    Energy Technology Data Exchange (ETDEWEB)

    De Feo, Giovanni, E-mail: g.defeo@unisa.it [Department of Industrial Engineering, University of Salerno, via Ponte don Melillo 1, 84084 Fisciano (Italy); De Gisi, Sabino [Department of Industrial Engineering, University of Salerno, via Ponte don Melillo 1, 84084 Fisciano (Italy); Williams, Ian D. [Waste Management Research Group, Faculty of Engineering and the Environment, University of Southampton, Highfield, Southampton SO17 1BJ (United Kingdom)

    2013-04-15

    Highlights: ► Effects of closing MSW facilities on perception of odour and pollution studied. ► Residents’ perception of odour nuisance considerably diminished post closure. ► Odour perception showed an association with distance from MSW facilities. ► Media coverage increased knowledge about MSW facilities and how they operate. ► Economic compensation possibly affected residents’ views and concerns. - Abstract: If residents’ perceptions, concerns and attitudes towards waste management facilities are either not well understood or underestimated, people can produce strong opposition that may include protest demonstrations and violent conflicts such as those experienced in the Campania Region of Italy. The aim of this study was to verify the effects of the closure of solid waste treatment and disposal facilities (two landfills and one RDF production plant) on public perception of odour and environmental pollution. The study took place in four villages in Southern Italy. Identical questionnaires were administered to residents during 2003 and after the closure of the facilities occurred in 2008. The residents’ perception of odour nuisance considerably diminished between 2003 and 2009 for the nearest villages, with odour perception showing an association with distance from the facilities. Post closure, residents had difficulty in identifying the type of smell due to the decrease in odour level. During both surveys, older residents reported most concern about the potentially adverse health impacts of long-term exposure to odours from MSW facilities. However, although awareness of MSW facilities and concern about potentially adverse health impacts varied according to the characteristics of residents in 2003, substantial media coverage produced an equalisation effect and increased knowledge about the type of facilities and how they operated. It is possible that residents of the village nearest to the facilities reported lower awareness of and concern about

  3. Public perception of odour and environmental pollution attributed to MSW treatment and disposal facilities: A case study

    International Nuclear Information System (INIS)

    De Feo, Giovanni; De Gisi, Sabino; Williams, Ian D.

    2013-01-01

    Highlights: ► Effects of closing MSW facilities on perception of odour and pollution studied. ► Residents’ perception of odour nuisance considerably diminished post closure. ► Odour perception showed an association with distance from MSW facilities. ► Media coverage increased knowledge about MSW facilities and how they operate. ► Economic compensation possibly affected residents’ views and concerns. - Abstract: If residents’ perceptions, concerns and attitudes towards waste management facilities are either not well understood or underestimated, people can produce strong opposition that may include protest demonstrations and violent conflicts such as those experienced in the Campania Region of Italy. The aim of this study was to verify the effects of the closure of solid waste treatment and disposal facilities (two landfills and one RDF production plant) on public perception of odour and environmental pollution. The study took place in four villages in Southern Italy. Identical questionnaires were administered to residents during 2003 and after the closure of the facilities occurred in 2008. The residents’ perception of odour nuisance considerably diminished between 2003 and 2009 for the nearest villages, with odour perception showing an association with distance from the facilities. Post closure, residents had difficulty in identifying the type of smell due to the decrease in odour level. During both surveys, older residents reported most concern about the potentially adverse health impacts of long-term exposure to odours from MSW facilities. However, although awareness of MSW facilities and concern about potentially adverse health impacts varied according to the characteristics of residents in 2003, substantial media coverage produced an equalisation effect and increased knowledge about the type of facilities and how they operated. It is possible that residents of the village nearest to the facilities reported lower awareness of and concern about

  4. Laser peripheral iridoplasty for angle-closure.

    Science.gov (United States)

    Ng, Wai Siene; Ang, Ghee Soon; Azuara-Blanco, Augusto

    2012-02-15

    Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.   To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012. We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations

  5. APSIC guidelines for disinfection and sterilization of instruments in health care facilities

    Directory of Open Access Journals (Sweden)

    Moi Lin Ling

    2018-02-01

    Full Text Available Abstract Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

  6. Quality management standards for facility services in the Italian health care sector.

    Science.gov (United States)

    Cesarotti, Vittorio; Di Silvio, Bruna

    2006-01-01

    Health care, one of the most dynamic sectors in Italy, is studied with a particular focus on outsourcing non-core activities such as facility management (FM) services. The project's goals are to define national standards to balance and control facility service evolution, and to drive FM services towards organisational excellence. The authors, in cooperation with a pool of facility service providers and hospitals managers, studied cleaning services--one of the most critical areas. This article describes the research steps and findings following definition and publication of the Italian standard and its application to an international benchmarking process. The method chosen for developing the Italian standard was to merge technical, strategic and organisational aspects with the goal of standardising the contracting system, giving service providers the chance to improve efficiency and quality, while helping healthcare organisations gain from a better, more reliable and less expensive service. The Italian standard not only improved services but also provided adequate control systems for outsourcing organisations. In this win-win context, it is hoped to continually drive FM services towards organisational excellence. This study is specific to the Italian national healthcare system. However, the strategic dynamics described are common to many other contexts. A systematic method for improving hospital FM services is presented. The authors believe that lessons learned from their Italian case study can be used to better understand and drive similar services in other countries or in other FM service outsourcing sectors.

  7. Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

    Science.gov (United States)

    Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

    2016-03-01

    In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in

  8. Patient-driven resource planning of a health care facility evacuation.

    Science.gov (United States)

    Petinaux, Bruno; Yadav, Kabir

    2013-04-01

    The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within

  9. Traditional Birth Attendant reorientation and Motherpacks incentive's effect on health facility delivery uptake in Narok County, Kenya: An impact analysis.

    Science.gov (United States)

    Kitui, John Emmanuel; Dutton, Vaughan; Bester, Dirk; Ndirangu, Rachel; Wangai, Susan; Ngugi, Stephen

    2017-04-21

    A community health programme in Narok County in Kenya aimed to improve skilled birth assistance during childbirth through two demand side interventions. First, traditional birth attendants (TBAs) were co-opted into using their influence to promote use of skilled birth attendants (SBAs) at health facilities during delivery, and to accompany pregnant women to health facilities in return for a Ksh500 (Approximately USD5 as of August 2016) cash incentive for each pregnant mother they accompanied. Secondly, a free Motherpack consisting of a range of baby care items was given to each mother after delivering at a health facility. This paper estimates the impact of these two interventions on trends of facility deliveries over a 36-month period here. Dependency or inferred causality was estimated between reorientation of TBAs and provision of Motherpacks with changes in facility delivery numbers. The outcome variable consists of monthly facility delivery data from 28 health facilities starting from January 2013 to December 2015 obtained from the District Health Information Systems 2 (DHIS2). Data were collected on the 13th, 14th or 15th of each month, resulting in a total of 35 collections, over 35 months. The intervention data consisted of the starting month for each of the two interventions at each of the 28 facilities. A negative binomial generalized linear model framework is applied to model the relationship as all variables were measured as count data and were overdispersed. All analyses were conducted using R software. During the 35 months considered, a total of 9095 health facility deliveries took place, a total of 408 TBAs were reached, and 2181 Motherpacks were distributed. The reorientation of TBAs was significant (p = 0.009), as was the provision of Motherpacks (p = .0001). The number of months that passed since the start of the intervention was also found to be significant (p = 0.033). The introduction of Motherpacks had the greatest effect on the

  10. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

    2015-01-01

    Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, pquality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced

  11. The impact of health information technology adoption by outpatient facilities on pregnancy outcomes.

    Science.gov (United States)

    Deily, Mary E; Hu, Tianyan; Terrizzi, Sabrina; Chou, Shin-Yi; Meyerhoefer, Chad D

    2013-02-01

    Examine whether health information technology (HIT) at nonhospital facilities (NHFs) improves health outcomes and decreases resource use at hospitals within the same heath care network, and whether the impact of HIT varies as providers gain experience using the technologies. Administrative claims data on 491,832 births in Pennsylvania during 1998-2004 from the Pennsylvania Health Care Cost Containment Council and HIT applications data from the Dorenfest Institute. Fixed-effects regression analysis of the impact of HIT at NHFs on adverse birth outcomes and resource use. Greater use of clinical HIT applications by NHFs is associated with reduced incidence of obstetric trauma and preventable complications, as well as longer lengths of stay. In addition, the beneficial effects of HIT increase the longer that technologies have been in use. However, we find no consistent evidence on whether or how nonclinical HIT in NHFs affects either resource use or health outcomes. Clinical HIT applications at NHFs may reduce the likelihood of adverse birth outcomes, particularly after physicians and staff gain experience using the technologies. © Health Research and Educational Trust.

  12. Prevalence of pregnancy-related complications and course of labour of surviving women who gave birth in selected health facilities in Rwanda: a health facility-based, cross-sectional study.

    Science.gov (United States)

    Semasaka Sengoma, Jean Paul; Krantz, Gunilla; Nzayirambaho, Manasse; Munyanshongore, Cyprien; Edvardsson, Kristina; Mogren, Ingrid

    2017-07-09

    This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes. This is health facility-based study and data were collected in 2014-2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes. Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility. The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

  13. Quality of antiretroviral therapy in public health facilities in Nigeria and perceptions of end users.

    Science.gov (United States)

    Chiegil, Robert J; Zungu, Lindiwe I; Jooste, Karien

    2014-04-01

    This paper describes perceptions of the end users on quality of antiretroviral therapy (ART) in public health facilities in Nigeria. Health care services in Nigeria face challenges of meeting end users' requirements and expectations for quality ART service provision. A qualitative design was followed. Unstructured focus group discussions were conducted with end users (n = 64) in six locations across the six geopolitical zones of Nigeria. The findings indicate that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV. A best practice guideline for the provision of end user focused ART service provision was developed for nurse managers. © 2013 John Wiley & Sons Ltd.

  14. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

    Science.gov (United States)

    Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

    2017-07-11

    There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

  15. Capacity of Health Facilities to Manage Hypertension in Mukono and Buikwe Districts in Uganda: Challenges and Recommendations.

    Science.gov (United States)

    Musinguzi, Geofrey; Bastiaens, Hilde; Wanyenze, Rhoda K; Mukose, Aggrey; Van Geertruyden, Jean-Pierre; Nuwaha, Fred

    2015-01-01

    The burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda. In a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations. Of the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5, 1.9%) indicated that they

  16. The 300 area waste acid treatment system closure plan

    International Nuclear Information System (INIS)

    Luke, S.N.

    1996-01-01

    The 300 Area Waste Acid Treatment System (WATS) is located within operable units 300-FF-2 (source) and 300-FF-5 (groundwater), as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) . Operable units 300-FF-2 and 300-FF-5 are scheduled to be remediated using the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) Remedial Investigation/Feasibility Study (RI/FS) process. Thus, any remediation of the 300 Area WATS with respect to contaminants not produced by those facilities and soils and groundwater will be deferred to the CERCLA RI/FS process. Final closure activities will be completed in 3 phases and certified in accordance with the 300 Area WATS closure plan by the Washington State Department of Ecology (Ecology) and the U.S. Environmental Protection Agency (EPA). It is anticipated that the 300 Area WATS closure would take 2 years to complete

  17. Nevada Test Site closure program

    International Nuclear Information System (INIS)

    Shenk, D.P.

    1994-08-01

    This report is a summary of the history, design and development, procurement, fabrication, installation and operation of the closures used as containment devices on underground nuclear tests at the Nevada Test Site. It also addresses the closure program mothball and start-up procedures. The Closure Program Document Index and equipment inventories, included as appendices, serve as location directories for future document reference and equipment use

  18. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

    de Faria, Pedro; Sofka, Wolfgang; Torres Preto, Miguel

    2013-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...... country but is also distant and therefore difficult to absorb. We predict an inverse u-shaped relationship between the exposure to foreign knowledge and the salary in the new job. We empirically support our predictions for a sample of almost 140,000 affected employees in Portugal from 2002 to 2009....

  19. Closure Report for Corrective Action Unit 553: Areas 19, 20 Mud Pits and Cellars, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Al Wickline

    2007-01-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 553: Areas 19, 20 Mud Pits and Cellars, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The corrective action sites (CASs) within CAU 553 are located within Areas 19 and 20 of the Nevada Test Site. Corrective Action Unit 553 is comprised of the following CASs: 19-99-01, Mud Spill 19-99-11, Mud Spill 20-09-09, Mud Spill 20-99-03, Mud Spill. The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CASs within CAU 553 were met. To achieve this, the following actions were or will be performed: Review the current site conditions including the concentration and extent of contamination. Implement any corrective actions necessary to protect human health and the environment. Properly dispose of corrective action and investigation wastes. Document the Notice of Completion and closure of CAU 553 to be issued by Nevada Division of Environmental Protection

  20. Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

    Science.gov (United States)

    Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

    2016-03-01

    Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

  1. Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    Kalaiselvi Selvaraj

    2016-01-01

    Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services.

  2. Oral health care in older people in long term care facilities : A systematic review of implementation strategies

    NARCIS (Netherlands)

    Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.

    Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the

  3. Chernobyl: closure by 2000

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    Discussions on the future of the Chernobyl nuclear plant between the Ukrainian government, the Group of Seven Industrial nations (GT) and the European Union (EU) are summarized. At the G7 meeting, a timetable for the closure of the entire station by 2000 was presented by Ukrainian officials. The timetable depends on financial commitments from Western governments. Without these, the project would take 10 to 15 years. Following this meeting, which took place on 16-17th May 1995. EU finance ministers authorized release of a ECU 85 million loan. On 23 May, the European Parliament's Committee on Research, Technology and Energy held a public hearing on the Chernobyl station. The primary topic was a feasibility study on the clean-up of Chernobyl 4 and plans for the sarcophagus. Other matters discussed included the effect of the delays and indecision in settling the plants's future. Safety improvements being made to other RBMKs were not being carried out at Chernobyl because of the expected closure. The replacement of the power now supplied to the Ukraine by the Chernobyl reactors is also an issue. The solution favoured by the Ukraine is to being on-line three VVER-1000s that are currently close to completion. Western governments find this solution difficult to accept, however. (UK)

  4. Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.

    Science.gov (United States)

    Cronk, Ryan; Bartram, Jamie

    2018-04-01

    Safe environmental conditions and the availability of standard precaution items are important to prevent and treat infection in health care facilities (HCFs) and to achieve Sustainable Development Goal (SDG) targets for health and water, sanitation, and hygiene. Baseline coverage estimates for HCFs have yet to be formed for the SDGs; and there is little evidence describing inequalities in coverage. To address this, we produced the first coverage estimates of environmental conditions and standard precaution items in HCFs in low- and middle-income countries (LMICs); and explored factors associated with low coverage. Data from monitoring reports and peer-reviewed literature were systematically compiled; and information on conditions, service levels, and inequalities tabulated. We used logistic regression to identify factors associated with low coverage. Data for 21 indicators of environmental conditions and standard precaution items were compiled from 78 LMICs which were representative of 129,557 HCFs. 50% of HCFs lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, 73% lack sterilization equipment, and 59% lack reliable energy services. Using nationally representative data from six countries, 2% of HCFs provide all four of water, sanitation, hygiene, and waste management services. Statistically significant inequalities in coverage exist between HCFs by: urban-rural setting, managing authority, facility type, and sub-national administrative unit. We identified important, previously undocumented inequalities and environmental health challenges faced by HCFs in LMICs. The information and analyses provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources. Copyright © 2018 The Authors. Published by Elsevier GmbH.. All rights reserved.

  5. 40 CFR 265.118 - Post-closure plan; amendment of plan.

    Science.gov (United States)

    2010-07-01

    ... mail. In addition, for facilities without approved post-closure plans, it must also be provided during... requirements. At the end of the specified period of suspension, the Regional Ad-min-is-tra-tor would then...

  6. Tight closure and vanishing theorems

    International Nuclear Information System (INIS)

    Smith, K.E.

    2001-01-01

    Tight closure has become a thriving branch of commutative algebra since it was first introduced by Mel Hochster and Craig Huneke in 1986. Over the past few years, it has become increasingly clear that tight closure has deep connections with complex algebraic geometry as well, especially with those areas of algebraic geometry where vanishing theorems play a starring role. The purpose of these lectures is to introduce tight closure and to explain some of these connections with algebraic geometry. Tight closure is basically a technique for harnessing the power of the Frobenius map. The use of the Frobenius map to prove theorems about complex algebraic varieties is a familiar technique in algebraic geometry, so it should perhaps come as no surprise that tight closure is applicable to algebraic geometry. On the other hand, it seems that so far we are only seeing the tip of a large and very beautiful iceberg in terms of tight closure's interpretation and applications to algebraic geometry. Interestingly, although tight closure is a 'characteristic p' tool, many of the problems where tight closure has proved useful have also yielded to analytic (L2) techniques. Despite some striking parallels, there had been no specific result directly linking tight closure and L∼ techniques. Recently, however, the equivalence of an ideal central to the theory of tight closure was shown to be equivalent to a certain 'multiplier ideal' first defined using L2 methods. Presumably, deeper connections will continue to emerge. There are two main types of problems for which tight closure has been helpful: in identifying nice structure and in establishing uniform behavior. The original algebraic applications of tight closure include, for example, a quick proof of the Hochster-Roberts theorem on the Cohen-Macaulayness of rings of invariants, and also a refined version of the Brianqon-Skoda theorem on the uniform behaviour of integral closures of powers of ideals. More recent, geometric

  7. Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh.

    Science.gov (United States)

    Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Keith P; Christian, Parul

    2015-01-31

    Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision. Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints. The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in

  8. Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala.

    Science.gov (United States)

    Cerón, Alejandro; Ruano, Ana Lorena; Sánchez, Silvia; Chew, Aiken S; Díaz, Diego; Hernández, Alison; Flores, Walter

    2016-05-13

    Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities. A participatory approach was used, involving CEGSS's researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis. Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants. Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public

  9. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda

    Science.gov (United States)

    Dhillon, Ranu S.; Bonds, Matthew H.; Fraden, Max; Ndahiro, Donald; Ruxin, Josh

    2011-01-01

    This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five ‘imidugudu’ or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights. PMID:21732708

  10. Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria.

    Directory of Open Access Journals (Sweden)

    Sanni Yaya

    Full Text Available Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women's access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility.Cross-sectional data on 37,086 community dwelling women aged between 15-49 years were collected from DHS surveys in Ethiopia (n = 13,053 and Nigeria (n = 24,033. Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1 Cost too much 2 Facility not open, 3 Too far/no transport, 4 don't trust facility/poor service, 5 No female provider, 6 Husband/family didn't allow, 7 Not necessary, 8 Not customary. Multivariable regression methods were used for measuring the associations.In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3-57.9 in Nigeria and 45.4% (42.0-47.5 in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high.Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation

  11. Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria.

    Science.gov (United States)

    Yaya, Sanni; Bishwajit, Ghose; Uthman, Olalekan A; Amouzou, Agbessi

    2018-01-01

    Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women's access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Cross-sectional data on 37,086 community dwelling women aged between 15-49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don't trust facility/poor service, 5) No female provider, 6) Husband/family didn't allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3-57.9) in Nigeria and 45.4% (42.0-47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and

  12. HealthSouth's inpatient rehabilitation facilities: how does their performance compare with other for-profit and nonprofit inpatient rehabilitation facilities?

    Science.gov (United States)

    McCue, Michael J; Thompson, Jon M

    2010-05-01

    To assess the financial and operational differences in freestanding inpatient rehabilitation facilities (IRFs) that are operated by HealthSouth Corporation relative to other for-profit and nonprofit system-affiliated ownership groups. Since 2003, when it faced fraud charges and financial penalties, HealthSouth has experienced new management and refocused its business strategy. Because HealthSouth is the largest provider of freestanding IRF services, it is important to understand how their performance may differ relative to other ownership groups. We used the Mann-Whitney U test to assess differences in median values for financial and operational variables of HealthSouth-owned IRFs compared with other for-profit system IRFs and nonprofit system IRFs. System-affiliated freestanding IRFs in the United States. Sixty-four HealthSouth IRFs, 18 nonprofit system-affiliated IRFs, and 18 for-profit system-affiliated IRFs. Not applicable. Net patient revenue per adjusted discharge, operating expense per adjusted discharge, salary expense per full-time equivalent, and cash flow margin. HealthSouth IRFs had significantly lower net patient revenue per adjusted discharge and operating expense per adjusted discharge; however, its cash flow margin was significantly higher than other comparison groups. HealthSouth IRFs treated a higher case mix of patients relative to these comparison groups. The financial and operating performance of HealthSouth IRFs is stronger than other ownership groups. Strong cash flow will enable HealthSouth to pay down long-term debt.

  13. Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

    Science.gov (United States)

    Dahlkvist, Eva; Hartig, Terry; Nilsson, Annika; Högberg, Hans; Skovdahl, Kirsti; Engström, Maria

    2016-09-01

    To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. A multi-level, cross-sectional, correlational design. Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  14. Are Health Facility Management Committees in Kenya ready to implement financial management tasks: findings from a nationally representative survey.

    Science.gov (United States)

    Waweru, Evelyn; Opwora, Antony; Toda, Mitsuru; Fegan, Greg; Edwards, Tansy; Goodman, Catherine; Molyneux, Sassy

    2013-10-10

    Community participation in peripheral public health facilities has in many countries focused on including community representatives in Health Facility Management Committees (HFMCs). In Kenya, HFMC roles are being expanded with the phased implementation of the Health Sector Services Fund (HSSF). Under HSSF, HFMCs manage facility funds which are dispersed directly from central level into facility bank accounts. We assessed how prepared HFMCs were to undertake this new role in advance of HSSF roll out, and considered the implications for Kenya and other similar settings. Data were collected through a nationally representative sample of 248 public health centres and dispensaries in 24 districts in 2010. Data collection included surveys with in-charges (n = 248), HFMC members (n = 464) and facility users (n = 698), and record reviews. These data were supplemented by semi-structured interviews with district health managers in each district. Some findings supported preparedness of HFMCs to take on their new roles. Most facilities had bank accounts and HFMCs which met regularly. HFMC members and in-charges generally reported positive relationships, and HFMC members expressed high levels of motivation and job satisfaction. Challenges included users' low awareness of HFMCs, lack of training and clarity in roles among HFMCs, and some indications of strained relations with in-charges. Such challenges are likely to be common to many similar settings, and are therefore important considerations for any health facility based initiatives involving HFMCs. Most HFMCs have the basic requirements to operate. However to manage their own budgets effectively and meet their allocated roles in HSSF implementation, greater emphasis is needed on financial management training, targeted supportive supervision, and greater community awareness and participation. Once new budget management roles are fully established, qualitative and quantitative research on how HFMCs are adapting to

  15. Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda

    DEFF Research Database (Denmark)

    Rutebemberwa, Elizeus; Buregyeya, Esther; Lal, Sham

    2016-01-01

    keeping, essential drugs for the treatment of malaria, pneumonia and diarrhoea; the sex, level of education, professional and in-service training of the persons found attending to patients in these facilities. A comparison was made between urban and rural facilities. Univariate and bivariate analysis...... was done. RESULTS: A total of 241 private facilities were assessed with only 47 (19.5 %) being in rural areas. Compared to urban areas, rural private facilities were more likely to be drug shops (OR 2.80; 95 % CI 1.23-7.11), less likely to be registered (OR 0.31; 95 % CI 0.16-0.60), not have trained...... attended to at least one sick child in the week prior to the interview. CONCLUSION: There were big gaps between rural and urban private facilities with rural ones having less trained personnel and less zinc tablets' availability. In both rural and urban areas, record keeping was low. Child health...

  16. Multipass mining sequence room closures: In situ data report

    International Nuclear Information System (INIS)

    Munson, D.E.; Jones, R.L.; Northrop-Salazar, C.L.; Woerner, S.J.

    1992-12-01

    During the construction of the Thermal/Structural In Situ Test Rooms at the Waste Isolation Pilot Plant (WIPP) facility, measurements of the salt displacements were obtained at very early times, essentially concurrent with the mining activity. This was accomplished by emplacing manually read closure gage stations directly at the mining face, actually between the face and the mining machine, immediately upon mining of the intended gage location. Typically, these mining sequence closure measurements were taken within one hour of mining of the location and within one meter of the mining face. Readings were taken at these gage stations as the multipass mining continued, with the gage station reestablished as each successive mining pass destroyed the earlier gage points. Data reduction yields the displacement history during the mining operation. These early mining sequence closure data, when combined with the later data of the permanently emplaced closure gages, gives the total time-dependent closure displacements of the test rooms. This complete closure history is an essential part of assuring that the in situ test databases will provide an adequate basis for validation of the predictive technology of salt creep behavior, as required by the WIPP technology development program for disposal of radioactive waste in bedded salt

  17. Closure Plan for the Area 5 Radioactive Waste Management Site at the Nevada Test Site

    International Nuclear Information System (INIS)

    NSTec Environmental Management

    2008-01-01

    The Area 5 Radioactive Waste Management Site (RMWS) at the Nevada Test Site (NTS) is managed and operated by National Security Technologies, LLC (NSTec), for the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). This document is the first update of the preliminary closure plan for the Area 5 RWMS at the NTS that was presented in the Integrated Closure and Monitoring Plan (DOE, 2005a). The major updates to the plan include a new closure schedule, updated closure inventory, updated site and facility characterization data, the Title II engineering cover design, and the closure process for the 92-Acre Area of the RWMS. The format and content of this site-specific plan follows the Format and Content Guide for U.S. Department of Energy Low-Level Waste Disposal Facility Closure Plans (DOE, 1999a). This interim closure plan meets closure and post-closure monitoring requirements of the order DOE O 435.1, manual DOE M 435.1-1, Title 40 Code of Federal Regulations (CFR) Part 191, 40 CFR 265, Nevada Administrative Code (NAC) 444.743, and Resource Conservation and Recovery Act (RCRA) requirements as incorporated into NAC 444.8632. The Area 5 RWMS accepts primarily packaged low-level waste (LLW), low-level mixed waste (LLMW), and asbestiform low-level waste (ALLW) for disposal in excavated disposal cells

  18. Closure Plan for the Area 5 Radioactive Waste Management Site at the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Management

    2008-09-01

    The Area 5 Radioactive Waste Management Site (RMWS) at the Nevada Test Site (NTS) is managed and operated by National Security Technologies, LLC (NSTec), for the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). This document is the first update of the preliminary closure plan for the Area 5 RWMS at the NTS that was presented in the Integrated Closure and Monitoring Plan (DOE, 2005a). The major updates to the plan include a new closure schedule, updated closure inventory, updated site and facility characterization data, the Title II engineering cover design, and the closure process for the 92-Acre Area of the RWMS. The format and content of this site-specific plan follows the Format and Content Guide for U.S. Department of Energy Low-Level Waste Disposal Facility Closure Plans (DOE, 1999a). This interim closure plan meets closure and post-closure monitoring requirements of the order DOE O 435.1, manual DOE M 435.1-1, Title 40 Code of Federal Regulations (CFR) Part 191, 40 CFR 265, Nevada Administrative Code (NAC) 444.743, and Resource Conservation and Recovery Act (RCRA) requirements as incorporated into NAC 444.8632. The Area 5 RWMS accepts primarily packaged low-level waste (LLW), low-level mixed waste (LLMW), and asbestiform low-level waste (ALLW) for disposal in excavated disposal cells.

  19. Summary of selected health statistics for counties with nuclear facilities, New York State excluding New York City, 1960--1975

    International Nuclear Information System (INIS)

    Burometto, E.; Therriault, G.; Logrillo, V.

    1977-08-01

    A previous report of the Office of Biostatistics of the New York State Department of Health, issued in 1971, summarized selected health statistics for the period 1960 through 1969, comparing counties in Upstate New York (New York State exclusive of New York City) in which nuclear facilities are located with counties without such facilities. This report will present comparisons extending the analysis of the previous study through 1975. At various times during the period from 1960 to 1975 nuclear facilities were operating in 12 of the 57 Upstate counties. Westchester, Wayne and Oswego counties are the sites for the three commercial power plants operating in Upstate New York. A nuclear fuel reprocessing plant is located in Cattaraugus County. Facilities with testing, training or research reactors are located in eight other Upstate counties

  20. Design, production and initial state of the closure

    International Nuclear Information System (INIS)

    2010-12-01

    The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

  1. Design, production and initial state of the closure

    Energy Technology Data Exchange (ETDEWEB)

    2010-12-15

    The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

  2. Computer usage among nurses in rural health-care facilities in South Africa: obstacles and challenges.

    Science.gov (United States)

    Asah, Flora

    2013-04-01

    This study discusses factors inhibiting computer usage for work-related tasks among computer-literate professional nurses within rural healthcare facilities in South Africa. In the past two decades computer literacy courses have not been part of the nursing curricula. Computer courses are offered by the State Information Technology Agency. Despite this, there seems to be limited use of computers by professional nurses in the rural context. Focus group interviews held with 40 professional nurses from three government hospitals in northern KwaZulu-Natal. Contributing factors were found to be lack of information technology infrastructure, restricted access to computers and deficits in regard to the technical and nursing management support. The physical location of computers within the health-care facilities and lack of relevant software emerged as specific obstacles to usage. Provision of continuous and active support from nursing management could positively influence computer usage among professional nurses. A closer integration of information technology and computer literacy skills into existing nursing curricula would foster a positive attitude towards computer usage through early exposure. Responses indicated that change of mindset may be needed on the part of nursing management so that they begin to actively promote ready access to computers as a means of creating greater professionalism and collegiality. © 2011 Blackwell Publishing Ltd.

  3. [Engineering aspects of seismic behavior of health-care facilities: lessons from California earthquakes].

    Science.gov (United States)

    Rutenberg, A

    1995-03-15

    The construction of health-care facilities is similar to that of other buildings. Yet the need to function immediately after an earthquake, the helplessness of the many patients and the high and continuous occupancy of these buildings, require that special attention be paid to their seismic performance. Here the lessons from the California experience are invaluable. In this paper the behavior of California hospitals during destructive earthquakes is briefly described. Adequate structural design and execution, and securing of nonstructural elements are required to ensure both safety of occupants, and practically uninterrupted functioning of equipment, mechanical and electrical services and other vital systems. Criteria for post-earthquake functioning are listed. In view of the hazards to Israeli hospitals, in particular those located along the Jordan Valley and the Arava, a program for the seismic evaluation of medical facilities should be initiated. This evaluation should consider the hazards from nonstructural elements, the safety of equipment and systems, and their ability to function after a severe earthquake. It should not merely concentrate on safety-related structural behavior.

  4. Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

    Energy Technology Data Exchange (ETDEWEB)

    Vigil-Holterman, Luciana R. [Los Alamos National Laboratory

    2012-05-07

    This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of the open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.

  5. Automation of the radiation measuring facilities for samples in health physics - MA 9

    International Nuclear Information System (INIS)

    Martini, M.

    1980-12-01

    Routine radation measurements of samples are performed by the HMI health physics department by means of test stations for individual samples and multiple samples (using a changing equipment). The basic device of these test stations is a SCALER/TIMER system (BF 22/25, BERTHOLD Corp.). This measuring facility has been extended by a CAMAC intrumentation which incorporates an autonomous CAMAC processor (CAPRO-1, INCAA B.V.) for monitoring an automatic control of the system. The programming language is BASIC. A DECwriter (LA 34) is used for user interaction and for printing the measurement results. This report describes the features of this system and present some examples of, the dialogue with the system and the printout of data. (orig.) [de

  6. The quality management journey: the progress of health facilities in Australia.

    Science.gov (United States)

    Carr, B J

    1994-12-01

    Many facilities in Australia have taken the Total Quality Management (TQM) step. The objective of this study was to examine progress of adopted formal quality systems in health. Sixty per cent of organizations surveyed have adopted formal systems. Of these, Deming adherents are the most common, followed by eclectic choices. Only 35% considered the quality transition as reasonably easy. There was no relationship between accreditation and formal quality systems identified. The most common improvement techniques were: flow charts, histograms, and cause and effect diagrams. Quality practitioners are happy to use several tools exceptionally well rather than have many tools at their disposal. The greatest impediment to the adoption of quality was the lack of top management support. This study did not support the view that clinicians are not readily actively supporting quality initiatives. Total Quality Management is not a mature concept; however, Chief Executive Officers are assured that rewards will be realized over time.

  7. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 prima