WorldWideScience

Sample records for improved oversight needed

  1. Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti

    Science.gov (United States)

    2016-09-30

    Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti S E P T E M B E R 3 0 , 2 0 1 6 Report...Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti Visit us at www.dodig.mil Objective We...Findings (cont’d) ii │ DODIG-2016-141 (Project No. D2014-D000RE-0157.000) Results in Brief Improvements Needed in Managing Scope Changes and Oversight

  2. Veterans Affairs Contracting: Improved Oversight Needed for Certain Contractual Arrangements

    Science.gov (United States)

    2015-07-01

    accounting officials. Financial Services Center officials reported that compliance has improved as a result of this training. Currently, VA does not provide...States Government Accountability Office Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of... provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid

  3. Military Health Care: Army Needs to Improve Oversight of Warrior Transition Units

    Science.gov (United States)

    2016-07-01

    their needs, undergo physical rehabilitation, meet with behavioral health therapists, participate in adaptive sports and reconditioning programs...soldiers at the former Walter Reed Army Medical Center. The program is to coordinate care for soldiers recovering from serious physical and...2) established processes to oversee the selection of WTU personnel, assess their training , and adjust staff levels; and (3) assessed adherence

  4. Counterfeit Parts: DOD Needs to Improve Reporting and Oversight to Reduce Supply Chain Risk

    Science.gov (United States)

    2016-02-01

    that develop international standards for the aerospace and automotive industry , such as the SAE International’s G-19 Committee. Specifically, in 2009...in part because they generally do not include the information – such as supplier names – industry and government entities needs to manage the risks ...International, an organization that develops international standards for the aerospace and automotive industry , established a subcommittee to develop

  5. Report: EPA Region 9 Needs to Improve Oversight Over Commonwealth of the Northern Mariana Islands Consolidated Cooperative Agreements

    Science.gov (United States)

    Report #16-P-0207, June 20, 2016. More than $58 million in consolidated cooperative agreement funds is not being administered efficiently and effectively due to inadequate oversight and a lack of internal controls.

  6. Defense Acquisitions: Future Aerostat and Airship Investment Decisions Drive Oversight and Coordination Needs

    Science.gov (United States)

    2012-10-01

    DEFENSE ACQUISITIONS Future Aerostat and Airship Investment Decisions Drive Oversight and Coordination Needs...Future Aerostat and Airship Investment Decisions Drive Oversight and Coordination Needs 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...Future Aerostat and Airship Investment Decisions Drive Oversight and Coordination Needs Why GAO Did This Study Use of lighter-than-air platforms, such

  7. U.S. Army Military Surface Deployment and Distribution Command Needs to Improve its Oversight of Labor Detention Charges at Military Ocean Terminal Sunny Point

    Science.gov (United States)

    2016-03-16

    and informs the public. Vision Our vision is to be a model oversight organization in the Federal Government by leading change, speaking truth, and...erroneously paid for contractor safety briefings as labor detention charges because the 596th Transportation Brigade (BDE) Contracting Officer’s...Officer, U.S. Transportation Command: • direct the 596th BDE COR to ensure that charges billed for safety briefings are in accordance with the

  8. Patriot Modernization: Oversight Mechanism Needed to Track Progress and Provide Accountability

    Science.gov (United States)

    2016-08-01

    PATRIOT MODERNIZATION Oversight Mechanism Needed to Track Progress and Provide Accountability Report to...Congressional Committees August 2016 GAO-16-488 United States Government Accountability Office United States Government Accountability Office...Provide Accountability Why GAO Did This Study Patriot is a mobile Army surface-to-air missile system deployed worldwide to defend critical

  9. Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight

    Science.gov (United States)

    2015-03-04

    H 4 , 2 0 1 5 Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Report No. DODIG-2015...04 MAR 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Naval...of Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and

  10. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight

    Science.gov (United States)

    2013-09-18

    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  11. Military Personnel: Additional Steps Are Needed to Strengthen DOD’s Oversight of Ethics and Professionalism Issues

    Science.gov (United States)

    2015-09-01

    Business Conduct, Waltham, Massachusetts Lockheed Martin Corporation Office of Ethics and Business Conduct EthicsOne, Inc. Executive Leadership, Boston...MILITARY PERSONNEL Additional Steps Are Needed to Strengthen DOD’s Oversight of Ethics and Professionalism Issues...DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Military Personnel: Additional Steps Are Needed to Strengthen DOD’s Oversight of Ethics

  12. Support for Afghanistan’s Justice Sector: State Department Programs Need Better Management and Stronger Oversight

    Science.gov (United States)

    2014-01-01

    component from the contractor that previously implemented the JSSP— PAE Incorporated ( PAE )—to IDLO. This audit assesses (1) INL’s management of...from PAE to IDLO affects INL’ s oversight of the program, and (3) State’s efforts to coordinate justice sector programs in Afghanistan across...management and oversight of the Justice Sector Support Program (JSSP) contract with PAE Incorporated ( PAE ) limited its ability to assess the

  13. Mobile health applications: the patchwork of legal and liability issues suggests strategies to improve oversight.

    Science.gov (United States)

    Yang, Y Tony; Silverman, Ross D

    2014-02-01

    Mobile health (mHealth) technology has facilitated the transition of care beyond the traditional hospital setting to the homes of patients. Yet few studies have evaluated the legal implications of the expansion of mHealth applications, or "apps." Such apps are affected by a patchwork of policies related to medical licensure, privacy and security protection, and malpractice liability. For example, the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may apply to only some uses of the apps. Similarly, it is not clear what a doctor's malpractice liability would be if he or she injured a patient as the result of inaccurate information supplied by the patient's self-monitoring health app. This article examines the legal issues related to the oversight of health apps, discusses current federal regulations, and suggests strategies to improve the oversight of these apps.

  14. International stem cell tourism and the need for effective regulation. Part II: Developing sound oversight measures and effective patient support.

    Science.gov (United States)

    Cohen, Cynthia B; Cohen, Peter J

    2010-09-01

    Part I of this article, published in the March 2010 issue of the Kennedy Institute of Ethics Journal, traces and addresses the provision of unproven stem cell treatments in Russia and India, examines the concept of innovative treatment, and concludes that stronger regulations are needed to protect the health and informed choices of patients. The current paper, Part II, proposes that the regulatory frameworks for the development of safe and efficacious treatments in effect in the United States and the United Kingdom provide examples of strong oversight measures from which countries seeking to obtain international credibility for their biotechnological competence could draw when developing regulations for stem cell treatments. Major sources of information available to persons who consider receiving such unproven treatments are explored in order to understand and address their concerns. The paper concludes with proposed measures to inform those considering the pursuit of unproven stem cell treatments abroad more accurately about their efficacy and safety and provide them with improved medical and social support in their home countries.

  15. Alternative considerations for environmental oversight training: Results from a needs assessment

    Energy Technology Data Exchange (ETDEWEB)

    Young, C.; Hensley, J.

    1995-11-01

    For staff to perform their jobs effectively and efficiently, they must be adequately trained. Well-trained staff are also more likely to be satisfied with their jobs and to remain with a given organization. In addition to hiring staff with relevant backgrounds and skills, critical steps in maintaining adequately trained staff are to analyze skill levels needed for the various tasks that personnel are required to perform and to provide training to improve staff s skill base. This first analysis is commonly referred to as a training needs assessment. Training needs are usually determined by defining the tasks required for a particular job and the associated knowledge, skills, and abilities necessary to adequately accomplish these tasks. The Office of Northwestern Area Programs of the U.S. Department of Energy`s (DOE`s) Office of Environmental Management (EM) oversees environmental remediation activities in the Chicago, Idaho, Oakland, and Richland Operations Offices. For this organization to effectively carry out its mission, its staff need to be as proficient as possible in the appropriate knowledge and skills. Therefore, a training needs assessment was conducted to determine staff`s level of knowledge and proficiency in various skills. The purpose of the assessment was to: (1) Examine the types of activities or tasks in which staff are involved, (2) Determine the skills needed to perform relevant tasks, and (3) Assess gaps in knowledge and skills for the tasks performed in order to suggest opportunities for skill development.

  16. Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

    Directory of Open Access Journals (Sweden)

    Michelle Lampl

    2016-11-01

    Full Text Available The Developmental Origins of Health and Disease (DOHaD model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond “getting bigger” is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting “healthy growth” are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements’ “promoting healthy growth” claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good.

  17. Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

    Science.gov (United States)

    Lampl, Michelle; Mummert, Amanda; Schoen, Meriah

    2016-01-01

    The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond “getting bigger” is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting “healthy growth” are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements’ “promoting healthy growth” claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good. PMID:27845744

  18. DOD Education Benefits: Further Actions Needed to Improve Oversight of Tuition Assistance Program. Testimony before the Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, Committee on Homeland Security and Governmental Affairs, United States Senate. GAO-11-389T

    Science.gov (United States)

    Scott, George A.

    2011-01-01

    This testimony discusses the Department of Defense's (DOD) oversight of its Military Tuition Assistance (TA) Program. In fiscal year 2010, the TA Program provided $531 million in tuition assistance to approximately 302,000 service members who elected to pursue off-duty postsecondary education. DOD offers these benefits to service members in order…

  19. Defense Infrastructure: Actions Needed to Enhance Oversight of Construction Projects Supporting Military Contingency Operations

    Science.gov (United States)

    2016-09-01

    Government,9 which states among other things that management should establish an organizational structure, assign responsibility, and delegate...O&M funds under the Contingency Construction Authority. The information may also enable DOD to determine whether existing departmental processes...construction needs; and revise existing departmental processes or seek additional authorities, as appropriate. • To help ensure that DOD limits demands

  20. Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need Additional Management Oversight

    Science.gov (United States)

    2016-04-28

    HEALTH AFFAIRS) AUDITOR GENERAL , DEPARTMENT OF THE ARMY SUBJECT: Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need...accordance with generally accepted government auditing standards. We considered management comments on a draft of this report when preparing the final...Inspector General . RHCE UBO will adhere to ABACUS grouping code reports and the message logs under the legacy process to ensure tracking of delinquent

  1. Commercial Multimodal Cargo Procedures in Dubai Were Generally Effective, but Contract Oversight Could Be Improved

    Science.gov (United States)

    2014-04-11

    performance measures. Specifically, USTRANSCOM contracting officials did not test the accuracy of the electronic data interchange ( EDI ) transactions to...having an official delegated contract oversight role. • test contractor-submitted EDI transactions used to verify contractor performance for the ITV...reports using EDI .8 The commercial multimodal contract quality assurance surveillance plan (QASP), states that contractor-provided EDI transactions are

  2. Comprehensive Risk Assessments of MOD and MOI Financial Management Capacity Could Improve Oversight of Over $4 Billion in Direct Assistance Funding

    Science.gov (United States)

    2013-11-01

    financial auditors , according to CJ8 officials. Most of the military officers assigned to CJ8 are budget and acquisition specialists, rather than...trained auditors . According to CJ8 personnel, these officers must learn a new task and become familiar with the Afghan government budgeting, acquisition...Frequent staff rotations compound the challenges which lead to potential deficiencies in CJ8’s oversight capacity. • Need for Increased Security

  3. Report: EPA’s Contract Oversight and Controls Over Personal Computers Need Improvement

    Science.gov (United States)

    Report #11-P-0705, September 26, 2011. EPA paid the CTS contractor a total of $489,734 over an 11-month period for 3,343 seats—a standard seat includes a leased computer with accessories and technical support—not ordered by the Agency during the period.

  4. Report: Controls and Oversight Needed to Improve Administration of EPA’s Customer Service Lines

    Science.gov (United States)

    Report #13-P-0432, September 26, 2013. The EPA has a variety of resources—including telephone hotlines, Web clearinghouses, and other online reference information—which the OIG has categorized as customer service lines (CSLs).

  5. Defense Facility Condition: Revised Guidance Needed to Improve Oversight of Assessments and Ratings

    Science.gov (United States)

    2016-06-01

    showed us a classroom inside of a hangar where mold had been found on picture frames, wall shelves, and desk items (see figure 5). Figure 5: Desk...Under Secretary of Defense for Acquisition, Technology , and Logistics Memorandum, Standardizing Facility Condition Assessments (Sept. 10, 2013). 7The...Under Secretary of Defense for Acquisition, Technology , and Logistics Memorandum, Facility Sustainment and Recapitalization Policy (Apr. 29, 2014

  6. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans

    Science.gov (United States)

    2016-12-01

    Health Care Letter 1 Background 6 VHA Lacks Complete and Accurate Data on VAMC Compliance with Environment of Care Requirements for Women Veterans...of Care Requirements 40 Appendix IV Veterans Health Administration (VHA) Gynecologist Availability 44 Appendix V Veterans Affairs (VA) Clinics...Veterans Health Administration (VHA) Requirements Related to the Outpatient Environment of Care for Women Veterans, December 2015-March 2016 40 Table

  7. Veterans’ Health Care: Improved Oversight of Community Care Physicians Credentials Needed

    Science.gov (United States)

    2016-09-01

    name of the source and the date the credential expires ). Both... expiration dates and did not include... medical facility—rather than the contractors—review Choice physicians’ credentials. GAO found that VHA did not require its staff to verify licenses

  8. Contract Oversight for Redistribution Property Assistance Team Operations in Afghanistan Needs Improvement

    Science.gov (United States)

    2015-05-18

    ultimate consumption or disposal of the property. The Army uses a financial liability investigation of property loss (FLIPL) to account for lost...Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be...Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and informs

  9. Research Ethics, Governance, Oversight And Public Interest

    Directory of Open Access Journals (Sweden)

    Abu Bakar Suleiman

    2008-12-01

    Full Text Available A better educated public has started to challengethe way decisions are made in medical research activities.Although Institutional and National Guidelines onResearch are in place, there are fears that InstitutionalReview Boards (IRBs and funding agencies are only fairlyactive in scientific and ethical reviews of research proposalsbut not on oversight of projects after their initiation. Theseissues are integral to good research governance andresearchers and custodians of research ethics must ensurethat public interest is not compromised. Medical progress is based on research including humanexperimentation carried out according to guidingprinciples as enunciated in the Declaration of Helsinki(2000, but the quality of compliance with theDeclaration is an important issue. Better choice and appropriate training of members of IRBsto improve the quality of decision making and governanceprocesses are urgently needed. Competency in evaluationof proposals requires not only the appropriate scientificknowledge but also access to relevant preclinical andother data. Unfortunately, the completeness and quality ofsuch data may not be adequate. Public interest demands that injury to trial subjects inclinical trials is minimized if not avoided completely.Unfortunately this is not always possible with trialswhere novel biological modes of action are tested.A more robust evaluation mechanism for projectapproval may minimize but not completely avoid injuryto subjects; thus insurance cover to provide care andcompensation to subjects must be compulsory.The decision to approve or reject a project must bebased on the balance of potential risks and benefits,taking into consideration justifiable distributive risks totarget communities and populations. Economicconsiderations should never be the primary focus,especially when there are real concerns that themigration of early phase clinical trials including vaccinetrials to developing countries is based on the perceivedless

  10. Needed improvements in the development of systemic corrective actions.

    Energy Technology Data Exchange (ETDEWEB)

    Campisi, John A.

    2009-07-01

    There are indications that corrective actions, as implemented at Sandia National Laboratories are not fully adequate. Review of independent audits spanning multiple years provides evidence of recurring issues within the same or similar operations and programs. Several external audits have directly called into question the ability Sandia's assessment and evaluation processes to prevent recurrence. Examples of repeated findings include lockout/tagout programs, local exhaust ventilation controls and radiological controls. Recurrence clearly shows that there are underlying systemic factors that are not being adequately addressed by corrective actions stemming from causal analyses. Information suggests that improvements in the conduct of causal analyses and, more importantly, in the development of subsequent corrective actions are warranted. Current methodolgies include Management Oversight Risk Tree, developed in the early 1970s and Systemic Factors Analysis. Recommendations for improvements include review of other causal analysis systems, training, improved formality of operations, improved documentation, and a corporate method that uses truly systemic solutions. This report was written some years ago and is being published now to form the foundation for current, follow-on reports being developed. Some outdated material is recognized but is retained for report completeness.

  11. Need for improved treatment of postoperative pain

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Thomsen, Berit Ahlmann; Kitter, Birgitte;

    2012-01-01

    A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential.......A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential....

  12. Prepositioned Stocks: Marine Corps Needs to Improve Cost Estimate Reliability and Oversight of Inventory Systems for Equipment in Norway

    Science.gov (United States)

    2015-09-01

    European and Eurasian Affairs, Washington, D.C. • U.S. Embassy, Oslo, Norway o Office of Defense Cooperation o Political and Economic Section Ministry...Connect with GAO on Facebook , Flickr, Twitter, and YouTube. Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts and read The

  13. DoD Needs to Improve Oversight of the Afghan National Police Training/Mentoring and Logistics Support Contract

    Science.gov (United States)

    2013-06-25

    months for the 6-month period from January 2012 through June 2012.5 For example, there was no COR at RTC Bamiyan for 5 consecutive months from...assigned onsite, and TPSO personnel did not revisit RTC Bamiyan to complete any additional audit checklists. When we visited RTC Bamiyan , onsite...personnel did not take action to nominate and appoint this person as the COR at RTC Bamiyan . According to the ANP contract, the contractor was required to

  14. U.S. Assistance to Yemen: Actions Needed to Improve Oversight of Emergency Food Aid and Assess Security Assistance

    Science.gov (United States)

    2013-03-01

    decision making and quality of service delivery. • Works with the Yemeni government to increase receptiveness and responsiveness to citizen concerns and...conflict victims, and refugees and migrants from the Horn of Africa who have fled to Yemen. Source: GAO analysis of USAID and State data

  15. Best Practices. Increased Focus on Requirements and Oversight Needed to Improve DOD’s Acquisition Environment and Weapon System Quality

    Science.gov (United States)

    2008-02-01

    Similar to DOD’s MIL-Q-9858A, ISO 9001 includes requirements for controlling a product’s design and development, and production, as well as processes...2 The ISO 9001 standard provides a framework for managing an organization’s...AS9100 is a set of quality standards for the aerospace industry; ISO /TS 16949 is a set of standards for the automotive industry. 4GAO, Best

  16. The Army Needs To Improve Property Accountability and Contractor Oversight at Redistribution Property Assistance Team Yards in Afghanistan

    Science.gov (United States)

    2014-03-04

    in its contractual relationships . To fulfill this responsibility, the Defense Federal Acquisition Regulation Supplement states that the contracting...RI, and the 401st AFSB all have a fiduciary responsibility to be stewards of DoD funds and to continually validate that the contractor is in...Director stated that ACC-RI and DCMA Afghanistan-North maintain a close operational relationship in resolving any critical concerns that may arise

  17. Improving Care for Children With Complex Needs

    Science.gov (United States)

    2016-12-28

    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  18. 5 CFR 330.711 - Oversight.

    Science.gov (United States)

    2010-01-01

    ... PLACEMENT (GENERAL) Interagency Career Transition Assistance Plan for Displaced Employees § 330.711 Oversight. OPM is responsible for oversight of the Interagency Career Transition Assistance Plan...

  19. Working Environment In Nursing: Needs Improvement?

    Directory of Open Access Journals (Sweden)

    Alicia Hanzeliková Pogrányivá

    2012-08-01

    Full Text Available Background: Knowing the quality of life of professionals is important because it is related to job performance, better results, and greater productivity, which results in better patient care. Objective: To know the Professional Quality of Life perceived by the nurses at the Geriatric Hospital of Toledo (Spain. Method: A descriptive cross-section study was employed to measure the Professional Quality of Life of all healthcare nurses (69 in total at the Geriatric Hospital of Toledo. The questionnaire used as a measuring instrument was the Professional Quality of Life - 35. The data obtained was analyzed by means of: descriptive statistics, single-factor ANOVA variance analysis, T Student tests, and simple and multiple regression analysis. The study was approved by both the research commission and the ethics commission at the Hospital Complex of Toledo. Participation in the study on behalf of the nursing staff was voluntary. Results: In total, 45 responses were obtained (65.2%. The overall mean score measured the perceived Professional Quality of Life to be low. In relation to the three dimensions evaluated in the study, the highest average found was in “intrinsic motivation,” followed by “workload”, and then “management support.” In the multivariate analysis, “management support” was shown as the most influential factor in the Professional Quality of Life with a 23% influence (P<0.001, followed by workload with 9% (P = 0.01. Conclusions: The professionals at the participating center perceive their workplace as having an elevated degree of responsibility, a large quantity of work, a high occurrence of rushes and fatigue, and all this with little support on behalf of management. Promotions are scarce or the policies for receiving a promotion are inadequate. The perception of Professional Quality of Life in nursing is low. The obtained results indicate a need for an organizing cultural change based on participation, motivation, and

  20. Corporate social responsibility for nanotechnology oversight.

    Science.gov (United States)

    Kuzma, Jennifer; Kuzhabekova, Aliya

    2011-11-01

    Growing public concern and uncertainties surrounding emerging technologies suggest the need for socially-responsible behavior of companies in the development and implementation of oversight systems for them. In this paper, we argue that corporate social responsibility (CSR) is an important aspect of nanotechnology oversight given the role of trust in shaping public attitudes about nanotechnology and the lack of data about the health and environmental risks of nanoproducts. We argue that CSR is strengthened by the adoption of stakeholder-driven models and attention to moral principles in policies and programs. In this context, we examine drivers of CSR, contextual and leadership factors that influence CSR, and strategies for CSR. To illustrate these concepts, we discuss existing cases of CSR-like behavior in nanotechnology companies, and then provide examples of how companies producing nanomedicines can exhibit morally-driven CSR behavior.

  1. More Pregnant Women Getting Flu Shot, But Improvement Needed

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_162444.html More Pregnant Women Getting Flu Shot, But Improvement Needed All ... and her baby. And while the percentage of pregnant American women who got the vaccine has doubled ...

  2. Gene therapy oversight: lessons for nanobiotechnology.

    Science.gov (United States)

    Wolf, Susan M; Gupta, Rishi; Kohlhepp, Peter

    2009-01-01

    Oversight of human gene transfer research ("gene therapy") presents an important model with potential application to oversight of nanobiology research on human participants. Gene therapy oversight adds centralized federal review at the National Institutes of Health's Office of Biotechnology Activities and its Recombinant DNA Advisory Committee to standard oversight of human subjects research at the researcher's institution (by the Institutional Review Board and, for some research, the Institutional Biosafety Committee) and at the federal level by the Office for Human Research Protections. The Food and Drug Administration's Center for Biologics Evaluation and Research oversees human gene transfer research in parallel, including approval of protocols and regulation of products. This article traces the evolution of this dual oversight system; describes how the system is already addressing nanobiotechnology in gene transfer: evaluates gene therapy oversight based on public opinion, the literature, and preliminary expert elicitation; and offers lessons of the gene therapy oversight experience for oversight of nanobiotechnology.

  3. 76 FR 31416 - Federal Acquisition Regulation; Oversight of Contractor Ethics Programs

    Science.gov (United States)

    2011-05-31

    ... Federal Acquisition Regulation; Oversight of Contractor Ethics Programs AGENCY: Department of Defense (DoD... contractors have implemented the mandatory contractor business ethics program requirements. DATES: Effective... to Improve DoD's Oversight of Contractor Ethics Programs. The ethics program requirement flows from...

  4. 12 CFR 370.10 - Oversight.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Oversight. 370.10 Section 370.10 Banks and... LIQUIDITY GUARANTEE PROGRAM § 370.10 Oversight. (a) Participating entities are subject to the FDIC's oversight regarding compliance with the terms of the temporary liquidity guarantee program. (b)...

  5. Mitral regurgitation — Unmet need for improved management strategies

    Directory of Open Access Journals (Sweden)

    Jean-Noel Trochu

    2014-12-01

    Conclusions: The current review represents one of the most comprehensive conducted in the medical/conservative management of MR. An increased risk of mortality and morbidity, which appeared to rise with greater severity, was associated with MR (versus no MR. An unmet need exists in the management of patients with severe symptomatic MR and a high surgical risk as they have a poor prognosis and limited treatment options. Further research into alternative medical strategies and patient management is needed to improve prognoses and reduce mortality and morbidity.

  6. Improving Catastrophe Modeling for Business Interruption Insurance Needs.

    Science.gov (United States)

    Rose, Adam; Huyck, Charles K

    2016-10-01

    While catastrophe (CAT) modeling of property damage is well developed, modeling of business interruption (BI) lags far behind. One reason is the crude nature of functional relationships in CAT models that translate property damage into BI. Another is that estimating BI losses is more complicated because it depends greatly on public and private decisions during recovery with respect to resilience tactics that dampen losses by using remaining resources more efficiently to maintain business function and to recover more quickly. This article proposes a framework for improving hazard loss estimation for BI insurance needs. Improved data collection that allows for analysis at the level of individual facilities within a company can improve matching the facilities with the effectiveness of individual forms of resilience, such as accessing inventories, relocating operations, and accelerating repair, and can therefore improve estimation accuracy. We then illustrate the difference this can make in a case study example of losses from a hurricane.

  7. Improving depression care: barriers, solutions, and research needs.

    Science.gov (United States)

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H

    2001-06-01

    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.

  8. Understanding what needs to be done to improve a school

    OpenAIRE

    Wilson, G Stuart

    2003-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. The purpose of this research is to discover different ways of understanding what needs to be done to improve a school, with particular reference to secondary school head teachers. The variation within those understandings, and how the understandings are logically and hierarchically related, are also of interest. Contributions of theory and knowledge to the quality of head teachers' thinking, ...

  9. DoDs Efforts to Consolidate Data Centers Need Improvement

    Science.gov (United States)

    2016-03-29

    through automation; and • enhance business agility and effectively manage change. DoD’s data center consolidation plan identified the following...Assistance The DoD OIG Quantitative Methods Division assisted with the nonstatistical sampling method that we used to select the data centers to visit...H 2 9 , 2 0 1 6 Report No. DODIG-2016-068 DoD’s Efforts to Consolidate Data Centers Need Improvement Mission Our mission is to provide independent

  10. Fiscal Year 2017 Oversight Plan

    Science.gov (United States)

    2016-12-01

    managing the development of a Mine Countermeasures Mission Package that will allow the Littoral Combat Ship to detect and neutralize mines or avoid...year. Of those investigations, an average Army Reserve and active duty agents participate in a joint training exercise focusing on crime scene ...a mock crime scene . Photo by Air Force Senior Airman Nesha Humes Office of Inspector General FY 2017 Oversight Plan Ensuring Ethical Conduct │ 99

  11. A qualitative phenomenological study: Enhanced, risk-based FAA oversight on part 145 maintenance practices

    Science.gov (United States)

    Sheehan, Bryan G.

    The purpose of this qualitative phenomenological study was to examine the phenomenon of enhanced, risk-based Federal Aviation Administration (FAA) oversight of Part 145 repair stations that performed aircraft maintenance for Part 121 air carriers between 2007 and 2014 in Oklahoma. Specifically, this research was utilized to explore what operational changes have occurred in the domestic Part 145 repair station industry such as variations in management or hiring practices, training, recordkeeping and technical data, inventory and aircraft parts supply-chain logistics, equipment, and facilities. After interviewing 12 managers from Part 145 repair stations in Oklahoma, six major theme codes emerged from the data: quality of oversight before 2007, quality of oversight after 2007, advantages of oversight, disadvantages of oversight, status quo of oversight, and process improvement . Of those six major theme codes, 17 subthemes appeared from the data that were used to explain the phenomenon of enhanced oversight in the Part 145 repair station industry. Forty-two percent of the participants indicated a weak FAA oversight system that has hindered the continuous process improvement program in their repair stations. Some of them were financially burdened after hiring additional full-time quality assurance inspectors to specifically manage enhanced FAA oversight. Notwithstanding, the participants of the study indicated that the FAA must apply its surveillance on a more standardized and consistent basis. They want to see this standardization in how FAA inspectors interpret regulations and practice the same quality of oversight for all repair stations, particularly those that are repeat violators and fail to comply with federal aviation regulations. They believed that when the FAA enforces standardization on a consistent basis, repair stations can become more efficient and safer in the performance of their scope of work for the U.S. commercial air transportation industry.

  12. Developing U.S. oversight strategies for nanobiotechnology: learning from past oversight experiences.

    Science.gov (United States)

    Paradise, Jordan; Wolf, Susan M; Kuzma, Jennifer; Kuzhabekova, Aliya; Tisdale, Alison W; Kokkoli, Efrosini; Ramachandran, Gurumurthy

    2009-01-01

    The emergence of nanotechnology, and specifically nanobiotechnology, raises major oversight challenges. In the United States, government, industry, and researchers are debating what oversight approaches are most appropriate. Among the federal agencies already embroiled in discussion of oversight approaches are the Food and Drug Administration (FDA), Environmental Protection Agency (EPA), Department of Agriculture (USDA), Occupational Safety and Health Administration (OSHA), and National Institutes of Health (NIH). All can learn from assessment of the successes and failures of past oversight efforts aimed at emerging technologies. This article reports on work funded by the National Science Foundation (NSF) aimed at learning the lessons of past oversight efforts. The article offers insights that emerge from comparing five oversight case studies that examine oversight of genetically engineered organisms (GEOs) in the food supply, pharmaceuticals, medical devices, chemicals in the workplace, and gene therapy. Using quantitative and qualitative analysis, the authors present a new way of evaluating oversight.

  13. Improving the Quality of Host Country Ethical Oversight of International Research: The Use of a Collaborative 'Pre-Review' Mechanism for a Study of Fexinidazole for Human African Trypanosomiasis.

    Science.gov (United States)

    Coleman, Carl H; Ardiot, Chantal; Blesson, Séverine; Bonnin, Yves; Bompart, Francois; Colonna, Pierre; Dhai, Ames; Ecuru, Julius; Edielu, Andrew; Hervé, Christian; Hirsch, François; Kouyaté, Bocar; Mamzer-Bruneel, Marie-France; Maoundé, Dionko; Martinent, Eric; Ntsiba, Honoré; Pelé, Gérard; Quéva, Gilles; Reinmund, Marie-Christine; Sarr, Samba Cor; Sepou, Abdoulaye; Tarral, Antoine; Tetimian, Djetodjide; Valverde, Olaf; Van Nieuwenhove, Simon; Strub-Wourgaft, Nathalie

    2015-12-01

    Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs for Neglected Diseases Initiative (DNDi), an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis (HAT). The project involved the implementation of a novel 'pre-review' process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process.

  14. Commentary: Emerging technologies oversight: research, regulation, and commercialization.

    Science.gov (United States)

    Johnson, Robbin

    2009-01-01

    This paper reviews the paper by Kuzma, Najmaie, and Larson that looks at what can be learned from the experience with genetically engineered organisms for oversight of emerging technologies more generally. That paper identifies key attributes of a good oversight system: promoting innovation, ensuring safety, identifying benefits, assessing costs, and doing so all while building public confidence. In commenting on that analysis, this paper suggests that looking at "oversight" in three phases - research and development, regulatory review, and market acceptance - can help to determine when certain of these attributes should take precedence over others and how to structure remedies when an error occurs. The result is an approach that is precautionary with respect to research and development, prudent and open to public input in the regulatory review stage, and purposefully persuasive once market acceptability is at stake, with remedies that are risk-containing in the first phase, risk-managing in the second, and risk-assuaging in the third. Combining the key attributes with the idea of three phases can help attune oversight to society's needs.

  15. A managed care cycle provides contract oversight.

    Science.gov (United States)

    Stevenson, Paul B; Messinger, Stephen F; Welter, Terri

    2002-03-01

    In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments.

  16. The Air Force Needs to Improve Cost-Effectiveness and Availability of the Joint Surveillance Target Attack Radar System (Redacted)

    Science.gov (United States)

    2016-11-01

    Introduction Objective We determined whether the Air Force made cost-effective purchases on the performance-based logistics ( PBL ) contract to support...logistics ( PBL ) contract to support JSTARS. Specifically, the JSTARS contracting officer did not establish adequate oversight procedures to validate the...must develop and implement PBL strategies that improve total system availability while minimizing cost and the size of spare parts inventory

  17. International research needs for improving sleep and health of workers.

    Science.gov (United States)

    Kogi, Kazutaka

    2005-01-01

    Research needs in identifying preventive measures dealing with working time arrangements and associated sleep problems are reviewed. These needs are based on the recognition of a range of risk factors for health involving disturbed circadian rhythms leading to various levels of sleep deficits. The review takes account of recent joint change approaches that address both working time arrangements and various relevant intervening factors. As examples of such approaches, voluntary industry-based guidelines for improving shift work are examined. Also reviewed is evidence indicating the effects of improved working time arrangements and sleep hygiene on the tolerance of workers working irregular shifts. Trends in action-oriented risk assessment are further discussed as the effects on health and sleep of these workers may be modified by complex aspects related to working situations, family and social conditions, personal characteristics and social support. Generally relevant are not only the relationships between sleep-affecting factors and health, but also advances in taking the various support measures. The effective use of participatory steps is found important in dealing with working time arrangements and associated health and sleep problems together. It is thus considered important to study (a) the efficacy of joint change approaches addressing complex sleep and health factors, (b) effective procedures for action-oriented health risk assessment in various work life situations, and (c) the relevance of innovative participatory steps to improving health and tolerance of workers. Future research topics mentioned by the participants of the international symposium on night and shift work held in Santos in 2003 are presented, and international efforts to promote research into these aspects in field conditions are discussed. Interactive research involving local people appears crucial.

  18. Meditation acutely improves psychomotor vigilance, and may decrease sleep need

    Directory of Open Access Journals (Sweden)

    Passafiume Jason

    2010-07-01

    Full Text Available Abstract Background A number of benefits from meditation have been claimed by those who practice various traditions, but few have been well tested in scientifically controlled studies. Among these claims are improved performance and decreased sleep need. Therefore, in these studies we assess whether meditation leads to an immediate performance improvement on a well validated psychomotor vigilance task (PVT, and second, whether longer bouts of meditation may alter sleep need. Methods The primary study assessed PVT reaction times before and after 40 minute periods of mediation, nap, or a control activity using a within subject cross-over design. This study utilized novice meditators who were current university students (n = 10. Novice meditators completed 40 minutes of meditation, nap, or control activities on six different days (two separate days for each condition, plus one night of total sleep deprivation on a different night, followed by 40 minutes of meditation. A second study examined sleep times in long term experienced meditators (n = 7 vs. non-meditators (n = 23. Experienced meditators and controls were age and sex matched and living in the Delhi region of India at the time of the study. Both groups continued their normal activities while monitoring their sleep and meditation times. Results Novice meditators were tested on the PVT before each activity, 10 minutes after each activity and one hour later. All ten novice meditators improved their PVT reaction times immediately following periods of meditation, and all but one got worse immediately following naps. Sleep deprivation produced a slower baseline reaction time (RT on the PVT that still improved significantly following a period of meditation. In experiments with long-term experienced meditators, sleep duration was measured using both sleep journals and actigraphy. Sleep duration in these subjects was lower than control non-meditators and general population norms, with no apparent

  19. Needs assessment to improve neonatal intensive care in Mexico.

    Science.gov (United States)

    Weiss, K J; Kowalkowski, M A; Treviño, R; Cabrera-Meza, G; Thomas, E J; Kaplan, H C; Profit, J

    2015-08-01

    At the time of the research, Dr Weiss was a clinical fellow in neonatal-perinatal medicine at Baylor College of Medicine, Texas Children's Hospital. Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence where he collaborated with Dr Kowalkowski.: Improving the quality of neonatal intensive care is an important health policy priority in Mexico. A formal assessment of barriers and priorities for quality improvement has not been undertaken. To provide guidance to providers and policy makers with regard to addressing opportunities for better care delivery in Mexican neonatal intensive care units. To conduct a needs assessment regarding improvement of quality of neonatal intensive care delivery in Mexico. Spanish-language survey administered to a volunteer sample of Mexican neonatal care providers attending a large paediatric conference in Mexico in June 2011. Survey domains included institutional context of quality improvement, barriers, priorities, safety culture, and respondents' characteristics. Results were analysed using descriptive analyses of frequencies, proportions and percentage positive response (PPR) rates. Of 91 respondents, the majority identified neonatology as their primary specialty (n = 48, 65%) and were physicians (n = 55, 73%). Generally, providers expressed a desire to improve quality of care (PPR 69%) but reported notable deterrents. Respondents (n, %) identified family inability to pay (38, 48%), overcrowded work areas (38, 44%), insufficient financial reimbursement (25, 36%), lack of availability of nurses (26, 30%), ancillary staff (25, 29%), and subspecialists (22, 25%) as the principal barriers. Respiratory care (27, 39%)--reduction of mechanical ventilation and

  20. 14 CFR 1203b.108 - Management oversight.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Management oversight. 1203b.108 Section 1203b.108 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.108 Management oversight. (a)...

  1. The need and prospects for improved fusion reactors

    Science.gov (United States)

    Krakowski, R. A.; Miller, R. L.; Hagenson, R. L.

    1986-09-01

    Conceptual fusion reactor studies over the past 10-15 yr have projected systems that may be too large, complex, and costly to be of commercial interest. One main direction for improved fusion reactors points toward smaller, higher-power-density approaches. First-order economic issues (i.e., unit direct cost and cost of electricity) are used to support the need for more compact fusion reactors. The results of a number of recent conceptual designs of reversed-field pinch, spheromak, and tokamak fusion reactors are summarized as examples of more compact approaches. While a focus has been placed on increasing the fusion-power-core mass power density beyond the minimum economic threshold of 100-200 kWe/tonne, other means by which the overall attractiveness of fusion as a long-term energy source are also addressed.

  2. Need for improved monitoring in patients with acromegaly

    Science.gov (United States)

    Silverstein, Julie M

    2015-01-01

    Acromegaly is a rare and insidious disease characterized by the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF1) and is most commonly due to a pituitary adenoma. Patients with acromegaly who experience prolonged exposure to elevated levels of GH and IGF1 have an increased mortality risk and progressive worsening of disease-related comorbidities. Multimodal treatment with surgery, medical therapy, and radiotherapy provides biochemical control, defined by recent acromegaly clinical guidelines from the Endocrine Society as a reduction of GH levels to acromegaly, even those without clinical symptoms of disease, require long-term monitoring of GH and IGF1 levels if the benefits associated with biochemical control are to be maintained and the risk of developing recurrent disease is to be abated. However, suboptimal monitoring is common in patients with acromegaly, and this can have negative health effects due to delays in detection of recurrent disease and implementation of appropriate treatment. Because of the significant health consequences associated with prolonged exposure to elevated levels of GH and IGF1, optimal monitoring in patients with acromegaly is needed. This review article will discuss the biochemical assessments used for therapeutic monitoring in acromegaly, the importance of monitoring after surgery and medical therapy or radiotherapy, the consequences of suboptimal monitoring, and the need for improved monitoring algorithms for patients with acromegaly. PMID:26381160

  3. Improvements Needed on DoD Procurements from Robertson Fuel Systems (REDACTED)

    Science.gov (United States)

    2015-06-25

    Mission Our mission is to provide independent, relevant, and timely oversight of the Department of Defense that supports the warfighter; promotes ...oversight organization in the Federal Government by leading change, speaking truth, and promoting excellence—a diverse organization, working together...made commercial item determinations and identified a minor modification, specifically when no evidence of commercial sales existed for items

  4. Tennessee Oversight Agreement combined annual reports, May 13, 1991--May 12, 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-07-01

    The Tennessee Oversight Agreement provides independent oversight and monitoring of the Department of Energy`s activities on the Oak Ridge Reservation by the State. The agreement obligates the state to provide an annual report to DOE and for public distribution of the results of the DOE Oversight Division`s monitoring and analysis activities and its findings of the quality and effectiveness of the Department of Energy`s environmental monitoring and surveillance programs. The DOE Oversight Division`s first report will discuss the status of the entire oversight agreement for the first two years of its existence. The 1991--1993 combined annual reports include a short history of the Division, a list of the Tennessee Oversight Agreement commitments and a status report on each of DOE Oversight Division`s programs. Each Division program includes a descriptive status of its findings and recommendations. These findings and recommendations were also consolidated into a separate segment of the report (Chapter 7). Findings indicate there have been genuine successes in the areas of site access and data availability. More effort, however, is required in both of these areas before the state can verify that DOE and its contractors are meeting its obligations. Ambient surveillance monitoring by DOE is extensive. The DOE Oversight Division reviews this data to assure the state and its citizens that all areas of the environment are adequately protected by DOE operations. There is a noticeable lack of research and development in the technology for environmental remediation and radiological and mixed waste treatment, storage and disposal. The DOE Oversight Division`s recommendations for improvement are provided with each of the findings listed in this report.

  5. The urgent need for quality improvement in Russia.

    Science.gov (United States)

    Ruevekamp, D

    1994-01-01

    Induced abortion became accepted as a legal method of family planning after the October Revolution of 1917 from which terminations were performed in state hospitals free of charge upon a woman's request. The procedure was made legal in response to then newly voiced egalitarian ideals and the increasing involvement of women in the labor market, as well as because of the rapidly deteriorating situation and post-Revolution period of famine. Administrators fully expected to reduce the incidence of abortion once living conditions improved. Little was done at the time to develop contraceptives. Stalin, however, in the 1920s and 1930s, lamented a falling birth rate in the face of manpower needed for labor and the military; abortion and contraceptives were banned, leading to post-abortion complications without really stimulating the birth rate. Abortion was relegalized in 1956, but the right to contraception was never fully restored. Seven million induced abortions were officially registered to have taken place in each of the last ten years in the former Soviet Union. A woman typically undergoes one abortion per year, or approximately twenty abortions during the childbearing period of her life. Lacking knowledge about contraception, contraceptives, and what many Western countries regard to be women's reproductive health rights, most Russian women, however, freely tolerate frequent repeated abortion as a normal method of fertility regulation. Lack of access to contraceptives along with the lack of domestic contraceptive method production facilities and lack of hard currency to secure quality supplies from abroad are contributing factors to this ongoing trend. Gynecologists also receive lucrative fees for illegal abortions and are unlikely to promote change. Plans to open twelve family planning centers in Moscow have been hampered by the inertia of bureaucracy, the lack of financial means, the lack of trained personnel, and people's suspicion of government bodies. Much needs

  6. Teacher training program for medical students: improvements needed

    Directory of Open Access Journals (Sweden)

    van Diggele C

    2015-04-01

    Full Text Available Christie van Diggele,1 Annette Burgess,2 Craig Mellis21The University of Sydney, Sydney, NSW, Australia; 2Sydney Medical School – Central, The University of Sydney, Sydney, NSW, AustraliaIntroduction: Skills in peer teaching, assessment, and feedback are increasingly documented internationally as required graduate attributes in medicine. Yet these skills are rarely taught in medical schools. We sought to design and deliver a short but effective teacher training (TT program for medical students that could be easily integrated into the professional development curriculum. This study sought to evaluate such a pilot program, based on student perception.Methods: The study took place at a major metropolitan teaching hospital, where 38 medical students were invited to attend a voluntary, newly designed four-module TT program. In total, 23/38 (61% of invited students attended. Mixed methods were used for evaluation. Questionnaires were completed by 21/23 (91% of students, and 6/23 (26% of students participated in a focus group.Results: Students reported that as a result of the program they felt more confident to facilitate small group teaching activities and to provide feedback to peers using the suggested frameworks. Students would like the program to contain more in-depth educational theory and to allow a more time for small group learning activities. They would also like to see opportunities for participation across all clinical schools.Conclusion: The TT program was successful in increasing student awareness of educational theory and practice, thereby improving their confidence in teaching and assessing their peers and making them feel better prepared for their careers as medical practitioners. Key improvements to the program are needed in terms of more in-depth theory and more time spent on small group learning. This might be achieved by complementing the course with e-learning.Keywords: teacher training, medical students, peer teaching, peer

  7. 13 CFR 120.1005 - Bureau of PCLP Oversight.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Bureau of PCLP Oversight. 120.1005 Section 120.1005 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Risk-Based Lender Oversight Supervision § 120.1005 Bureau of PCLP Oversight. SBA's Bureau of PCLP Oversight...

  8. Ethics Oversight Mechanisms for Surgical Innovation: A Systematic and Comparative Review of Arguments.

    Science.gov (United States)

    Karpowicz, Lila; Bell, Emily; Racine, Eric

    2016-04-01

    Surgical innovation typically falls under the purview of neither conventional clinical ethics nor research ethics. Due to a lack of oversight for surgical innovation-combined with a potential for significant risk-a wide range of arguments has been advanced in the literature to support or undermine various oversight mechanisms. To scrutinize the argumentation surrounding oversight options, we conducted a systematic review of published arguments. We found that the arguments are typically grounded in common sense and speculation instead of evidence. Presently, the justification or superiority for any single oversight mechanism for surgical innovation cannot be established convincingly. We suggest ways to improve the argument-based literature and discuss the value of systematic reviews of arguments and reasons. © The Author(s) 2016.

  9. DoD Needs to Improve the Management and Oversight of Operations at the Defense Reutilization and Marketing Office-Camp Arifjan, Kuwait

    Science.gov (United States)

    2011-01-12

    cnoicca do noc conform to contract requiren~nts, the government may require the Contractor to pcrfiJnn ~ scrvi.:cs 11gnin in eonfonllil)’" ith the comrnct...any Di~positiun Services follow-up contra-.; •• Cllfi\\P Arifjan. Rccon’ll’l~endatjon; 1\\.3. J\\ .3.a. Direclor. T>I. .. A Dio~rooition S.: nic ~. in

  10. DOD Oversight Improvements are Needed on the Contractor Accounting System for the Army’s Cost-Reimbursable Stryker Logistics Support Contract

    Science.gov (United States)

    2013-07-16

    Policy FAR Federal Acquisition Regulation GDLS General Dynamics Land System PCO Procuring Contracting Officer PEO Program Executive Officer...our March 2012 preliminary briefing of the accounting system deficiencies, PMO Stryker issued a procuring contracting officer ( PCO ) letter that...and such a billing practice must be corrected. Specifically, the PCO letter, dated March 7, 2012, stated: This PCO [procuring contracting officer

  11. Improving Maslow’s Hierarchy of Needs: New Approach to needs hierarchy

    OpenAIRE

    Babak Nemati

    2013-01-01

    In this article Maslow's hierarchy of needs is reviewed with two viewpoints: critical and supportive. We try to extract and classify the relevant subject related to the research content after studying and analysis of documents. Thus, because of their common characters, the needs that have been cited from some scientists could be gathered and make some new levels.The new Maslow's hierarchy of needs has been presented in this research and we added three levels EPISTEMOLOGY, LOG and EROS (Freedo...

  12. Oversight Institutions Within the United Nations

    DEFF Research Database (Denmark)

    Pontoppidan, Caroline Aggestam

    2015-01-01

    This article will give a description of the role of internal audit and governance functions within the United Nations system. The United Nations has, during the last 10 years, worked to establish effective oversight services. Oversight, governance and hereunder the internal audit function has been...... a key priority within the United Nations and a crucial ingredient in the Secretary-General’s efforts to reform and strengthen the United Nations to meet the challenges of the 21st century....

  13. Oversight Institutions Within the United Nations

    DEFF Research Database (Denmark)

    Pontoppidan, Caroline Aggestam

    2015-01-01

    This article will give a description of the role of internal audit and governance functions within the United Nations system. The United Nations has, during the last 10 years, worked to establish effective oversight services. Oversight, governance and hereunder the internal audit function has been...... a key priority within the United Nations and a crucial ingredient in the Secretary-General’s efforts to reform and strengthen the United Nations to meet the challenges of the 21st century....

  14. Improving Early Numeracy of Young Children with Special Education Needs.

    Science.gov (United States)

    Van Luit, Johannes E. H.; Schopman, Esther A.

    2000-01-01

    Sixty-two students from special needs kindergartens were given early mathematics intervention. The early numeracy program was developed for children with disabilities and early numeracy difficulties by basing instruction on perceptual gestalt theory. Children performed better at posttest than controls but failed to transfer their knowledge to…

  15. Improving the assessment of instream flow needs for fish populations

    Energy Technology Data Exchange (ETDEWEB)

    Sale, M.J. (Oak Ridge National Lab., TN (USA)); Otto, R.G. (Otto (R.G.) and Associates, Arlington, VA (USA))

    1991-01-01

    Instream flow requirements are one of the most frequent and most costly environmental issues that must be addressed in developing hydroelectric projects. Existing assessment methods for determining instream flow requirements have been criticized for not including all the biological response mechanisms that regulate fishery resources. A new project has been initiated to study the biological responses of fish populations to altered stream flows and to develop improved ways of managing instream flows. 21 refs., 3 figs.

  16. Emergency obstetric care in Punjab, Pakistan: improvement needed.

    Science.gov (United States)

    Ali, Moazzam; Ahmed, Khawaja Masuood; Kuroiwa, Chushi

    2008-06-01

    This paper describes an approach to maternal mortality reduction in Pakistan that uses UN emergency obstetric care (EmOC) process indicators to examine if public health care centres in Pakistan's Punjab province comply with minimum recommendations for basic and comprehensive services. In a cross sectional study in September 2003, through random sampling at area and health-facility levels from 30% of districts in Punjab province (n = 11/34 districts), all public health facilities providing EmOC were included (n = 120). Facility data were used for analysis. No district in Punjab met the minimum standards laid down by the UN for providing EmOC services. The number of facilities providing basic and comprehensive EmOC services fell far short of recommended levels. Only 4.7% of women with complications attended hospitals. Caesarean section was carried out in only 0.4% of births. The case fatality rate was hard to accurately calculate due to poor record keeping and data quality. The study may be taken as a baseline for developing and improving the standards of services in Punjab province. It is vital to upgrade existing basic EmOC facilities and to ensure that staff skills be improved, facilities be better equipped in critical areas, and record keeping be improved. Hence to reduce maternal mortality, facilities for EmOC must exist, be accessible, offer quality services, and be utilized by patients with complications.

  17. Heroin users: the need for improved treatment for incarcerated women.

    Science.gov (United States)

    Horton, Arthur

    2011-01-01

    This paper addresses the use of drugs, specifically heroin, by women. While women's rate of incarceration in the nation have dramatically increased, tripling in the last decade, prisons have not kept pace with the growth of the number of women in prison and the need for drug treatment and recovery for this population. This paper examines one programmatic effort to provide services to this most vulnerable population in the state of Illinois. The continuum of care model is considered in light of the challenges of high recidivism rates, particularly in the state of Illinois. It identifies a need for more effective evidence-based services at the state level for prison inmates before and after discharge. Effective program evaluation has not been a priority in some states, and perhaps Illinois correction is prototypical. More effective intervention may require more community involvement post-release for ex-offenders. Barriers to healthcare, employment and housing, are just as evident with female drug offenders as in the male population.

  18. What does the history of technology regulation teach us about nano oversight?

    Science.gov (United States)

    Marchant, Gary E; Sylvester, Douglas J; Abbott, Kenneth W

    2009-01-01

    As policy makers struggle to develop regulatory oversight models for nanotechnologies, there are important lessons that can be drawn from previous attempts to govern other emerging technologies. Five such lessons are the following: (1) public confidence and trust in a technology and its regulatory oversight is probably the most important factor for the commercial success of a technology; (2) regulation should avoid discriminating against particular technologies unless there is a scientifically based rationale for the disparate treatment; (3) regulatory systems need to be flexible and adaptive to rapidly changing technologies; (4) ethical and social concerns of the public about emerging technologies need to be expressly acknowledged and addressed in regulatory oversight; and (5) international harmonization of regulation may be beneficial in a rapidly globalizing world.

  19. Need to improve clinical trials in rare neurodegenerative disorders

    Directory of Open Access Journals (Sweden)

    Maria Puopolo

    2011-01-01

    Full Text Available Rare neurodegenerative diseases are fatal and no therapy is available to cure or slow down the progression of disease. We report possibly weaknesses in the management of clinical studies in these diseases, ranging from poor preclinical studies, difficulties in the recruitment of patients, delay in the onset of treatment because of lack in early disease-specific biomarkers, and suboptimal design of Phase II clinical trials. The adoption of innovative statistical approaches in early Phase II trials might improve the screening of drugs in rare neurodegenerative disorders, but this implicates efforts from clinical researchers, statisticians, and regulatory people to the development of new strategies that should maintain rigorous scientific integrity together with a more ethical approach to human experimentations.

  20. Capturing User Needs to Improve Processes at EOSDIS Data Centers

    Science.gov (United States)

    Sofinowski, E. J.; Boquist, C. L.

    2009-12-01

    Since 2004 the Earth Observing System Data and Information System (EOSDIS) has conducted an annual comprehensive survey of user satisfaction using the American Customer Satisfaction Index (ACSI). Customer satisfaction ratings for EOSDIS consistently rate better than the overall government ratings. As part of the survey users are asked to submit comments concerning their experiences and interests. These user comments provide valuable insight into the effect of data center processes on users' experiences. Although user satisfaction has remained high, their preferences have changed with the rapid advances in web-based services. This analysis investigates the correlation between user comments, process changes or capability improvements at the individual data centers, and whether the changes at the data centers and web sites show a corresponding increase in user satisfaction. We will evaluate the comments in the areas of Product Search, Product Selection and Order, Delivery, Product Quality and Customer Support.

  1. Vaccination for tomorrow: the need to improve immunisation rates.

    Science.gov (United States)

    Kassianos, George

    2010-01-01

    Since the 1998 health scare about measles mumps and rubella (MMR) immunisation, vaccination rates for measles have suffered. Although these recovered for a brief period in 2004-05, they have stalled again and latest figures suggest that only 85% of children are now immunised against this disease. The UK has become one of the five countries in the European Union with the highest measles rates. Meanwhile the wider picture indicates that other vaccination rates, including for seasonal influenza, are not meeting targets. This is a potential sign that the MMR scare and myths around immunisation are setting a worrying trend of some people losing confidence in the practice of vaccination. The UK has expanded its childhood immunisation programme to include the human papilloma virus vaccine (HPV) which protects against some types of cervical cancer. New life-saving vaccines for diseases, including meningococcal B meningitis (a strain of meningitis not yet covered by the existing vaccination programme), shingles and hepatitis C will soon become available. It is therefore important that information is available to the general public about the excellent safety record and benefits of vaccination to ensure that as many people as possible can take advantage of these new vaccines. This article explores the current uptake of, and attitudes towards, vaccination programmes and discusses some myths about immunisation. It suggests that community health care teams with access to adults, including parents of children and young people who need vaccination, are well placed to help challenge some of these myths and promote the benefits of immunisation. Practical suggestions are included on how this can be achieved.

  2. The Urgent Need for Improved Climate Models and Predictions

    Science.gov (United States)

    Goddard, Lisa; Baethgen, Walter; Kirtman, Ben; Meehl, Gerald

    2009-09-01

    An investment over the next 10 years of the order of US$2 billion for developing improved climate models was recommended in a report (http://wcrp.wmo.int/documents/WCRP_WorldModellingSummit_Jan2009.pdf) from the May 2008 World Modelling Summit for Climate Prediction, held in Reading, United Kingdom, and presented by the World Climate Research Programme. The report indicated that “climate models will, as in the past, play an important, and perhaps central, role in guiding the trillion dollar decisions that the peoples, governments and industries of the world will be making to cope with the consequences of changing climate.” If trillions of dollars are going to be invested in making decisions related to climate impacts, an investment of $2 billion, which is less than 0.1% of that amount, to provide better climate information seems prudent. One example of investment in adaptation is the World Bank's Climate Investment Fund, which has drawn contributions of more than $6 billion for work on clean technologies and adaptation efforts in nine pilot countries and two pilot regions. This is just the beginning of expenditures on adaptation efforts by the World Bank and other mechanisms, focusing on only a small fraction of the nations of the world and primarily aimed at anticipated anthropogenic climate change. Moreover, decisions are being made now, all around the world—by individuals, companies, and governments—that affect people and their livelihoods today, not just 50 or more years in the future. Climate risk management, whether related to projects of the scope of the World Bank's or to the planning and decisions of municipalities, will be best guided by meaningful climate information derived from observations of the past and model predictions of the future.

  3. 12 CFR 985.4 - Finance Board oversight.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Finance Board oversight. 985.4 Section 985.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD OFFICE OF FINANCE THE OFFICE OF FINANCE § 985.4 Finance Board oversight. (a) Oversight and enforcement actions. The Finance Board shall have the same...

  4. 13 CFR 120.1000 - Risk-Based Lender Oversight.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Risk-Based Lender Oversight. 120.1000 Section 120.1000 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Risk-Based Lender Oversight Supervision § 120.1000 Risk-Based Lender Oversight. (a) Risk-Based...

  5. 13 CFR 120.1070 - Lender oversight fees.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Lender oversight fees. 120.1070 Section 120.1070 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Risk-Based Lender Oversight Supervision § 120.1070 Lender oversight fees. Lenders are required to pay to SBA fees...

  6. A Study on the Construct Validity of Safety Culture Oversight Model for Nuclear Power Operating Organization

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Su Jin; Choi, Young Sung; Oh, Jang Jin [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2015-05-15

    In Korea, the safety policy statement declared in 1994 by government stressed the importance of safety culture and licensees were encouraged to manage and conduct their self-assessments. A change in regulatory position about safety culture oversight was made after the event of SBO cover-up in Kori unit 1 and several subsequent falsification events. Since then KINS has been developing licensee's safety culture oversight system including conceptual framework of oversight, prime focus area for oversight, and specific details on regulatory expectations, all of which are based on defence-in-depth (DiD) safety enhancement approach. Development and gathering of performance data which is related to actual 'safety' of nuclear power plant are needed to identify the relationship between safety culture and safety performance. Authors consider this study as pilot which has a contribution on verifying the construct validity of the model and the effectiveness of survey based research. This is the first attempt that the validity of safety culture oversight model has been investigated with empirical data obtained from Korean nuclear power operating organization.

  7. Workshop Report: Joint Requirements. Oversight Council Process.

    Science.gov (United States)

    2007-11-02

    Brinkley ...................................... 73 10. Integration, Dr. W illiam G. Lese, Jr ....................................... 81 Part III...author. several MORS prizes that recognize outstanding Quoted in: Alan L. Mackay, The Harvest of a Quiet Eye analysis efforts. (1977). 22 Joint...Oversight Council Process 72 9. Joint Readiness William A. Brinkley Introduction 9 individual JWCA assessments and The Military Operations Research

  8. Toward Better Oversight of NGS Tests.

    Science.gov (United States)

    2016-09-01

    The FDA has published two draft guidance documents aimed at streamlining its oversight of tests based on next-generation sequencing (NGS). One contains preliminary recommendations addressing the analytic validity of NGS-based tests for hereditary diseases; the other explains how test developers can obtain official recognition of their genetic variant databases, potentially speeding marketing clearance or approval.

  9. Oversight of the Liberian National Police

    Science.gov (United States)

    2009-01-01

    Capetown , 2005. 3 Open Society Foundation for South Africa, Strengthening Police Oversight in South Africa, 2005. African Experience 7 The national...Berg, Police Accountability in Southern Africa Commonwealth Countries, Cape Town, South Africa: Institute of Crimi- nology, University of Capetown ...Institute of Criminology, University of Capetown , 2005. ———, Police Accountability in Southern Africa Commonwealth Countries, Cape Town, South Africa

  10. DOD Financial Management: Improvements Needed in the Navys Audit Readiness Efforts for Fund Balance with Treasury

    Science.gov (United States)

    2016-08-01

    DOD FINANCIAL MANAGEMENT Improvements Needed in the Navy’s Audit Readiness Efforts for Fund Balance with Treasury...Accountability Office Highlights of GAO-16-47, a report to congressional committees August 2016 DOD FINANCIAL MANAGEMENT Improvements Needed...Guidance to provide a standard methodology for DOD components to follow to improve financial management and achieve audit readiness, and designated

  11. Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence.

    Science.gov (United States)

    Millar, Ross; Freeman, Tim; Mannion, Russell

    2015-06-16

    Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards' ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study. The article draws on 10 interviews with key informants and policy actors who form part of the 'issue network' interested in the promotion of patient safety in the English National Health Service. The interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated on the role of trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on 'trust' characterised by styles of leadership and behaviours that are attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of 'intelligence' generated from both national and local information sources. We call for a re-imagination of hospital board oversight in the light of these different perspectives and articulate an emerging research agenda in this area.

  12. Program Manager Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices

    Science.gov (United States)

    2015-05-05

    5 , 2 0 1 5 Program Manager Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices Report No. DODIG-2015-116 Report...TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Program Manager Medium and Heavy Tactical Vehicles Needs to Improve... Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices Visit us at www.dodig.mil Objective The objective was to assess the propriety

  13. An evaluation of the role and effectiveness of institutional biosafety committees in providing oversight and security at biocontainment laboratories.

    Science.gov (United States)

    Race, Margaret S; Hammond, Edward

    2008-03-01

    Institutional biosafety committees (IBCs) have been charged with the oversight and review of biosafety at thousands of biocontainment labs nationwide, hundreds of which are high-level BSL-3 and BSL-4 labs. In light of the recent rapid proliferation of BSL-3 and BSL-4 facilities and the increases in research in the areas of biodefense, select agents, recombinant DNA, and synthetic biology and dual-use research, questions have been raised about whether IBCs are fulfilling their oversight responsibilities. This article reviews information on the responsibilities and expectations of IBCs as currently constituted and provides an analysis of IBC performance from survey data of hundreds of research institutions over the past several years. The findings highlight serious ongoing problems with IBCs' adherence to NIH Guidelines. This raises questions about the current voluntary governance framework as an effective system to monitor and oversee U.S. research facilities, including high-containment facilities, and their research activities. The findings strongly suggest the need for immediate improvement or replacement of the IBC system.

  14. F-35 Sustainment: Need for Affordable Strategy, Greater Attention to Risks, and Improved Cost Estimates

    Science.gov (United States)

    2014-09-01

    F - 35 SUSTAINMENT Need for Affordable Strategy, Greater Attention to Risks, and Improved Cost Estimates Report...2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE F - 35 Sustainment: Need for Affordable Strategy, Greater...House of Representatives September 2014 F - 35 SUSTAINMENT Need for Affordable Strategy, Greater Attention to Risks, and Improved Cost Estimates Why

  15. DOD Education Benefits: Increased Oversight of Tuition Assistance Program Is Needed. Report to the Chairman, Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security, Committee on Homeland Security and Governmental Affairs, United States Senate. GAO-11-300

    Science.gov (United States)

    Scott, George A.

    2011-01-01

    In fiscal year 2009, the Department of Defense's (DOD) Military Tuition Assistance (TA) Program provided $517 million in tuition assistance to approximately 377,000 service members. US Government Accountability Office (GAO) was asked to report on (1) DOD's oversight of schools receiving TA funds, and (2) the extent to which DOD coordinates with…

  16. The Spider Web of Oversight: An Analysis of External Oversight of Higher Education

    Science.gov (United States)

    Lane, Jason E.

    2007-01-01

    Over the past several decades, state officials and various interest groups and civic organizations have increased their level of direct involvement in the affairs of public higher education. The increase in external attention toward the academy would likely be accompanied by the development of oversight mechanisms to ensure that societal…

  17. 10 CFR 440.23 - Oversight, training, and technical assistance.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Oversight, training, and technical assistance. 440.23... PERSONS § 440.23 Oversight, training, and technical assistance. (a) The Secretary and the appropriate..., directly or indirectly, training and technical assistance to any grantee or subgrantee. Such training and...

  18. 32 CFR 2700.51 - Information Security Oversight Committee.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Information Security Oversight Committee. 2700.51 Section 2700.51 National Defense Other Regulations Relating to National Defense OFFICE FOR MICRONESIAN STATUS NEGOTIATIONS SECURITY INFORMATION REGULATIONS Implementation and Review § 2700.51 Information Security Oversight Committee. The...

  19. 41 CFR 105-53.133 - Information Security Oversight Office.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Information Security... FUNCTIONS Central Offices § 105-53.133 Information Security Oversight Office. (a) Creation and authority. The Information Security Oversight Office (ISOO), headed by the Director of ISOO, who is appointed...

  20. 76 FR 71081 - Public Aircraft Oversight Safety Forum

    Science.gov (United States)

    2011-11-16

    ... SAFETY BOARD Public Aircraft Oversight Safety Forum The National Transportation Safety Board (NTSB) will convene a Public Aircraft Oversight Safety Forum which will begin at 9 a.m., Wednesday, November 30, 2011. NTSB Chairman Deborah A.P. Hersman will chair the two-day forum and all five Board Members will...

  1. Computer Literacy Improvement Needs: Physicians' Self Assessment in the Makkah Region

    Directory of Open Access Journals (Sweden)

    Hani Abdulsattar Shaker

    2013-11-01

    Full Text Available Objective: A confidential inquiry by the Directorate General of health affairs, Makkah region, Saudi Arabia, found physicians were resistant to enter patient-related information in the electronic medical records system at different hospitals. This study aims to highlight their computer literacy needs.Methods: This cross-sectional survey was conducted on physicians using a structured questionnaire bearing nine questions/stems with dichotomous answers, (i.e., yes/no that was distributed among physicians at six different Ministry of Health hospitals in the Makkah Region, Saudi Arabia, between May and August 2009. The results for future needs in computer skills were categorized as "none" if the rate of answer "yes" to any stem was 0-25%, "little" if 26-50%, "some" if 51-75% and "substantial" if >75% rated "yes".Results: The response rate of 82% of determined sample size (n = 451 was attained. Computer literacy improvement elements (CLIE, i.e., "word processing software skills (MS Word", "presentation software skills (Power Point", "internet search skills", "medical database search skills", "spreadsheet software skills (Excel" and "advanced e-mail management skills" were in "substantial" need of improvement among the majority of settings and categories. All other computer literacy improvement elements were in "some" need of improvement.Conclusion: The overall outcome of this study indicates that physicians need further computer literacy improvements.

  2. F-35 Joint Strike Fighter: Development of New Capabilities Requires Continued Oversight

    Science.gov (United States)

    2016-04-26

    number of changes affecting the planned quantities and associated costs . According to current projections, the U.S. portion of the program will require...Strike Fighter F-35 Joint Strike Fighter Block 4 Development Costs Increase Near-Term Funding Needs DOD does not currently plan to manage...difficult for Congress to hold it accountable for achieving its cost , schedule, and performance requirements. Given that congressional oversight

  3. Improvements to Controls Over Cash Are Needed at Army Disbursing Stations in Kuwait and Saudi Arabia

    Science.gov (United States)

    2014-04-09

    and receipt for cash and vouchers on hand. Reporting Structure of the Army’s Disbursing Stations in Kuwait The Army disbursing station at Camp...No. DODIG-2014-057 A P R I L 9 , 2 0 1 4 Improvements to Controls Over Cash Are Needed at Army Disbursing Stations in Kuwait and Saudi Arabia...2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Improvements to Controls Over Cash Are Needed at Army

  4. Cerritos Community College: Improvements Needed in Aspects of Operating the District and Its Auxiliary Organization.

    Science.gov (United States)

    California State Office of the Auditor General, Sacramento.

    This audit report discusses the operation of the Enterprise Fund by Cerritos Community College District in California. In addition, the Cerritos College Foundation's conflict of interest policies, its relationship with the district, and its award of contracts for services was reviewed. It was found that the district needed improvement in its…

  5. Exploring New Service Models: Can Consolidating Public Service Points Improve Response to Customer Needs?

    Science.gov (United States)

    Flanagan, Pat; Horowitz, Lisa R.

    2000-01-01

    Describes an experimental integrated service point that combines the desks and staff who perform reference and circulation at one of Massachusetts Institute of Technology's libraries. Considers whether this service model can consolidate public service points to improve response to customer needs; discusses performance measurement; and offers…

  6. Transformation in Higher Education: A Learner-Needs Segmentation Leads to Improved Learner Satisfaction

    Science.gov (United States)

    Rogers, Gayla; Finley, Donna S.; Patterson, Margaret

    2006-01-01

    Segmentation is a marketing concept that can be applied in a post-secondary context. This article delineates the outcome of applying a learner-needs segmentation that resulted in significantly improved learner satisfaction scores in a professional faculty at a large public university. Our original work described the purpose and value of…

  7. THE NEED TO IMPROVE PRACTICAL INFORMATION SYSTEM IN AGRICULTURE AND SPECIALIZED INDUSTRY

    Directory of Open Access Journals (Sweden)

    Romeo Cătălin CREŢU

    2015-04-01

    Full Text Available In Romania, the establishment of the market economy has required the elaboration and implementation of agricultural, alimentary and nutritional policies, based on scientific criteria, to ensure that the structure of Romanian agriculture would come close to that of the European Union agriculture. Agricultural policy needs to be coherent, flexible and directed towards the economic, social and environmental protection performance. Worldwide practice shows that empiric experience of economic agents does not suffice, but requires plenty of scientific knowledge. The hereby study undertakes to carry out a radiography of the production potential of agricultural operations in Romania and to demonstrate the need for improving practical information systems in agriculture and specialized industry.

  8. Application of multimedia services in the broadband environment to improve logistic needs of the army

    Directory of Open Access Journals (Sweden)

    Radiša R. Stefanović

    2012-07-01

    Full Text Available The paper analyzes the flow of some multimedia services, and points to the possibility of applying some of the services in the broadband environment to improve the logistic needs of the army. The need to convey information in different forms (from text, data, graphics, still pictures to video motion pictures is increasing continually. Requests for information transfer in high resolution require increasing the flow to several dozens of Mb/s. Broadband represents the platform for a wide range of multimedia services. Each multimedia service requires a certain flow which can be partially decreased with advanced coding techniques.

  9. The potential and need for improvement in the training of new university lecturers

    Directory of Open Access Journals (Sweden)

    Jesús Conde-Jiménez

    2016-01-01

    Full Text Available This article presents a case study which explores and analyzes aspects perceived as potentialities or needing improvement (SWOT analysis in new university lecturers, from the analysis of clinical supervision or improvement cycles, studied within the framework of the training program for new lecturers at the Institute of Education Sciences (ICE in Spanish at the Universidad de Sevilla in Spain. The results show potential/positive aspects both internally (Strengths and externally (Opportunities in new lecturers, and aspects for improvement internally (Weaknesses and externally (Threats. This study shows an example through which improvement strategies for the training of new university lecturers can be directed, or existing ones can be redefined, meaning that the case study establishes a framework in which dominant socio-educational strategies can be reflected, as perceived by new university lecturers.

  10. A synthesis of research needs for improving the understanding of atmospheric mercury cycling

    Science.gov (United States)

    Zhang, Leiming; Lyman, Seth; Mao, Huiting; Lin, Che-Jen; Gay, David A.; Wang, Shuxiao; Sexauer Gustin, Mae; Feng, Xinbin; Wania, Frank

    2017-07-01

    This synthesis identifies future research needs in atmospheric mercury science, based on a series of review papers, as well as recent developments in field data collection, modeling analysis, and emission assessments of speciated atmospheric mercury. Research activities are proposed that focus on areas that we consider important. These include refinement of mercury emission estimations, quantification of dry deposition and air-surface exchange, improvement of the treatment of chemical mechanisms in chemical transport models, increase in the accuracy of oxidized mercury measurements, better interpretation of atmospheric mercury chemistry data, and harmonization of network operation. Knowledge gained in these research areas will significantly improve our understanding of atmospheric cycling from local to global scales.

  11. Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation.

    Science.gov (United States)

    Manganelli, Joe; Threatt, Anthony; Brooks, Johnell O; Healy, Stan; Merino, Jessica; Yanik, Paul; Walker, Ian; Green, Keith

    2014-01-01

    This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more useful, usable, and actively assistive over-the-bed table. Manganelli et al. (2014) generated a list of 74 needs for use in developing an actively assistive over-the-bed table. This present study assesses the value and importance of those needs. Fourteen healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process. A mixed methods qualitative approach used methodological triangulation to confirm the value of the findings and ratings to establish importance. Open and closed card sorts and a Delphi study were used. Data analysis methods included frequency analysis, content analysis, and a modified Kano analysis. A table demonstrating the needs that are of high importance to both groups of subject matter experts and classification of the design challenges each represents was produced. Through this process, the list of 74 needs was refined to the 37 most important need statements for both groups. Designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients. © 2014 Vendome Group, LLC.

  12. Challenges of Using Quality Improvement Methods in Nursing Homes that “Need Improvement”

    Science.gov (United States)

    Rantz, Marilyn J.; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna

    2012-01-01

    A randomized, two-group, repeated-measures design was used to test a two year intervention for improving quality of care and resident outcomes in facilities in “need of improvement”. Intervention group (n=29) received an experimental multilevel intervention designed to help them (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve 1) leadership team (NHA, DON) who are interested in learning to use their federal Quality Indicator/Quality Measure (QI/QM) reports to improve resident care and outcomes; 2) one leader who will be the “change champion” and others make sure that current QI/QM reports are consistently shared on each nursing unit; 3) willingness to involve all staff in educational activities to learn about the QI/QM process and federal reports that compare the home with others in the state and nation; 4) plan and continuously educate new staff about the QI/QM process and how to do quality improvement; 5) continuously involve all staff in quality improvement committee and team activities so they “own” the process and are responsible for change. PMID:22926322

  13. Army’s Management of Gray Eagle Spare Parts Needs Improvement (REDACTED)

    Science.gov (United States)

    2016-04-29

    Brief Army’s Management of Gray Eagle Spare Parts Needs Improvement Recommendations (cont’d) located at DoD-fielded locations when forecasting spare...spare parts for Gray Eagle. Review of Internal Controls DoD Instruction 5010.40, “ Managers ’ Internal Control Program Procedures,” May 30, 2013...intended and to evaluate the effectiveness of the controls . We identified internal control weaknesses within the Army’s management of Gray Eagle

  14. Actions Needed to Improve the Reliability of Afghan Security Force Assessments

    Science.gov (United States)

    2010-06-29

    Assessment Tool VTT Validation Transition Team SIGAR Audit-10-11 Security/ANSF Capability Ratings Page 1 Actions Needed to Improve the...the part of Afghan units. In addition, IJC’s Validation Transition Team ( VTT ), which provides independent validation of CM1 capabilities for the...personnel were present for duty in ANA-fielded combat units. The ANA’s manning shortage was confirmed in statements by VTT officials who reported

  15. Air Force Civil Engineer Center Management of Energy Savings Performance Contracts Needs Improvement

    Science.gov (United States)

    2016-05-04

    generated a database of trained Air Force personnel. Air Force Energy Office officials stated that they did not reach out to DOE-FEMP to track Air Force...completed, and terminated Air Force energy -savings performance-contract projects. The database should include, but not be limited to, appropriate...Force Civil Engineer Center Management of Energy Savings Performance Contracts Needs Improvement M A Y 4 , 2 0 1 6 Report No. DODIG-2016-087 Mission

  16. Task Group report to the Assistant Secretary for Environment, Safety and Health on oversight of chemical safety at the Department of Energy. Volume 2, Appendices

    Energy Technology Data Exchange (ETDEWEB)

    1992-11-01

    This report presents the results of a preliminary review of chemical safety within the Department of Energy (DOE). The review was conducted by Chemical Safety Oversight Review (CSOR) Teams composed of Office of Environment, Safety and Health (EH) staff members and contractors. The primary objective of the CSOR was to assess, the safety status of DOE chemical operations and identify any significant deficiencies associated with such operations. Significant was defined as any situation posing unacceptable risk, that is, imminent danger or threat to workers, co-located workers, the general public, or the environment, that requires prompt action by EH or the line organizations. A secondary objective of the CSOR was to gather and analyze technical and programmatic information related to chemical safety to be used in conjunction with the longer-range EH Workplace Chemical Accident Risk Review (WCARR) Program. The WCARR Program is part of the ongoing EH oversight of nonnuclear safety at all DOE facilities. `` The program objective is to analyze DOE and industry chemical safety programs and performance and determine the need for additional or improved safety guidance for DOE. During the period June 6, 1992, through July 31, 1992, EH conducted CSORs at five DOE sites. The sites visited were Los Alamos National Laboratory (LANL), Savannah River Site (SRS), the Y-12 Plant (Y-12), Oak Ridge National Laboratory (ORNL), and Lawrence Livermore National Laboratory (LLNL).

  17. Review of the OSHA framework for oversight of occupational environments.

    Science.gov (United States)

    Choi, Jae-Young; Ramachandran, Gurumurthy

    2009-01-01

    The OSHA system for oversight of chemicals in the workplace was evaluated to derive lessons for oversight of nanotechnology. Criteria relating to the development, attributes, evolution, and outcomes of the system were used for evaluation that was based upon quantitative expert elicitation and historical literature analysis. The oversight system had inadequate resources in terms of finances, expertise, and personnel, and insufficient incentive for compliance. The system showed a lack of flexibility in novel situations. There were minimal requirements on companies for data on health and safety of their products. These factors have a strong influence on public confidence and health and safety. The oversight system also scored low on attributes such as public input, transparency, empirical basis, conflict of interest, and informed consent. The experts in our sample tend to believe that the current oversight system for chemicals in the workplace is neither adequate nor effective. It is very likely that the performance of the OSHA oversight system for nanomaterials will be equally inadequate.

  18. Student nurses need more than maths to improve their drug calculating skills.

    Science.gov (United States)

    Wright, Kerri

    2007-05-01

    Nurses need to be able to calculate accurate drug calculations in order to safely administer drugs to their patients (NMC, 2002). Studies have shown however that nurses do not always have the necessary skills to calculate accurate drug dosages and are potentially administering incorrect dosages of drugs to their patients (Hutton, M. 1998. Nursing Mathematics: the importance of application. Nursing Standard 13(11), 35-38; Kapborg, I. 1994. Calculation and administration of drug dosage by Swedish nurses, Student Nurses and Physicians. International Journal for Quality in Health Care 6(4), 389-395; O'Shea, E. 1999. Factors contributing to medication errors: a literature review. Journal of Advanced Nursing 8, 496-504; Wilson, A. 2003. Nurses maths: researching a practical approach. Nursing Standard 17(47), 33-36). The literature indicates that in order to improve drug calculations strategies need to focus on both the mathematical skills and conceptual skills of student nurses so they can interpret clinical data into drug calculations to be solved. A study was undertaken to investigate the effectiveness of implementing several strategies which focussed on developing the mathematical and conceptual skills of student nurses to improve their drug calculation skills. The study found that implementing a range of strategies which addressed these two developmental areas significantly improved the drug calculation skills of nurses. The study also indicates that a range of strategies has the potential ensuring that the skills taught are retained by the student nurses. Although the strategies significantly improved the drug calculation skills of student nurses, the fact that only 2 students were able to achieve 100% in their drug calculation test indicates a need for further research into this area.

  19. Indian Health Service Oversight and Reauthorization of Indian Health Care Improvement Act. Hearing before the Select Committee on Indian Affairs, United States Senate, Ninety-Sixth Congress, Second Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Select Committee on Indian Affairs.

    The transcript of the March 28, 1980, Senate hearing on the Indian Health Service (IHS) and reauthorization of the Indian Health Care Improvement Act (Public Law 94-437) held in Billings, Montana, is presented with testimony from the Three Affiliated Tribes of North Dakota, Montana United Indian Association, Montana Indian Health Board, Fort Peck…

  20. Construction Delay Analysis Techniques—A Review of Application Issues and Improvement Needs

    Directory of Open Access Journals (Sweden)

    Nuhu Braimah

    2013-07-01

    Full Text Available The time for performance of a project is usually of the essence to the employer and the contractor. This has made it quite imperative for contracting parties to analyse project delays for purposes of making right decisions on potential time and/or cost compensation claims. Over the years, existing delay analysis techniques (DATs for aiding this decision-making have been helpful but have not succeeded in curbing the high incidence of disputes associated with delay claims resolutions. A major source of the disputes lies with the limitations and capabilities of the techniques in their practical use. Developing a good knowledge of these aspects of the techniques is of paramount importance in understanding the real problematic issues involved and their improvement needs. This paper seeks to develop such knowledge and understanding (as part of a wider research work via: an evaluation of the most common DATs based on a case study, a review of the key relevant issues often not addressed by the techniques, and the necessary improvements needs. The evaluation confirmed that the various techniques yield different analysis results for the same delay claims scenario, mainly due to their unique application procedures. The issues that are often ignored in the analysis but would also affect delay analysis results are: functionality of the programming software employed for the analysis, resource loading and levelling requirements, resolving concurrent delays, and delay-pacing strategy. Improvement needs by way of incorporating these issues in the analysis and focusing on them in future research work are the key recommendations of the study.

  1. National Swine Genetic Improvement: An overview of essential program components and organizational structure needed for success

    Institute of Scientific and Technical Information of China (English)

    John; MABRY

    2005-01-01

    The swine industry in China is a thrivingand evolving industry that has shown phenome-nal growth over the past10years.Newand mod-ern swine farms have been started in locationsacross the country.Genetics has been importedfrom many different countries in an effort to up-grade the quality and efficiency of the traditionalbreeds of swine.But to insure long term successand viability in a worldwide competitive industrysuch as pork,there is need for a National SwineGenetic Improvement Program.This programneeds to ...

  2. Management of Excess Material in the Navys Real Time Reutilization Asset Management Facilities Needs Improvement

    Science.gov (United States)

    2017-01-23

    also own material in the RRAM facilities. NAVSUP procures and supplies the parts, components , and assemblies that keep Navy forces mission ready. In...No. DODIG-2017-043 J A N U A R Y 2 3 , 2 0 1 7 Management of Excess Material in the Navy’s Real-Time Reutilization Asset Management Facilities...Management of Excess Material in the Navy’s Real‑Time Reutilization Asset Management Facilities Needs Improvement Visit us at www.dodig.mil January 23, 2017

  3. A synthesis of research needs for improving the understanding of atmospheric mercury cycling

    Directory of Open Access Journals (Sweden)

    L. Zhang

    2017-07-01

    Full Text Available This synthesis identifies future research needs in atmospheric mercury science, based on a series of review papers, as well as recent developments in field data collection, modeling analysis, and emission assessments of speciated atmospheric mercury. Research activities are proposed that focus on areas that we consider important. These include refinement of mercury emission estimations, quantification of dry deposition and air–surface exchange, improvement of the treatment of chemical mechanisms in chemical transport models, increase in the accuracy of oxidized mercury measurements, better interpretation of atmospheric mercury chemistry data, and harmonization of network operation. Knowledge gained in these research areas will significantly improve our understanding of atmospheric cycling from local to global scales.

  4. How Serious Do We Need to Be? Improving Information Literacy Skills through Gaming and Interactive Elements

    Directory of Open Access Journals (Sweden)

    Ana van Meegen

    2010-09-01

    Full Text Available Catching the attention of highly technologically and visually oriented students is a challenge for libraries. The number of students entering the universities is increasing and a face-to-face learning setting is an impossible mission for the few available subject librarians. This paper demonstrates how effective the use of serious game or other web-based interactive elements can be for teaching information literacy. By means of quasi-experimental research the impact that the game Saving Asia on students’ learning is analysed and compared to a web-based online tutorial of the Vrije Universiteit Amsterdam (Free University of Amsterdam. This research demonstrated that the game needs to be improved if it is to fit into the regular curriculum of the university, but interactive elements definitely improve learning results.

  5. Operational research for improved tuberculosis control: the scope, the needs and the way forward.

    Science.gov (United States)

    Lienhardt, C; Cobelens, F G J

    2011-01-01

    The promotion of research is one of the main components of the World Health Organizations Stop TB Strategy, which includes 'programme-based operational research (OR)' and 'research on introducing new tools into practice'. The importance of OR in improving tuberculosis (TB) control was recognised a long time ago, and historical OR studies have been instrumental in the development of major strategies for TB control. Although a growing number of OR projects are being conducted in the world today, little is known about their results or their likely impact on TB control programmes. As funding organisations increasingly recognise the need for OR, we propose a rational framework to conduct OR, which covers a spectrum from local setting-oriented to international policy guiding research, and determines the relevance, replicability and generalisability of the results. OR in TB control is aimed at 1) improving programme performance; 2) assessing the feasibility, effectiveness and impact of new strategies or interventions on TB control; and 3) collecting evidence to guide policy recommendations on specific interventions. This requires strengthened capacity to plan and conduct OR in low-income countries and appropriate support to conduct both nationally and internationally led OR projects. Suggestions are made for potential steps for improved purpose-driven OR, which may help to improve TB control locally and inform policy recommendations internationally.

  6. Improved Formulations for Air-Surface Exchanges Related to National Security Needs: Dry Deposition Models

    Energy Technology Data Exchange (ETDEWEB)

    Droppo, James G.

    2006-07-01

    The Department of Homeland Security and others rely on results from atmospheric dispersion models for threat evaluation, event management, and post-event analyses. The ability to simulate dry deposition rates is a crucial part of our emergency preparedness capabilities. Deposited materials pose potential hazards from radioactive shine, inhalation, and ingestion pathways. A reliable characterization of these potential exposures is critical for management and mitigation of these hazards. A review of the current status of dry deposition formulations used in these atmospheric dispersion models was conducted. The formulations for dry deposition of particulate materials from am event such as a radiological attack involving a Radiological Detonation Device (RDD) is considered. The results of this effort are applicable to current emergency preparedness capabilities such as are deployed in the Interagency Modeling and Atmospheric Assessment Center (IMAAC), other similar national/regional emergency response systems, and standalone emergency response models. The review concludes that dry deposition formulations need to consider the full range of particle sizes including: 1) the accumulation mode range (0.1 to 1 micron diameter) and its minimum in deposition velocity, 2) smaller particles (less than .01 micron diameter) deposited mainly by molecular diffusion, 3) 10 to 50 micron diameter particles deposited mainly by impaction and gravitational settling, and 4) larger particles (greater than 100 micron diameter) deposited mainly by gravitational settling. The effects of the local turbulence intensity, particle characteristics, and surface element properties must also be addressed in the formulations. Specific areas for improvements in the dry deposition formulations are 1) capability of simulating near-field dry deposition patterns, 2) capability of addressing the full range of potential particle properties, 3) incorporation of particle surface retention/rebound processes, and

  7. Ethics in action: Approving and improving medical research with human subjects

    NARCIS (Netherlands)

    J.P. de Jong

    2013-01-01

    In this thesis, Jean Philippe de Jong presents a new understanding of ethical oversight on medical research with human subjects and proposes that two philosophies for ethical oversight exist: '(dis)approving' and 'improving'. Systems for ethical oversight on medical research have been in place for m

  8. Surgeon-Reported Needs for Improved Training in Identifying and Managing Free Flap Compromise.

    Science.gov (United States)

    McMillan, Catherine; D'Hondt, Veerle; Marshall, Alexandra H; Binhammer, Paul; Lipa, Joan; Snell, Laura

    2017-07-01

    Background This study examined the need for improved training in the identification and management of free flap (FF) compromise and assessed a potential role for simulated scenario training. Methods Online needs assessment surveys were completed by plastic surgeons and a subsample with expertise in microsurgery education participated in focus groups. Data were analyzed using descriptive statistics and mixed qualitative methods. Results In this study, 77 surgeons completed surveys and 11 experts participated in one of two focus groups. Forty-nine (64%) participants were educators, 65 and 45% of which reported having an insufficient volume of FF cases to adequately teach the management and identification of compromise, respectively. Forty-three percent of educators felt that graduating residents are not adequately prepared to manage FF compromise independently. Exposure to normal and abnormal FF cases was felt to be critical for effective training by focus group participants. Experts identified low failure rates, communication issues, and challenging teaching conditions as current barriers to training. Most educators (74%) felt that simulated scenario training would be "very useful" or "extremely useful" to current residents. Focus groups highlighted the need for a widely accepted algorithm for re-exploration and salvage on which to base the development of a training adjunct consisting of simulated scenarios. Conclusion Trainee exposure to FF compromise is inadequate in existing plastic surgery programs. Early exposure, high case volume, and a standardized algorithmic approach to management with a focus on decision making may improve training. Simulated scenario training may be valuable in addressing current barriers. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Incorporating evidence review into quality improvement: meeting the needs of innovators.

    Science.gov (United States)

    Danz, Margie Sherwood; Hempel, Susanne; Lim, Yee-Wei; Shanman, Roberta; Motala, Aneesa; Stockdale, Susan; Shekelle, Paul; Rubenstein, Lisa

    2013-11-01

    Achieving quality improvement (QI) aims often requires local innovation. Without objective evidence review, innovators may miss previously tested approaches, rely on biased information, or use personal preferences in designing and implementing local QI programmes. To develop a practical, responsive approach to evidence review for QI innovations aimed at both achieving the goals of the Patient Centered Medical Home (PCMH) and developing an evidence-based QI culture. Descriptive organisational case report. As part of a QI initiative to develop and spread innovations for achieving the Veterans Affairs (VA) PCMH (termed Patient Aligned Care Team, or PACT), we involved a professional evidence review team (consisting of review experts, an experienced librarian, and administrative support) in responding to the evidence needs of front-line primary care innovators. The review team developed a systematic approach to responsive innovation evidence review (RIER) that focused on innovator needs in terms of time frame, type of evidence and method of communicating results. To assess uptake and usefulness of the RIERs, and to learn how the content and process could be improved, we surveyed innovation leaders. In the first 16 months of the QI initiative, we produced 13 RIERs on a variety of topics. These were presented as 6-15-page summaries and as slides at a QI collaborative. The RIERs focused on innovator needs (eg, topic overviews, how innovations are carried out, or contextual factors relevant to implementation). All 17 innovators who responded to the survey had read at least one RIER; 50% rated the reviews as very useful and 31%, as probably useful. These responsive evidence reviews appear to be a promising approach to integrating evidence review into QI processes.

  10. Future needs for improvement of NIHL awareness training and HPD practices in the South African mining industry

    CSIR Research Space (South Africa)

    Edwards, A

    2012-08-01

    Full Text Available methods and self motivated prevention and protection of hearing 4. Amount of training in relation to extent of the problem 5. Properly equipped trainers- Who should do the training 10 Awareness training - Data analysis What should it look... NIHL and HPD fitting and use 8. Needs of various target audiences-need to know (self protection), need to motivate (supervisors), need to co- operate( team effort-managers and workers), need to measure and improve(reporting processes) 9. Evaluate...

  11. Work improvement and occupational safety and health management systems: common features and research needs.

    Science.gov (United States)

    Kogi, Kazutaka

    2002-04-01

    There is a growing trend in re-orientating occupational health research towards risk management. Such a trend is accelerated by the increasing attention to occupational safety and health management systems. The trend, also seen in many Asian countries, is offering new opportunities for strengthening primary prevention. Useful examples are provided from recent work improvement projects dealing with technology transfer, small workplaces and rural areas. Common features of both these work improvement projects and accepted occupational risk management principles are reviewed based on recent experiences in Asian countries. Such features seem highly relevant in examining the occupational health research strategies. These experiences clearly show that locally adjusted procedures for risk assessment and control must be developed. There are new research needs concerning (a) the effective ways to encourage voluntary control at the workplace; (b) practical methods for local risk assessment; and (c) the types of participatory steps leading to continual improvements in the varying local context. Criteria of action-oriented research that can contribute to more effective risk control in different settings are discussed. Six relevant criteria may be mentioned: (a) adaptive risk management; (b) work/risk relationships; (c) action-oriented risk assessment; (d) use of collective expertise; (e) participation of local people; and (f) mutual learning. It appears crucial to stimulate research into the practical risk control procedures adjusted to the local situation.

  12. Methods for measurements of energy and emissions related to motor vehicles: Identification of needs for improvements

    Energy Technology Data Exchange (ETDEWEB)

    Karl-Erik Egebaeck, K.E. [Luleaa Univ. of Technology, Luleaa (Sweden). Dept. of Environmental Technology; Karlsson, Hua L. [MTC AB, Haninge (Sweden); Westerholm, R. [Stockholm Univ. (Sweden). Dept. of Analytical Chemistry

    2002-01-01

    The official methods in use today for emission testing of vehicles and engines were primarily developed for the characterisation of exhaust emissions from motor vehicles fuelled with petrol or diesel oil. The setting of new lower emission standards will make it difficult to obtain sufficient accuracy, using the present systems, for the quantification of exhaust emissions in the future. Development of new emission control technology and improved fuels has made it possible to meet these more stringent standards. Consequently new emission standards will lead to a need for new and improved methodologies and new instrumentation for the characterisation of the emissions from vehicles/engines/fuels. The present report comprises a discussion and comments on questions related to improved methods for emission measurements. The report is based on a study of the literature, site visits to laboratories and research institutes etc in the US and a meeting with representatives of the EU Commission, carried out during the spring of 2001. The conclusions and recommendations in the pre-study report are summarised in sub titles: General, regulated emissions, unregulated emissions, greenhouse gases and fuel consumption. Since the questions and problems discussed have an international connection they should be discussed in an international forum. However, before such discussions can be organised the problems related to measurement of emissions and fuel consumption must be more extensively studied than in this pre-study.

  13. Preventive medicine oversight of splash pads on military installations.

    Science.gov (United States)

    Hardcastle, Lisa Raysby; Perry, Matthew; Browne, Ashley

    2015-01-01

    Over the past several years, an increasing number of military installations have installed splash pads that provide fun, recreational water entertainment for Soldiers and their families. The addition of splash pads brings added responsibilities for medical treatment facility preventive medicine oversight and installation facilities maintenance to ensure a safe and healthy environment. Currently, there are no consistent standards or detailed guidance for military installations to follow when installing and maintaining splash pads. The central issues associated with splash pads on military installations are water quality and risk for waterborne illnesses, responsibility for safety and health oversight, and federal energy and water sustainability mandates. This article examines the importance of implementing a standard for design and oversight to ensure the health and safety of Soldiers and their families.

  14. VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing Accuracy of Suicide Data

    Science.gov (United States)

    2014-11-01

    VA HEALTH CARE Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing...00-2014 4. TITLE AND SUBTITLE VA Health Care: Improvements Needed in Monitoring Antidepressant Use for Major Depressive Disorder and in Increasing... disorder with mixed anxiety and depressed mood. 29American Psychiatric Association: Diagnostic and Statistical Manual. Depression not otherwise

  15. Does the world need a scientific society for research on how to improve healthcare?

    Directory of Open Access Journals (Sweden)

    Wensing Michel

    2012-02-01

    Full Text Available Abstract In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. The society would be open to researchers from all traditions. Thus, we take an inclusive approach to what constitutes scientific research, as long as it uses rigorous methods, is focused on improving healthcare, and aims at knowledge that can be transferred across settings. The society would primarily target scientific researchers but would invite others with an interest in this area of research, regardless of their discipline, position, field of application, or group affiliation (e.g., improvement science, behavioral medicine, knowledge translation. A society would need fruitful collaboration with related societies and organizations, which may include having combined meetings. Special links may be developed with one or more journals. A website to provide information on relevant resources, events, and training opportunities is another key activity. It would also provide a voice for the field at funding agencies, political arenas, and similar institutions. An organizational structure and financial resources are required to develop and run these activities. Our aim is to start an international debate, to discover if we can establish a shared vision across academics and stakeholders engaged with creating scientific knowledge on how to improve healthcare. We invite readers to express their views in the online questionnaire accessed by following the URL link provided at the end of the editorial.

  16. Does the world need a scientific society for research on how to improve healthcare?

    Science.gov (United States)

    Wensing, Michel; Grimshaw, Jeremy M; Eccles, Martin P

    2012-02-29

    In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. The society would be open to researchers from all traditions. Thus, we take an inclusive approach to what constitutes scientific research, as long as it uses rigorous methods, is focused on improving healthcare, and aims at knowledge that can be transferred across settings. The society would primarily target scientific researchers but would invite others with an interest in this area of research, regardless of their discipline, position, field of application, or group affiliation (e.g., improvement science, behavioral medicine, knowledge translation). A society would need fruitful collaboration with related societies and organizations, which may include having combined meetings. Special links may be developed with one or more journals. A website to provide information on relevant resources, events, and training opportunities is another key activity. It would also provide a voice for the field at funding agencies, political arenas, and similar institutions. An organizational structure and financial resources are required to develop and run these activities. Our aim is to start an international debate, to discover if we can establish a shared vision across academics and stakeholders engaged with creating scientific knowledge on how to improve healthcare. We invite readers to express their views in the online questionnaire accessed by following the URL link provided at the end of the editorial.

  17. Depot Maintenance: Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements

    Science.gov (United States)

    2009-09-01

    of Representatives DEPOT MAINTENANCE Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future...Depot Maintenance. Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements 5a... Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements Highlights of GAO-09-865, a report to

  18. [Internationalized medical care services increase need of health care providers to improve English communication skills].

    Science.gov (United States)

    Yang, Chia-Ling

    2011-02-01

    English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication.

  19. Improvement of Patient- and Family-Specific Care for Children with Special Behavioral Needs in the Emergency Setting: A Behavioral Needs Education.

    Science.gov (United States)

    Brynes, Nicole; Lee, Heeyoung; Ren, Dianxu; Beach, Michael

    2017-05-01

    Improvements in staff training, identification, and treatment planning for children with special health care needs who have behavioral issues are routinely recommended, but a literature review revealed no coherent plans targeted specifically toward pediatric ED staff. An educational module was delivered to emergency staff along with a survey before and after and 1 month after the intervention to examine comfort in working with children with behavioral special needs and the ability to deliver specialized care. Child life consultations in the pediatric emergency department were measured 3 months before and 3 months after the education was provided. A total of 122 staff participated and reported clinically significant improvements across all areas of care that were maintained at 1 month. To the best of our knowledge, this project represents the first quality improvement project offering behavioral needs education to emergency staff at a large pediatric hospital with an examination of its impact on staff competence, comfort, and outcomes. A large-scale educational module is a practical option for improvement in pediatric ED staff competence in caring for patients with behavioral special needs. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  20. Institutional Oversight of the Graduate Medical Education Enterprise: Development of an Annual Institutional Review

    Science.gov (United States)

    Amedee, Ronald G.; Piazza, Janice C.

    2016-01-01

    Background: The Accreditation Council for Graduate Medical Education (ACGME) fully implemented all aspects of the Next Accreditation System (NAS) on July 1, 2014. In lieu of periodic accreditation site visits of programs and institutions, the NAS requires active, ongoing oversight by the sponsoring institutions (SIs) to maintain accreditation readiness and program quality. Methods: The Ochsner Health System Graduate Medical Education Committee (GMEC) has instituted a process that provides a structured, process-driven improvement approach at the program level, using a Program Evaluation Committee to review key performance data and construct an annual program evaluation for each accredited residency. The Ochsner GMEC evaluates the aggregate program data and creates an Annual Institutional Review (AIR) document that provides direction and focus for ongoing program improvement. This descriptive article reviews the 2014 process and various metrics collected and analyzed to demonstrate the program review and institutional oversight provided by the Ochsner graduate medical education (GME) enterprise. Results: The 2014 AIR provided an overview of performance and quality of the Ochsner GME program for the 2013-2014 academic year with particular attention to program outcomes; resident supervision, responsibilities, evaluation, and compliance with duty‐hour standards; results of the ACGME survey of residents and core faculty; and resident participation in patient safety and quality activities and curriculum. The GMEC identified other relevant institutional performance indicators that are incorporated into the AIR and reflect SI engagement in and contribution to program performance at the individual program and institutional levels. Conclusion: The Ochsner GME office and its program directors are faced with the ever-increasing challenges of today's healthcare environment as well as escalating institutional and program accreditation requirements. The overall commitment of

  1. Achievement for All: improving psychosocial outcomes for students with special educational needs and disabilities.

    Science.gov (United States)

    Humphrey, Neil; Lendrum, Ann; Barlow, Alexandra; Wigelsworth, Michael; Squires, Garry

    2013-04-01

    Students with special educational needs and disabilities (SEND) are at a greatly increased risk of experiencing poor psychosocial outcomes. Developing effective interventions that address the cause of these outcomes has therefore become a major policy priority in recent years. We report on a national evaluation of the Achievement for All (AfA) programme that was designed to improve outcomes for students with SEND through: (1) academic assessment, tracking and intervention, (2) structured conversations with parents, and (3) developing provision to improve wider outcomes (e.g. positive relationships). Using a quasi-experimental, pre-test-post-test control group design, we assessed the impact of AfA on teacher ratings of the behaviour problems, positive relationships and bullying of students with SEND over an 18-month period. Participants were 4758 students with SEND drawn from 323 schools across England. Our main impact analysis demonstrated that AfA had a significant impact on all three response variables when compared to usual practice. Hierarchical linear modelling of data from the intervention group highlighted a range of school-level contextual factors and implementation activities and student-level individual differences that moderated the impact of AfA on our study outcomes. The implications of our findings are discussed, and study strengths and limitations are noted.

  2. Haptic Guidance Needs to Be Intuitive Not Just Informative to Improve Human Motor Accuracy

    Science.gov (United States)

    Mugge, Winfred; Kuling, Irene A.; Brenner, Eli; Smeets, Jeroen B. J.

    2016-01-01

    Humans make both random and systematic errors when reproducing learned movements. Intuitive haptic guidance that assists one to make the movements reduces such errors. Our study examined whether any additional haptic information about the location of the target reduces errors in a position reproduction task, or whether the haptic guidance needs to be assistive to do so. Holding a haptic device, subjects made reaches to visible targets without time constraints. They did so in a no-guidance condition, and in guidance conditions in which the direction of the force with respect to the target differed, but the force scaled with the distance to the target in the same way. We examined whether guidance forces directed towards the target would reduce subjects’ errors in reproducing a prior position to the same extent as do forces rotated by 90 degrees or 180 degrees, as it might because the forces provide the same information in all three cases. Without vision of the arm, both the accuracy and precision were significantly better with guidance directed towards the target than in all other conditions. The errors with rotated guidance did not differ from those without guidance. Not surprisingly, the movements tended to be faster when guidance forces directed the reaches to the target. This study shows that haptic guidance significantly improved motor performance when using it was intuitive, while non-intuitively presented information did not lead to any improvements and seemed to be ignored even in our simple paradigm with static targets and no time constraints. PMID:26982481

  3. The Math You Need at Baylor University: Improving Quantitative Skills in an Introductory Geology Lab Course

    Science.gov (United States)

    Browning, S.

    2014-12-01

    The Math You Need (TMYN) modules were introduced at Baylor University in fall 2012 to address issues of math anxiety common among freshmen non-majors completing their lab science requirement, and to reduce lab time spent reviewing basic math concepts. Modules and associated assessment questions commonly use geoscience examples to illustrate the mathematical principles involved, reinforcing topics addressed in lab. Large enrollments in the course selected for these modules necessitate multiple graduate teaching assistants in the lab, making the online nature of the modules and minimal required involvement of the teaching assistants even more valuable. Students completed three selected modules before encountering associated topics in lab, as well as a pre and post-test to gauge improvement. This presentation will review lessons learned and changes made in the first two years of TMYN at Baylor. Results indicate continued increases in mean pre to post test scores (e.g. 3.2% in fall 2012 to 11.9% in spring 2014), percentage of student pre to post- test improvement (59% in fall 2012 to 72% in spring 2014) and student participation (95 in fall 2012 to 186 in spring 2014). Continued use of these modules is anticipated.

  4. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  5. Does influenza vaccination improve pregnancy outcome? Methodological issues and research needs.

    Science.gov (United States)

    Savitz, David A; Fell, Deshayne B; Ortiz, Justin R; Bhat, Niranjan

    2015-11-25

    Evidence that influenza vaccination during pregnancy is safe and effective at preventing influenza disease in women and their children through the first months of life is increasing. Several reports of reduced risk of adverse outcomes associated with influenza vaccination have generated interest in its potential for improving pregnancy outcome. Gavi, the Vaccine Alliance, estimates maternal influenza immunization programs in low-income countries would have a relatively modest impact on mortality compared to other new or under-utilized vaccines, however the impact would be substantially greater if reported vaccine effects on improved pregnancy outcomes were accurate. Here, we examine the available evidence and methodological issues bearing on the relationship between influenza vaccination and pregnancy outcome, particularly preterm birth and fetal growth restriction, and summarize research needs. Evidence for absence of harm associated with vaccination at a point in time is not symmetric with evidence of benefit, given the scenario in which vaccination reduces risk of influenza disease and, in turn, risk of adverse pregnancy outcome. The empirical evidence for vaccination preventing influenza in pregnant women is strong, but the evidence that influenza itself causes adverse pregnancy outcomes is inconsistent and limited in quality. Studies of vaccination and pregnancy outcome have produced mixed evidence of potential benefit but are limited in terms of influenza disease assessment and control of confounding, and their analytic methods often fail to fully address the longitudinal nature of pregnancy and influenza prevalence. We recommend making full use of results of randomized trials, re-analysis of existing observational studies to account for confounding and time-related factors, and quantitative assessment of the potential benefits of vaccination in improving pregnancy outcome, all of which should be informed by the collective engagement of experts in influenza

  6. 20 CFR 667.410 - What are the oversight roles and responsibilities of recipients and subrecipients?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the oversight roles and... INVESTMENT ACT Oversight and Monitoring § 667.410 What are the oversight roles and responsibilities of recipients and subrecipients? (a) Roles and responsibilities for all recipients and subrecipients of funds...

  7. 75 FR 39954 - Oversight of Laboratory Developed Tests; Public Meeting; Change of Meeting Location

    Science.gov (United States)

    2010-07-13

    ... HUMAN SERVICES Food and Drug Administration Oversight of Laboratory Developed Tests; Public Meeting... entitled ``Oversight of Laboratory Developed Tests.'' A new address is given for those attending the public... interested stakeholders to discuss the agency's oversight of laboratory developed tests. FDA announced in...

  8. Board oversight of quality: any differences in process of care and mortality?

    Science.gov (United States)

    Jiang, H Joanna; Lockee, Carlin; Bass, Karma; Fraser, Irene

    2009-01-01

    In response to legal and accreditation mandates as well as pressures from purchasers and consumers for quality improvement, hospital governing boards seek to improve their oversight of quality of care by adopting various practices. Based on a previous survey of hospital presidents/chief executive officers, this study examines differences in hospital quality performance associated with the adoption of particular practices in board oversight of quality. Quality was measured by performance in process of care and risk-adjusted mortality, using the Hospital Compare data from the Centers for Medicare & Medicaid Services and the Healthcare Cost and Utilization Project inpatient databases of the Agency for Healthcare Research and Quality. Board practices found to be associated with better performance in both process of care and mortality include (1) having a board quality committee; (2) establishing strategic goals for quality improvement; (3) being involved in setting the quality agenda for the hospital; (4) including a specific item on quality in board meetings; (5) using a dashboard with national benchmarks that includes indicators for clinical quality, patient safety, and patient satisfaction; and (6) linking senior executives' performance evaluation to quality and patient safety indicators. Involvement of physician leadership in the board quality committee further enhanced the hospital's quality performance. Taken together, these findings seem to support the will-execution-constancy of purpose framework on improving the effectiveness of hospital boards in overseeing quality. Future study should examine how specific board practices influence the culture and operations of the hospital that lead to better quality of care.

  9. 32 CFR 2103.51 - Information Security Oversight Committee.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Information Security Oversight Committee. 2103.51 Section 2103.51 National Defense Other Regulations Relating to National Defense NATIONAL SECURITY COUNCIL REGULATIONS TO IMPLEMENT E.O. 12065-INCLUDING PROCEDURES FOR PUBLIC ACCESS TO DOCUMENTS THAT MAY BE DECLASSIFIED Implementation and Review...

  10. 15 CFR 2008.18 - Information Security Oversight Committee.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Information Security Oversight Committee. 2008.18 Section 2008.18 Commerce and Foreign Trade Regulations Relating to Foreign Trade Agreements OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE REGULATIONS TO IMPLEMENT E.O. 12065; OFFICE OF THE UNITED STATES TRADE...

  11. 13 CFR 130.800 - Oversight of the SBDC program.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Oversight of the SBDC program. 130.800 Section 130.800 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS... funds for the benefit of the small business community....

  12. Oversight Report on Nontraditional Vocational Training for Female Inmates.

    Science.gov (United States)

    Florida State House of Representatives, Tallahassee.

    In January 1993, Florida's Correctional Education School Authority (CESA) studied the vocational interests of 125 randomly selected female inmates at the 3 female state correctional facilities in Florida. After two additional informal studies, an interim oversight review was conducted to determine the following: whether CESA was in compliance with…

  13. 42 CFR 460.71 - Oversight of direct participant care.

    Science.gov (United States)

    2010-10-01

    ... FOR THE ELDERLY (PACE) PACE Administrative Requirements § 460.71 Oversight of direct participant care... directly to participants demonstrate the skills necessary for performance of their position. (1) The PACE... PACE organization must develop a competency evaluation program that identifies those skills, knowledge...

  14. 22 CFR 96.32 - Internal structure and oversight.

    Science.gov (United States)

    2010-04-01

    ... selection, monitoring, and oversight of supervised providers. (e) The agency or person discloses to the accrediting entity the following information: (1) Any other names by which the agency or person is or has been... number of such other provider; and (3) The name, address, and phone number of any entity it uses or...

  15. Fiscal Year 2014: Comprehensive Oversight Plan for Southwest Asia

    Science.gov (United States)

    2013-09-30

    Accountability Office (GAO). This oversight community is committed to maintaining an effective working relationship to minimize duplication of efforts...four issues to better fit with drawdown concerns relating to U.S. personnel, property, fiduciary responsibility, and transition activities. 8

  16. Establishing an Ambulatory Medicine Quality and Safety Oversight Structure: Leveraging the Fractal Model.

    Science.gov (United States)

    Kravet, Steven J; Bailey, Jennifer; Demski, Renee; Pronovost, Peter

    2016-07-01

    Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in Medicaid value-based purchasing metrics, which are linked to several million dollars of revenue. As this model matures, it will serve as a mechanism to align quality standards and programs across regional, national, and international partners and to provide a clear quality structure as new practices join the health system. Future efforts will link this model to JHM's academic mission, enhancing education to address Accreditation Council for Graduate Medical Education core competencies.

  17. Improving rural newspaper coverage of nutrition stories: an educational assessment of editors' attitudes and learning needs.

    Science.gov (United States)

    Nothwehr, Faryle; Chrisman, Matthew; Andsager, Julie L

    2014-11-01

    Local newspapers are an important source of information for rural residents but often lack accurate or helpful nutrition-related information. To improve the quantity and quality of nutrition stories in rural, local newspapers, it is important to understand the perspective of editors. An online survey of 51 rural Midwest editors was conducted to assess attitudes toward writing nutrition stories, sources of information, perceived challenges, and interest in learning more about writing such stories. Of respondents, 49% were female, and 63% had at least a 4-year college degree. Through a mix of closed- and open-ended questions, the majority indicated positive attitudes toward nutrition stories, were confident in their abilities to write them, and expressed interest in learning more. Challenges cited include lack of print space, small staff, lack of specific requests from readers for nutrition stories, and the need to avoid offending local agricultural businesses. Results should be useful in planning an educational intervention for editors. Meanwhile, public health practitioners should provide concise press releases to their local newspapers about their activities. Also, greater expressions of appreciation from public health professionals and other readers may lead to higher prioritization of nutrition-related stories, and ultimately to an environment more supportive of healthy eating.

  18. Improving of the financial statements forms of credit unions under stakeholders information needs

    Directory of Open Access Journals (Sweden)

    O.L. Bilyachenko

    2016-07-01

    Full Text Available The need for a satisfaction of credit union users’ information requests causes necessity to improve procedure of disclosure of financial information in their financial statements. Analysis of statistics on the activities of credit unions in Ukraine has allowed revealing decrease in their number on the background of organizational consolidation. The study of international financial reporting framework, regulatory documents on accounting and reporting in Ukraine provided an opportunity to identify deficiencies of the disclosure of information about credit unions’ business activities. The result of the study is that the balance sheet and a profit and loss statement for the credit union have been added by the items, which will more fully disclose the information on assets and liabilities, business activities income and costs. In addition, these changes will avoid duplication of such information in the specialized reports provided by credit unions to the National Commission for State Regulation of Financial Services Markets. In general, this will help to protect of credit unions members’ rights and will strengthen the depositors’ and creditors’ confidence in the credit unions activities.

  19. Improving Rural Newspaper Coverage of Nutrition Stories: An Educational Assessment of Editors’ Attitudes and Learning Needs

    Science.gov (United States)

    Nothwehr, Faryle; Chrisman, Matthew; Andsager, Julie L.

    2014-01-01

    Local newspapers are an important source of information for rural residents but often lack accurate or helpful nutrition-related information. To improve the quantity and quality of nutrition stories in rural, local newspapers, it is important to understand the perspective of editors. An online survey of 51 rural Midwest editors was conducted to assess attitudes toward writing nutrition stories, sources of information, perceived challenges, and interest in learning more about writing such stories. Of respondents, 49% were female, and 63% had at least a 4-year college degree. Through a mix of closed- and open-ended questions, the majority indicated positive attitudes toward nutrition stories, were confident in their abilities to write them, and expressed interest in learning more. Challenges cited include lack of print space, small staff, lack of specific requests from readers for nutrition stories, and the need to avoid offending local agricultural businesses. Results should be useful in planning an educational intervention for editors. Meanwhile, public health practitioners should provide concise press releases to their local newspapers about their activities. Also, greater expressions of appreciation from public health professionals and other readers may lead to higher prioritization of nutrition-related stories, and ultimately to an environment more supportive of healthy eating. PMID:24648288

  20. Oversight of the Radiation Exposure Compensation Act. Hearing of the Committee on Labor and Human Resources, United States Senate, One Hundred Third Congress, First Session, June 5, 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    The hearing addresses oversight of The Radiation Exposure Compensation Act and considers the need for changes in the 1990 legislation because it is not working as intended. Statements of government and industry officials are included, along with documents submitted for the record.

  1. Innovative Resources Based on ICTs and Authentic Materials to Improve EFL Students' Communicative Needs

    Science.gov (United States)

    González Otero, Rebeca

    2016-01-01

    Our global society and our current communication needs have put a strain on English as a Foreign Language (EFL) teaching, since common resources such as textbooks may fail to adapt to the needs and interests of our students. The present action research study aims at identifying EFL students' communicative needs and developing their oral skills…

  2. Focusing on patient needs and preferences may improve genetic counseling for colorectal cancer

    NARCIS (Netherlands)

    Salemink, S.; Dekker, N.; Kets, C.M.; Looij, E. van der; Zelst-Stams, W.A.G. van; Hoogerbrugge-van der Linden, N.

    2013-01-01

    During cancer genetic counseling, different items which counselors consider important are discussed. However, relatively little empirical evidence exists regarding the needs and preferences of counselees. In this study needs and preferences were assessed from counselees with a personal and/or family

  3. Local Authorities' Experiences of Improving Parental Confidence in the Special Educational Needs Process. LGA Research Report

    Science.gov (United States)

    White, Richard; Macleod, Shona; Jeffes, Jennifer; Atkinson, Mary

    2010-01-01

    How can we help parents to understand the special educational needs (SEN) process? What sort of information and support do they need? This report details the results of research with SEN officers (or their equivalent) in 26 local authorities, covering: (1) the referral process; (2) early identification and intervention; (3) local authority and…

  4. A transparent oversight policy for human anatomical specimen management: the University of California, Davis experience.

    Science.gov (United States)

    Schmitt, Brandi; Wacker, Charlotte; Ikemoto, Lisa; Meyers, Frederick J; Pomeroy, Claire

    2014-03-01

    The authors describe the development and implementation of a University of California (UC) system of oversight, education, tracking, and accountability for human anatomical specimen use in education and research activities. This program was created and initially implemented at UC Davis in 2005. Several incidents arising out of the handling of human anatomical specimens at UC campuses revealed significant challenges in the system for maintaining control of human anatomical specimens used in education and research. These events combined to undermine the public perception for research and educational endeavors involving anatomical materials at public institutions. Risks associated with the acquisition, maintenance, and disposal of these specimens were not fully understood by the faculty, staff, and students who used them. Laws governing sources of specimens are grouped with those that govern organ procurement and tissue banking, and sometimes are found in cemetery and funeral regulations. These variables complicate interpretations and may hinder compliance. To regain confidence in the system, the need to set appropriate and realistic guidelines that mitigate risk and facilitate an institution's research and educational mission was identified. This article chronicles a multiyear process in which diverse stakeholders developed (1) a regulatory policy for oversight, (2) a policy education program, (3) procedures for tracking and accountability, and (4) a reporting and enforcement mechanism for appropriate and ethical use of human anatomical specimens in university education and research.

  5. Nanotechnology, voluntary oversight, and corporate social performance: does company size matter?

    Science.gov (United States)

    Kuzma, Jennifer; Kuzhabekova, Aliya

    2011-04-01

    In this article, we examine voluntary oversight programs for nanotechnology in the context of corporate social performance (CSP) in order to better understand the drivers, barriers, and forms of company participation in such programs. At the theoretical level, we use the management framework of CSP to understand the voluntary behavior of companies. At the empirical level, we investigate nanotech industry participation in the Environmental Protection Agency's Nanoscale Materials Stewardship Program (NMSP) as an example of CSP, in order to examine the effects of company characteristics on CSP outcomes. The analysis demonstrates that, on the average, older and larger companies for which nanotech is one of the many business activities demonstrate greater CSP as judged by company actions, declarations, and self-evaluations. Such companies tended to submit more of the requested information to the NMSP, including specific information about health and safety, and to claim fewer of the submitted items as confidential business information. They were also more likely to have on-line statements of generic and nano-specific corporate social responsibility principles, policies, and achievements. The article suggests a need to encourage smaller and younger companies to participate in voluntary oversight programs for nanotechnology and presents options for better design of these programs.

  6. Interweaving Curriculum Committees: A New Structure to Facilitate Oversight and Sustain Innovation.

    Science.gov (United States)

    Stoddard, Hugh A; Brownfield, Erica D; Churchward, Gordon; Eley, J William

    2016-01-01

    Undergraduate medical education curricula have increased in complexity over the past 25 years; however, the structures for administrative oversight of those curricula remain static. Although expectations for central oversight of medical school curricula have increased, individual academic departments often expect to exert control over the faculty and courses that are supported by the department. The structure of a governance committee in any organization can aid or inhibit that organization's functioning. In 2013, following a major curriculum change in 2007, the Emory University School of Medicine (EUSOM) implemented an "interwoven" configuration for its curriculum committee to better oversee the integrated curriculum. The new curriculum committee structure involves a small executive committee and 10 subcommittees. Each subcommittee performs a specific task or oversees one element of the curriculum. Members, including students, are appointed to two subcommittees in a way that each subcommittee is composed of representatives from multiple other subcommittees. This interweaving facilitates communication between subcommittees and also encourages members to become experts in specific tasks while retaining a comprehensive perspective on student outcomes. EUSOM's previous structure of a single committee with members representing individual departments did not promote cohesive management. The interwoven structure aligns neatly with the goals of the integrated curriculum. Since the restructuring, subcommittee members have been engaged in discussions and decisions on many key issues and expressed satisfaction with the format. The new structure corresponds to EUSOM's educational goals, although the long-term impact on student outcomes still needs to be assessed.

  7. San Antonio MICC and POM Personnel Properly Awarded and Administered the POM UESC, but Improved Procedures and Guidance Are Needed

    Science.gov (United States)

    2016-04-08

    2016 MEMORANDUM FOR UNDER SECRETARY OF DEFENSE FOR ACQUISITION, TECHNOLOGY, AND LOGISTICS AUDITOR GENERAL , DEPARTMENT OF THE ARMY SUBJECT: San...I N T E G R I T Y  E F F I C I E N C Y  A C C O U N TA B I L I T Y  E XC E L L E N C E Inspector General U.S. Department of Defense San...6 Report No. DODIG-2016-077 Mission Our mission is to provide independent, relevant, and timely oversight of the Department of Defense that supports

  8. Delivering primary care in prison: the need to improve health information

    Directory of Open Access Journals (Sweden)

    Sudy Anaraki

    2003-12-01

    Conclusions To provide 'equivalence of care' for prisoners, primary care trusts need to implement full electronic clinical records in prisons and ensure staff have access to resources on the internet.

  9. Congressional Oversight of Homeland Security: Help or Hinderance?

    Science.gov (United States)

    2012-12-01

    gather the information required to conduct effective oversight many intelligence abuses ensued. The 1972 Watergate scandal was the event that...Political Science 28, no. 1 (1984): 166. 6 scandals or failures for its 65-year history. Although there have been instances where fire alarm...their findings. The Iran-Contra scandal occurred less than ten years later. Furthermore, the intelligence community’s slow adaptation to the post

  10. Military Base Realignments and Closures: Process for Reusing Property for Homeless Assistance Needs Improvements

    Science.gov (United States)

    2015-03-01

    and HUD to assist communities in determining the best reuse of land and facilities, balancing needs of the local economy with those of homeless...individuals and families . GAO was mandated to review the extent to which DOD and HUD implemented the homeless assistance provisions while...faced with determining the best reuse of the land and facilities, including balancing the needs of the local economy with those of homeless

  11. Collaborative improvement: What do we know? Where do we need to go?

    NARCIS (Netherlands)

    Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.

    2005-01-01

    Although especially through research performed across the CINet community, a lot of theoretical and practical knowledge has been developed on intra-firm continuous improvement, there is still a substantial lack of empirically grounded contributions and theories on collaborative improvement (CoI),

  12. Nanotechnology, risk, and oversight: learning lessons from related emerging technologies.

    Science.gov (United States)

    Kuzma, Jennifer; Priest, Susanna

    2010-11-01

    Emerging technologies are defined by their novelty and thus are accompanied by significant uncertainty in determining appropriate ways to manage risks associated with them. Yet, there is a body of prior knowledge about risk management and oversight policy for other technologies that have already permeated society. Here, we describe two ways in which prospective oversight policy analysis for emerging technologies can draw upon these past experiences. One involves comparing specific products that have already been marketed to similar products of the emerging technology (cognate-product approach). The other treats the emerging technology as a body of products and methods and relates it to another technological field that has already emerged and penetrated markets (whole-technology approach). In this article, we describe our work using these approaches to inform risk and oversight policy for nanotechnology and its products. We draw parallels between biotechnology and nanotechnology as whole fields of development and also between genetically engineered organisms in the food supply and agricultural products of nanotechnology. Through these comparisons, we find that both approaches to historical learning have value and present lessons that could be applied to nanotechnology. © 2010 Society for Risk Analysis.

  13. What kind of knowledge do small companies need to improve their working environment?

    DEFF Research Database (Denmark)

    Antonsson, Ann-Beth; Hasle, Peter

    2015-01-01

    Background One of the main obstacles identified for small companies´ improvement of the working environment is lack of knowledge. Aim To discuss what kind of knowledge is required by small companies if they are to be able to improve their working environment and the pros and cons of different kinds...... with providing different kinds of knowledge will be discussed from a theoretical point of view. This question will be further scrutinized in the project SESAME, which aims at developing strategies to improve the working environment in SME:s....

  14. Needs assessment for performance improvement of personnel in charge of epidemiological surveillance in Morocco.

    Directory of Open Access Journals (Sweden)

    Gerardo Priotto

    Full Text Available BACKGROUND: In line with the International Health Regulations (IHR 2005, the Morocco health surveillance system has been reinforced via infrastructure strengthening and decentralization in its regions. To plan for personnel capacity reinforcement actions, a national workforce needs assessment was conducted by the National Epidemiological Surveillance Service and the World Health Organization. METHODS: The assessment used an ad-hoc method comprising two stages: (1 A survey via a standardized electronic questionnaire, administered to all staff in regional and provincial surveillance teams. Data collected included demographics, basic qualification, complementary training, perceived training needs, and preferred training modalities. Individuals were asked to grade, on a nine-point scale, their perception of importance of a given list of tasks and of their capacity to perform them. The gap between perceptions was quantified and described. (2 Field visits to national, regional and provincial sites for direct observation and opinion gathering on broader issues such as motivators, barriers, and training needs from the local perspective. RESULTS: Questionnaire respondents were 122/158 agents at 78 surveillance units countrywide. Mean age was 43.6 years and job longevity 5.7 years. Only 53% (65/122 had epidemiology training, posted in 62% (48/78 of the structures. Self-assessed capacity varied by basic qualification and by structure level (regional vs. provincial. The gap between the importance granted to a task and the perceived capacity to perform it was sizable, showing an uneven distribution across competency domains, regions, surveillance level and staff's basic qualification. From the opinions gathered, a problem of staff demotivation and high turnover emerged clearly. CONCLUSIONS: Our method was successful in revealing specific details of the training needs countrywide. A national strategy is needed to ensure rational planning of training

  15. Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research.

    Science.gov (United States)

    Millar, Ross; Mannion, Russell; Freeman, Tim; Davies, Huw T O

    2013-12-01

    Recurring problems with patient safety have led to a growing interest in helping hospitals' governing bodies provide more effective oversight of the quality and safety of their services. National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review. This article presents a narrative review of empirical research to inform the debate about hospital boards' oversight of quality and patient safety. A systematic and comprehensive search identified 122 papers for detailed review. Much of the empirical work appeared in the last ten years, is from the United States, and employs cross-sectional survey methods. Recent empirical studies linking board composition and processes with patient outcomes have found clear differences between high- and low-performing hospitals, highlighting the importance of strong and committed leadership that prioritizes quality and safety and sets clear and measurable goals for improvement. Effective oversight is also associated with well-informed and skilled board members. External factors (such as regulatory regimes and the publication of performance data) might also have a role in influencing boards, but detailed empirical work on these is scant. Health policy debates recognize the important role of hospital boards in overseeing patient quality and safety, and a growing body of empirical research has sought to elucidate that role. This review finds a number of areas of guidance that have some empirical support, but it also exposes the relatively inchoate nature of the field. Greater theoretical and methodological development is required if we are to secure more evidence-informed governance systems and practices that can contribute to safer care. © 2013 Milbank Memorial Fund.

  16. Improving ESL Teacher Education: Meeting Students' Needs for More "Practical" Activities.

    Science.gov (United States)

    Reichelt, Melinda

    2003-01-01

    Interviewed students in an English-as-a-Second-Language (ESL) teacher education program to gain input for course and program revision. Lists 12 suggestion for improvement based on students' comments. (Author/VWL)

  17. The Wind Forecast Improvement Project (WFIP). A Public-Private Partnership Addressing Wind Energy Forecast Needs

    Energy Technology Data Exchange (ETDEWEB)

    Wilczak, James M. [NOAA, Boulder, CO (United States); Finley, Cathy [WindLogics, Inc., St. Paul, MN (United States); Freedman, Jeff [AWS Truepower, Albany, NY (United States); Cline, Joel [USDOE Office of Energy Efficiency and Renewable Energy, Washington, DC (United States); Bianco, L. [Univ. of Colorado, Boulder, CO (United States); Olson, J. [Univ. of Colorado, Boulder, CO (United States); Djalaova, I. [Univ. of Colorado, Boulder, CO (United States); Sheridan, L. [WindLogics, Inc., St. Paul, MN (United States); Ahlstrom, M. [WindLogics, Inc., St. Paul, MN (United States); Manobianco, J. [Meso, Inc., Troy, NY (United States); Zack, J. [Meso, Inc., Troy, NY (United States); Carley, J. [National Oceanic and Atmospheric Administration (NOAA), College Park, MD (United States); Benjamin, S. [NOAA, Boulder, CO (United States); Coulter, R. L. [Argonne National Lab. (ANL), Lemont, IL (United States); Berg, Larry K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mirocha, Jeff D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Clawson, K. [National Oceanic and Atmospheric Administration (NOAA), Idaho Falls, ID (United States); Natenberg, E. [Meso, Inc., Troy, NY (United States); Marquis, M. [NOAA, Boulder, CO (United States)

    2015-10-30

    The Wind Forecast Improvement Project (WFIP) is a public-private research program, the goals of which are to improve the accuracy of short-term (0-6 hr) wind power forecasts for the wind energy industry and then to quantify the economic savings that accrue from more efficient integration of wind energy into the electrical grid. WFIP was sponsored by the U.S. Department of Energy (DOE), with partners that include the National Oceanic and Atmospheric Administration (NOAA), private forecasting companies (WindLogics and AWS Truepower), DOE national laboratories, grid operators, and universities. WFIP employed two avenues for improving wind power forecasts: first, through the collection of special observations to be assimilated into forecast models to improve model initial conditions; and second, by upgrading NWP forecast models and ensembles. The new observations were collected during concurrent year-long field campaigns in two high wind energy resource areas of the U.S. (the upper Great Plains, and Texas), and included 12 wind profiling radars, 12 sodars, 184 instrumented tall towers and over 400 nacelle anemometers (provided by private industry), lidar, and several surface flux stations. Results demonstrate that a substantial improvement of up to 14% relative reduction in power root mean square error (RMSE) was achieved from the combination of improved NOAA numerical weather prediction (NWP) models and assimilation of the new observations. Data denial experiments run over select periods of time demonstrate that up to a 6% relative improvement came from the new observations. The use of ensemble forecasts produced even larger forecast improvements. Based on the success of WFIP, DOE is planning follow-on field programs.

  18. Needs and Opportunities to Improve the Operational Quality of Forwarding Companies

    OpenAIRE

    Dovilė Kontautaitė; Virgilija Zinkevičiūtė

    2013-01-01

    It is essential for forwarding companies to improve their activity by improving their internal and external processes in order to provide for a client an estimated basic and added value and effectively manage the flow of information in the general logistic supply chain. The article analyses the concepts of quality management and activity process, emphasising the main process of a forwarding enterprise and the demand to optimise the activity establishing quality management systems. The scienti...

  19. Mining the gap: Assessing leadership needs to improve 21st century plant pathology

    Science.gov (United States)

    Scientists and plant pathologists are trained in scientific knowledge and critical thinking as part of their career preparation process. However, the extensive training in science-related skills comes at a cost to “soft skills”, the competencies needed for interpersonal skills, communication, manage...

  20. Hearing in Athletes with Intellectual Disabilities: The Need for Improved Ear Care

    Science.gov (United States)

    McCracken, W.; Lumm, J.; Laoide-Kemp, S.

    2011-01-01

    Background: The Special Olympics offer the opportunity for athletes with intellectual disabilities to participate in a range of sports at regional, national and international level. A parallel Healthy Athletes programme was introduced to ensure safety at the games but also to collect data on the health needs of those with intellectual disabilities…

  1. Need to Improve Efficiency of Reserve Training. Report to the Congress.

    Science.gov (United States)

    Comptroller General of the U.S., Washington, DC.

    The report discusses the need to vary the training of Reserve and Guard units by skill and readiness requirements and to make more efficient use of training time. It contains recommendations to the Secretaries of Defense, Transportation, Army, Navy, and Air Force. The review was based on questionnaires mailed to 2,209 randomly selected reservists…

  2. The need for a Communicative Approach to improve Environmental Policy integration in urban Land Use Planning

    NARCIS (Netherlands)

    Simeonova, V.; Valk, van der A.J.J.

    2009-01-01

    The debate on sustainable development emphasizes the importance of integrating environmental policy into all policy sectors. It is increasingly recognized that this integration is needed at both the national and the local levels of governance. The Environmental Policy Integration (EPI) principle agr

  3. Science Faculty Improving Teaching Practice: Identifying Needs and Finding Meaningful Professional Development

    Science.gov (United States)

    Bouwma-Gearhart, Jana

    2012-01-01

    While research into the effectiveness of teaching professional development for postsecondary educators has increased over the last 40 years, little is known about science faculty members' teaching professional development needs and their perceptions regarding what constitutes meaningful teaching professional development. Informed by an extensive…

  4. What we need to improve the Public Health Workforce in Europe?

    Directory of Open Access Journals (Sweden)

    Vesna Bjegovic-Mikanovic

    2015-12-01

    multidisciplinary public health workforce is needed, supported by new skills and expertise. It has been demonstrated that public health education needs to include a wider range of health related professionals including: managers, health promotion specialists, health economists, lawyers and pharmacists. In the future, public health professionals will increasingly require enhanced communication and leadership skills, as well as a broad, interdisciplinary focus, if they are to truly impact upon the health of the population and compete successfully in today‘s job market. New developments comprise flexible academic programmes, lifelong learning, employability, and accreditation. In Europe‘s current climate of extreme funding constraints, the need for upgrading public health training and education is more important than ever. The broad supportive environment and context for change are in place. By focusing on assessment and evaluation of the current context, coordination and joint efforts to promote competency-based education, and support and growth of new developments, a stronger, more versatile and much needed workforce will be developed.

  5. When do tissues and cells become products? Regulatory oversight of emerging biological therapies.

    Science.gov (United States)

    Farrugia, Albert

    2006-01-01

    Although therapeutics derived from biological sources have been subjected to regulatory oversight for some time, the products used in transplantation procedures have historically been exempt from this oversight. These products have been viewed as being part of medical practice rather than as the result of mainstream pharmaceutical manufacture. Furthermore, their unique source makes them difficult to assess in traditional regulatory systems based on the tenets of pharmaceutical quality control. With the increasing use of transplantation therapies to both replace dysfunctional organs and to influence genetic and metabolic processes, public health concerns on these therapies have increased. In addition, it is recognized that therapeutic claims for some of these interventions need to be properly assessed. These considerations have led the established regulatory agencies of the developed world to develop new regulatory paradigms for the products of transplantation practice. While a number of concerns have driven these developments, the minimization of infectious disease risk remains the paramount driver for introducing these regulatory systems. More than the regulation of medicines and medical devices manufactured in traditional pharmaceutical modes, the regulation of cell and tissue products is intimately linked to areas of public health policy and funding. This places regulators in a challenging position as they attempt to reconcile their roles as independent assessors with the needs of the overall public health framework. This is particularly difficult when considering measures which may affect access to life saving therapies. Regulators have recognized the need to assess these therapies through systems which incorporate consideration of risk-benefit ratios and include mechanisms for transparent and accountable release of products when full compliance to traditional concepts of manufacturing practice is not possible.

  6. Needs and Opportunities to Improve the Operational Quality of Forwarding Companies

    Directory of Open Access Journals (Sweden)

    Dovilė Kontautaitė

    2013-04-01

    Full Text Available It is essential for forwarding companies to improve their activity by improving their internal and external processes in order to provide for a client an estimated basic and added value and effectively manage the flow of information in the general logistic supply chain. The article analyses the concepts of quality management and activity process, emphasising the main process of a forwarding enterprise and the demand to optimise the activity establishing quality management systems. The scientific literature analysis assists in the provision of quality assessment indicators of forwarding companies and ascertaining quality management systems that are suitable for transport companies.Article in Lithuanian

  7. Improvements needed in the Environmental Protection Agency's testing program for radon measurement companies

    Energy Technology Data Exchange (ETDEWEB)

    Hembra, R.L.

    1990-05-01

    Radon, a naturally occurring, colorless, odorless gas, has been shown to cause lung cancer. As a result, EPA and the Public Health Service advise homeowners to test their homes and to take action if elevated radon levels are discovered. However, GAO believes that to make health decisions, homeowners need more assurance that the radon test results they obtain are accurate. This report discusses how greater accuracy in radon measurements would result from mandating company participation in the Radon Measurement Proficiency program and requiring radon measurement firms to meet minimum quality assurance requirements as a condition to participation. In addition, to ensure that state programs provide a minimum degree of control and consistency over radon measurement companies, GAO recommends that EPA issue guidance on the type of state programs and level of control it believes are needed at the state level in order to provide homeowners with adequate assurances that radon measurements are accurate.

  8. Air Force Training: Further Analysis and Planning Needed to Improve Effectiveness

    Science.gov (United States)

    2016-09-01

    Force’s process for assessing the effectiveness of its annual training against leading practices that we have identified for managing strategic training...needed to measure the effectiveness of training sorties. For example, the upgrade training syllabus for the F-22 provides desired learning objectives...commanders to measure and collect data on the effectiveness of annual training for several reasons. These officials stated that Air Force instructions

  9. The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia

    OpenAIRE

    McMahon, Catherine M.; Bamini Gopinath; Julie Schneider; Jennifer Reath; Louise Hickson; Leeder, Stephen R; Paul Mitchell; Robert Cowan

    2013-01-01

    Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older ...

  10. U.S. Southern Command Government Purchase Card Controls Need Improvement to Prevent Improper Purchases

    Science.gov (United States)

    2014-12-19

    Comptroller and Staff Judge Advocate officials approved the request on September 28, 2011. Gift items purchased included 11 iPod Touch devices engraved...cardholder made the payment on September 29, 2011. The USSOUTHCOM Protocol Office received the iPods in November 2011 and stored them in the gift...locker. Consequently, the iPods were an unnecessary purchase because they did not meet the needs of the command during the fiscal year the purchase

  11. Defense Acquisitions: Joint Action Needed by DOD and Congress to Improve Outcomes

    Science.gov (United States)

    2015-10-27

    Strategy: rigorous systems engineering coupled with more achievable requirements are essential to achieve faster delivery of needed capability to the...by counting on unproven technologies) while promising low cost and short schedules. These incentives, coupled with a marketplace that is...and Members of the Committee, this concludes my statement and I would be happy to answer any questions. If you or your staff has any questions

  12. Evaluating oversight systems for emerging technologies: a case study of genetically engineered organisms.

    Science.gov (United States)

    Kuzma, Jennifer; Najmaie, Pouya; Larson, Joel

    2009-01-01

    The U.S. oversight system for genetically engineered organisms (GEOs) was evaluated to develop hypotheses and derive lessons for oversight of other emerging technologies, such as nanotechnology. Evaluation was based upon quantitative expert elicitation, semi-standardized interviews, and historical literature analysis. Through an interdisciplinary policy analysis approach, blending legal, ethical, risk analysis, and policy sciences viewpoints, criteria were used to identify strengths and weaknesses of GEOs oversight and explore correlations among its attributes and outcomes. From the three sources of data, hypotheses and broader conclusions for oversight were developed. Our analysis suggests several lessons for oversight of emerging technologies: the importance of reducing complexity and uncertainty in oversight for minimizing financial burdens on small product developers; consolidating multi-agency jurisdictions to avoid gaps and redundancies in safety reviews; consumer benefits for advancing acceptance of GEO products; rigorous and independent pre- and post-market assessment for environmental safety; early public input and transparency for ensuring public confidence; and the positive role of public input in system development, informed consent, capacity, compliance, incentives, and data requirements and stringency in promoting health and environmental safety outcomes, as well as the equitable distribution of health impacts. Our integrated approach is instructive for more comprehensive analyses of oversight systems, developing hypotheses for how features of oversight systems affect outcomes, and formulating policy options for oversight of future technological products, especially nanotechnology products.

  13. Regulatory Oversight Program, July 1, 1993--March 3, 1997. Volume 2: Appendices

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    On July, 1993, a Regulatory Oversight (RO) organization was established within the US DOE, Oak Ridge Operations to provide regulatory oversight of the DOE uranium enrichment facilities leased to the United States Enrichment Corporation (USEC). The purpose of the OR program was to ensure continued plant safety, safeguards and security while the plants were transitioned to regulatory oversight by the Nuclear Regulatory Commission (NRC). Volume 2 contains copies of the documents which established the relationship between NRC, DOE, USEC, and DOL (Dept of Labor) required to facilitate regulatory oversight transition.

  14. Photosynthesis: ancient, essential, complex, diverse .. and in need of improvement in a changing world

    Science.gov (United States)

    A challenge to crop improvement is the fact that the photosynthetic process has been fine tuned by billions of years of natural selection, and is subject to deeply rooted genetic controls shaped in the native environments of the crop ancestors. These may be difficult to change and may not be optima...

  15. Does the world need a scientific society for research on how to improve healthcare?

    NARCIS (Netherlands)

    Wensing, M.J.; Grimshaw, J.M.; Eccles, M.P.

    2012-01-01

    In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, th

  16. Needs and barriers to improve the collaboration in oral anticoagulant therapy: a qualitative study

    Directory of Open Access Journals (Sweden)

    Drewes Hanneke W

    2011-12-01

    Full Text Available Abstract Background Oral anticoagulant therapy (OAT involves many health care disciplines. Even though collaboration between care professionals is assumed to improve the quality of OAT, very little research has been done into the practice of OAT management to arrange and manage the collaboration. This study aims to identify the problems in collaboration experienced by the care professionals involved, the solutions they proposed to improve collaboration, and the barriers they encountered to the implementation of these solutions. Methods In the Netherlands, intensive follow-up of OAT is provided by specialized anticoagulant clinics (ACs. Sixty-eight semi-structured face-to-face interviews were conducted with 103 professionals working at an AC. These semi-structured interviews were transcribed verbatim and analysed inductively. Wagner's chronic care model (CCM and Cabana's framework for improvement were used to categorize the results. Results AC professionals experienced three main bottlenecks in collaboration: lack of knowledge (mostly of other professionals, lack of consensus on OAT, and limited information exchange between professionals. They mentioned several solutions to improve collaboration, especially solutions of CCM's decision support component (i.e. education, regular meetings, and agreements and protocols. Education is considered a prerequisite for the successful implementation of other proposed solutions such as developing a multidisciplinary protocol and changing the allocation of tasks. The potential of the health care organization to improve collaboration seemed to be underestimated by professionals. They experienced several barriers to the successful implementation of the proposed solutions. Most important barriers were the lack motivation of non-AC professionals and lack of time to establish collaboration. Conclusions This study revealed that the collaboration in OAT is limited by a lack of knowledge, a lack of consensus, and a

  17. A Quality Function Deployment Analysis of Customer Needs for Meeting School Improvement Goals: The Voice of the School Principal.

    Science.gov (United States)

    Kushner, Susan N.; And Others

    In providing leadership for school improvement teams, principals must employ group communication and decision-making skills. In this study, a planning procedure called Quality Function Deployment (QFD) was modified for use with school-based administrators. Teams of school leaders used QFD to generate the top priority needs of school customers…

  18. Manic Monday to fabulous Friday: partnering to improve behavioral and mental health needs of students.

    Science.gov (United States)

    Schwind, Karen S; Freeman, Sally Ann; Garcia, Molly; Roberts, Ruth

    2015-01-01

    School nurses across the United States continue to see an increase in the number of children and families with behavioral and mental health issues that affect many aspects of overall health and education. When referral to a mental health professional is indicated, there are often few available community mental health providers, long waits for appointments, or both. This article describes how school nurses can leverage school district and community resources and increase their capacity to meet the behavioral and mental health needs of children in the school setting.

  19. Do we need to improve teaching style in physics to get more students in physics?

    Science.gov (United States)

    Masood, Samina

    2014-03-01

    We give a qualitative analysis based on the interaction with students from different communities that how the social and cultural values can deeply affect the young population and their priorities in life. Also the educational strategies and teaching methods have to be changed according to the demographic situations and the needs of corresponding students. Most of the known facts in this regard are accepted as realities however, some further modifications are still required and some of them have to be taken back to fulfil the requirements of the individual subjects. We specially focus on physics students and describe about their requirements based on their background.

  20. Why we need interprofessional education to improve the delivery of safe and effective care

    Directory of Open Access Journals (Sweden)

    Scott Reeves

    2016-03-01

    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

  1. Veterans Health Care: Improvements Needed in Operationalizing Strategic Goals and Objectives

    Science.gov (United States)

    2016-10-01

    health care service delivery in response to concerns regarding the VHA wait-time crisis that year. However, it did not develop similar strategy...time crisis that year.25 These strategies, which are linked to the goals and objectives in VHA’s current strategic plan, include operating a health...progress in reducing veteran homelessness , improving the employee experience, staffing critical positions, transforming Office of Information

  2. Improving the performance of interorganizational networks for preventing chronic disease: identifying and acting on research needs.

    Science.gov (United States)

    Willis, Cameron D; Riley, Barbara L; Taylor, Martin; Best, Allan

    2014-01-01

    This article describes the role of interorganizational networks in chronic disease prevention and an action research agenda for promoting understanding and improvement. Through a model of engaged scholarship, leaders with expertise and experience in chronic disease prevention networks helped shape research directions focused on network value, governance, and evolution. The guiding principles for facilitating this research include applying existing knowledge, developing network-appropriate methods and measures, creating structural change, promoting an impact orientation, and fostering cultural change.

  3. Reporting quality of survival analyses in medical journals still needs improvement. A minimal requirements proposal.

    Science.gov (United States)

    Abraira, Víctor; Muriel, Alfonso; Emparanza, José I; Pijoan, José I; Royuela, Ana; Plana, María Nieves; Cano, Alejandra; Urreta, Iratxe; Zamora, Javier

    2013-12-01

    We reviewed publications with two main objectives: to describe how survival analyses are reported across medical journal specialties and to evaluate changes in reporting across periods and journal specialties. Systematic review of clinical research articles published in 1991 and 2007, in 13 high-impact medical journals. The number of articles performing survival analysis published in 1991 (104) and 2007 (240) doubled (17% vs. 33.5%; P = 0.000), although not uniformly across specialties. The percentage of studies using regression models and the number of patients included also increased. The presentation of results improved, although only the reporting of precision of effect estimates reached satisfactory levels (53.1% in 1991 vs. 94.2% in 2007; P = 0.000). Quality of reporting also varied across specialties; for example, cardiology articles were less likely than oncology ones to discuss sample size estimation (odds ratio = 0.12; 95% confidence interval: 0.05, 0.30). We also detected an interaction effect between period and specialty regarding the likelihood of reporting precision of curves and precision of effect estimates. The application of survival analysis to medical research data is increasing, whereas improvement in reporting quality is slow. We propose a list of minimum requirements for improved application and description of survival analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Digital divide and information needs for improving family support among the poor and underserved.

    Science.gov (United States)

    Collins, Sarah A; Yoon, Sunmoo; Rockoff, Maxine L; Nocenti, David; Bakken, Suzanne

    2016-03-01

    Despite of its emotional benefits, communication with family members who live abroad can present a large financial burden for low-income foreign-born individuals. The aims of this study were (1) to explore the current technologies available for low-cost communication with family living abroad and (2) to assess the level of awareness and use of low-cost technologies for family communication as well as related information needs among low-income foreign-born individuals. This mixed-methods study included an environmental scan, survey, and focus groups with low-income foreign-born individuals living in East Harlem in New York City. Low-income individuals who have family members living abroad face financial stress with complicated technology choices for communication with family living abroad and they have many information needs. They would welcome interactive and convenient educational tools that (1) build skills for utilization of various technologies and (2) provide decision support to simplify choosing among the vast array of available communication options.

  5. The unmet need for a national surgical quality improvement curriculum: a systematic review.

    Science.gov (United States)

    Medbery, Rachel L; Sellers, Morgan M; Ko, Clifford Y; Kelz, Rachel R

    2014-01-01

    The Accreditation Council for Graduate Medical Education Next Accreditation System will require general surgery training programs to demonstrate outstanding clinical outcomes and education in quality improvement (QI). The American College of Surgeons-National Surgical Quality Improvement Project Quality In-Training Initiative reports the results of a systematic review of the literature investigating the availability of a QI curriculum. Using defined search terms, a systematic review was conducted in Embase, PubMed, and Google Scholar (January 2000-March 2013) to identify a surgical QI curriculum. Bibliographies from selected articles and other relevant materials were also hand searched. Curriculum was defined as an organized program of learning complete with content, instruction, and assessment for use in general surgical residency programs. Two independent observers graded surgical articles on quality of curriculum presented. Overall, 50 of 1155 references had information regarding QI in graduate medical education. Most (n = 24, 48%) described QI education efforts in nonsurgical fields. A total of 31 curricular blueprints were identified; 6 (19.4%) were specific to surgery. Targeted learners were most often post graduate year-2 residents (29.0%); only 6 curricula (19.4%) outlined a course for all residents within their respective programs. Plan, Do, Study, Act (n = 10, 32.3%), and Root Cause Analysis (n = 5, 16.1%) were the most common QI content presented, the majority of instruction was via lecture/didactics (n = 26, 83.9%), and only 7 (22.6%) curricula used validated tool kits for assessment. Elements of QI curriculum for surgical education exist; however, comprehensive content is lacking. The American College of Surgeons-National Surgical Quality Improvement Project Quality In-Training Initiative will build on the high-quality components identified in our review and develop data-centered QI content to generate a comprehensive national QI curriculum for use in

  6. Toward improved survivorship: supportive care needs of esophageal cancer patients, a literature review.

    Science.gov (United States)

    Graham, L; Wikman, A

    2016-11-01

    The growing prevalence of esophageal cancer survivors represent a population typified by an extensive treatment regime, significant postsurgical long-term effects, and a dismal prognosis. Despite this, little is known of the supportive care needs of this patient group and the extent to which these are being met in practice. This review provides a synthesis of the research evidence to date; emphasizing opportunities for clinical application and setting a future agenda with research priorities. A literature search was performed using Medline/Embase, PsycINFO, and Web of Science. Search headings used included; [esophagus] or [esopohageal] or [upper gastrointestinal] or [upper GI] AND [cancer] or [carcinoma] or [squamous cell] AND [supportive care] or [survivorship] or [psychological] or [emotional] or [information] or [social] or [communication] or [spiritual] or [health-related-quality-of-life] or [HRQL] or [qualitative] or [patient narrative] or [clinical nurse specialist] or [CNS]. Related articles in English were reviewed, with additional articles harvested from reference sections. Esophageal cancer survivors report significant late-term effects posttreatment, encompassing sustained impairment in most areas of health-related quality of life. With a necessitated change in eating behavior, survivors find it particularly challenging to adjust to a new social identity and as a cancer population report high levels of psychological morbidity. Although the determinants of psychological morbidity are largely unknown, illness representations may be a key contributor. Several multidisciplinary supportive care interventions have been developed with promising results. The research summarized in this paper provides valuable insight into the psychosocial well-being of the esophageal cancer survivor. However, knowledge gaps remain, alongside a dearth of applied examples in meeting supportive care need. © 2015 International Society for Diseases of the Esophagus.

  7. Elementary School Teacher Training Based on Needs and Interests of Teachers and The Effectiveness of The Improvement of Students Competence

    Science.gov (United States)

    Suyitno, A.; Sugiharti, E.; Pujiastuti, E.

    2017-04-01

    Teachers need always to improve their competence because of the growth of science very rapidly as well as elementary school teachers. However, the provision of training will not produce an increase in the competence effectively if it is implemented without considering the needs and interests of teachers. The novelty factor which is highlighted through this research results, want to answer a problem, namely: how to conduct an effective training based on the needs and interests of teachers so that the effects of training can improve the competence of teachers? After going through research for two years with a qualitative approach which was preceded by a visit to the school and a series of interviews, treatment of training model, FGD, and triangulation then have been produced a way to implement of training based on the needs and interests of teachers. The training model includes face to face training which structured and scheduled according to the needs of elementary school teachers, followed by workshops, simulations, then the coach holds guidance in the classroom, and ends with reflections.

  8. Examining the FDA's oversight of direct-to-consumer advertising.

    Science.gov (United States)

    Gahart, Martin T; Duhamel, Louise M; Dievler, Anne; Price, Roseanne

    2003-01-01

    Our analysis examined the effects of the Food and Drug Administration's (FDA's) 1997 draft guidance regarding advertisements for prescription drugs broadcast directly to consumers. We found that although direct-to-consumer (DTC) advertising spending by pharmaceutical companies has increased, more than 80 percent of their promotional spending is directed to physicians. DTC advertising appears to increase the use of prescription drugs among consumers. The FDA's oversight has not prevented companies from making misleading claims in subsequent advertisements, and a recent policy change has lengthened the FDA's review process, raising the possibility that some misleading campaigns could run their course before review.

  9. [Reporting of side-effects--a system in need of improvement. Reporting of a physician questionnaire].

    Science.gov (United States)

    Ekbom, Ylva; Hedenmalm, Karin; Dalin, Linda; Lönnroth, Knut; Persson, Ingemar

    2002-08-22

    The spontaneous reporting system in Sweden is based on reporting by health care professionals of adverse drug reactions (ADRs) to the Medical Products Agency. The usefulness of the spontaneous reporting system is limited by a substantial degree of underreporting. In order to study factors that make reporting of ADRs difficult as well as to obtain responses to suggestions that could increase the reporting of ADRs, an enquiry was sent to 300 randomly selected physicians. The most important factors that make reporting of ADRs more difficult are lack of time and forgetfulness. Most physicians stated that they would report ADRs to a greater extent if reporting was simpler, if resources were available or if the response to the reporting was improved. The majority of the physicians who had a computer at work stated that they would like to access the reporting form electronically.

  10. Efficiency and emission of crop residues combustion facilities in Serbia: Status and needed measures for improvement

    Directory of Open Access Journals (Sweden)

    Martinov Milan

    2006-01-01

    Full Text Available Use of crop residues as fuel has a long tradition in rural areas of Serbia. Numerous biomass-fueled facilities were built during the 80s. Among those were small facilities for household heating, with thermal power from 5 to 50 kW, medium-size facilities for farm and greenhouses, with thermal power 50 to 1000 kW, and large facilities for processing of agricultural products, with thermal powers higher than 1000 kW. The results showed that the level of biomass combustion facilities is in general very low. This is especially the case for heating facilities used for house-hold heating. The measures for improvement were proposed. .

  11. Unmet Need: Improving mHealth Evaluation Rigor to Build the Evidence Base.

    Science.gov (United States)

    Mookherji, Sangeeta; Mehl, Garrett; Kaonga, Nadi; Mechael, Patricia

    2015-01-01

    mHealth-the use of mobile technologies for health-is a growing element of health system activity globally, but evaluation of those activities remains quite scant, and remains an important knowledge gap for advancing mHealth activities. In 2010, the World Health Organization and Columbia University implemented a small-scale survey to generate preliminary data on evaluation activities used by mHealth initiatives. The authors describe self-reported data from 69 projects in 29 countries. The majority (74%) reported some sort of evaluation activity, primarily nonexperimental in design (62%). The authors developed a 6-point scale of evaluation rigor comprising information on use of comparison groups, sample size calculation, data collection timing, and randomization. The mean score was low (2.4); half (47%) were conducting evaluations with a minimum threshold (4+) of rigor, indicating use of a comparison group, while less than 20% had randomized the mHealth intervention. The authors were unable to assess whether the rigor score was appropriate for the type of mHealth activity being evaluated. What was clear was that although most data came from mHealth projects pilots aimed for scale-up, few had designed evaluations that would support crucial decisions on whether to scale up and how. Whether the mHealth activity is a strategy to improve health or a tool for achieving intermediate outcomes that should lead to better health, mHealth evaluations must be improved to generate robust evidence for cost-effectiveness assessment and to allow for accurate identification of the contribution of mHealth initiatives to health systems strengthening and the impact on actual health outcomes.

  12. Improving wheelchair prescription: an analysis of user needs and existing tools.

    Science.gov (United States)

    Moody, Louise; Woodcock, Andree; Heelis, Mike; Chichi, Cynthia; Fielden, Simon; Stefanov, Dimitar

    2012-01-01

    Wheelchair users experience many situations that affect the stability and associated performance of their wheelchair. Stability is affected by user characteristics and abilities, environmental features and conditions, and wheelchair modification and accessories. Wheelchair prescribers need effective tools and methods to provide quantitative evaluation and prediction of the behavior of the user-wheelchair system in a variety of static and dynamic situations. Such information is very important to guide efficient management of associated risks and adjust chairs accordingly. This project involves a user-centered approach for design and evaluation of a load cell based wheelchair stability assessment system (Wheel-SAS). Here, the current methods for assessing stability are described, and their shortcomings explained. The user-centered design approach being applied to the development of the associated Wheel-SAS hardware and software is described. Future work including semi-structured interviews and an online survey with wheelchair prescribers and associated healthcare professionals for deriving user requirements and a design specification for a load cell system for measuring dynamic wheelchair stability are detailed.

  13. The Need for Improved Detection and Management of Adult-Onset Hearing Loss in Australia

    Directory of Open Access Journals (Sweden)

    Catherine M. McMahon

    2013-01-01

    Full Text Available Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1 early identification of persons with chronic hearing impairment; (2 appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss.

  14. The need for improved detection and management of adult-onset hearing loss in australia.

    Science.gov (United States)

    McMahon, Catherine M; Gopinath, Bamini; Schneider, Julie; Reath, Jennifer; Hickson, Louise; Leeder, Stephen R; Mitchell, Paul; Cowan, Robert

    2013-01-01

    Adult-onset hearing loss is insidious and typically diagnosed and managed several years after onset. Often, this is after the loss having led to multiple negative consequences including effects on employment, depressive symptoms, and increased risk of mortality. In contrast, the use of hearing aids is associated with reduced depression, longer life expectancy, and retention in the workplace. Despite this, several studies indicate high levels of unmet need for hearing health services in older adults and poor use of prescribed hearing aids, often leading to their abandonment. In Australia, the largest component of financial cost of hearing loss (excluding the loss of well-being) is due to lost workplace productivity. Nonetheless, the Australian public health system does not have an effective and sustainable hearing screening strategy to tackle the problem of poor detection of adult-onset hearing loss. Given the increasing prevalence and disease burden of hearing impairment in adults, two key areas are not adequately met in the Australian healthcare system: (1) early identification of persons with chronic hearing impairment; (2) appropriate and targeted referral of these patients to hearing health service providers. This paper reviews the current literature, including population-based data from the Blue Mountains Hearing Study, and suggests different models for early detection of adult-onset hearing loss.

  15. What is needed to improve food sales in schools?Food vendors’ opinion from El Salvador

    Directory of Open Access Journals (Sweden)

    Caroline eHilari

    2015-07-01

    Full Text Available Latin America and the Caribbean are at the forefront of the double burden of malnourishment, with rocketing rates of overweight, obesity and stagnant prevalence of stunting in many countries. School children are at a crucial age for setting eating habits, physical activity, nutritional status and long term outcomes both in their health as well as their education and economic productivity. Save the Children International implements a school health and nutrition program in 45 rural schools in El Salvador, Central America. The program aims at increasing the consumption of protein and micronutrients while reducing intake of sugar and fats in school children. In addition, there is great emphasis on food hygiene and safe handling, through training of the food vendors. We developed a conceptual framework for school nutrition programs that is phrased around five different moments: school snacks, school stores, nutrition learning, bringing food to school and eating at home. Monitoring and control lies in the hands of student brigades, which fosters child participation. We present findings of a qualitative evaluation on sale regulation in school food stores, documenting additional interventions that were needed to foster compliance. We explore how vendors are making money on healthy food if head teachers and parents are involved in regulating food stores and children are motivated to cherish fruits and vegetables. Based on these findings, we discuss a model of an enabling environment for healthy food at school.

  16. Selecting Materials for Environmental-Friendly Buildings: The Need for Improved Environmental Impact Data

    Directory of Open Access Journals (Sweden)

    Nachawit T.

    2012-01-01

    Full Text Available Buildings of the future need to be more environmental-friendly. Selecting environmentally-benign materials in design stage would partly help achieving such goal. Examination of existing environmental impact data of building materials reveals that the data differ greatly from one source to another. Comparisons of environmental impact values of selected materials are presented. The sources that give rise to data variation are identified and discussed. The applicability of existing data is assessed from the designers’ perspective. Limitations of current practice in data acquisition and presentation are also discussed. It is concluded that existing environmental impact data of building materials are inconsistent and perplexing to designers. An alternative approach to data acquisition and presentation is to break the life cycle of building materials into several phases and to calculate the total impact value as the sum of the impacts of all phases. This would make the determination of the full life cycle value feasible and increase external validity of research results.

  17. Improving irrigation efficiency : the need for a relevant sequence of the management tools

    Science.gov (United States)

    Fayolle, Y.

    2009-04-01

    With 70 % of worldwide withdrawals, irrigation efficiency is a key issue in the overall problem of water resources. Management of water dedicated to agriculture should be improved to secure food production and save water to deal with increasing domestic and industrial demands. This paper is based on the results of a collaborative research project conducted in India with a local NGO (the Aga Khan Rural Support Programme, AKRSP(I)) during which GIS were tested. It is aimed at analyzing the efficiency of water usage in a water development programme conducted by the partner NGO in the semi-arid margins of Gujarat state. The analysis raises the question of the articulation of legal, institutional, economical, and technical tools to improve water efficiency. The NGO supervises the construction of surface water harvesting structures for irrigation purposes. Following a participatory approach, it creates and trains user groups to which the management of dams would then be devolved. User group membership depends on financial contribution to the building costs. A legal vacuum regarding surface water management combined with unequal investment capacities favor the concentration of water resources in the hands of a limited number of farmers. This causes low water use efficiency, irrigation choices being mostly oriented to high water consumptive crops and recipient farmers showing no interest in investing in water saving techniques. Our observations favor equality of access and paying more attention to the sequence in which management tools are articulated. On a national scale, as a prerequisite, water user rights as well as NGO's intervention legal framework should be clarified. On a project scale, before construction, information systems could help to identify all potential beneficiaries and optimize equality of access. It aims at reducing the volume of water per farmer to encourage them to irrigate low water consumptive crops and invest in water saving techniques. Depending

  18. A Hybrid MCDM Model for Improving the Electronic Health Record to Better Serve Client Needs

    Directory of Open Access Journals (Sweden)

    James J. H. Liou

    2017-10-01

    Full Text Available Although the electronic health record (EHR is a promising innovation in the healthcare industry, the implementation of EHR has been relatively slow. A theoretical structure for the exploration and improvement of this usage of EHR is proposed. Incorporating the theoretical structure of TOE (technology-organization-environment, we apply the DEMATEL (decision-making trial and evaluation laboratory technique to illustrate the influence-matrix and to construct the INRM (influential network relationship map. Based on this DEMATEL influence matrix and the fundamental concepts of ANP (Analytic Hierarchy Process, we derive influential weights for the criteria. These influential weights are then combined with the modified VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje method to find ways to understand and enhance the usage of EHR technology. The outcome demonstrates that our model can not only be used for implementation of EHR technology, but can also be applied to analyze the gaps in performance between the aspiration level and present performance values in individual criterion/dimension.

  19. Profit versus public health: the need to improve the food environment in recreational facilities.

    Science.gov (United States)

    Olstad, Dana Lee; Raine, Kim D

    2013-01-08

    Despite their wellness mandate, many publicly funded recreational facilities offer primarily unhealthy foods. Governments have developed programs and resources to assist facilities to improve their food offerings, however the challenge to incent preferential sale of healthier foods remains substantial. In the Canadian province of Alberta, uptake of government-issued voluntary nutrition guidelines for recreational facilities has been limited, and offers of free assistance to implement them as part of a research study were not embraced. Financial constraints appear to be the most important barrier to offering healthier items in Alberta's recreational facilities, as facility and food service managers perceive that selling healthier foods is unprofitable and might jeopardize sponsorship agreements. Mandatory government regulation may therefore be required to overcome the barriers to offering healthier foods in this setting. The advantages of a regulatory approach appear to outweigh any disadvantages, with benefits for population health, more effective use of public funds, and greater equity for the public and industry. Adverse effects on corporate profitability and freedom of choice are expected to be limited. Regulation may offer an efficient, effective and equitable means of ensuring that recreational facilities support child health and do not undermine it by exposing children to unhealthy food environments.

  20. Assessing the methods needed for improved dengue mapping: a SWOT analysis.

    Science.gov (United States)

    Attaway, David Frost; Jacobsen, Kathryn H; Falconer, Allan; Manca, Germana; Waters, Nigel M

    2014-01-01

    Dengue fever, a mosquito-borne viral infection, is a growing threat to human health in tropical and subtropical areas worldwide. There is a demand from public officials for maps that capture the current distribution of dengue and maps that analyze risk factors to predict the future burden of disease. To identify relevant articles, we searched Google Scholar, PubMed, BioMed Central, and WHOLIS (World Health Organization Library Database) for published articles with a specific set of dengue criteria between January 2002 and July 2013. After evaluating the currently available dengue models, we identified four key barriers to the creation of high-quality dengue maps: (1) data limitations related to the expense of diagnosing and reporting dengue cases in places where health information systems are underdeveloped; (2) issues related to the use of socioeconomic proxies in places with limited dengue incidence data; (3) mosquito ranges which may be changing as a result of climate changes; and (4) the challenges of mapping dengue events at a variety of scales. An ideal dengue map will present endemic and epidemic dengue information from both rural and urban areas. Overcoming the current barriers requires expanded collaboration and data sharing by geographers, epidemiologists, and entomologists. Enhanced mapping techniques would allow for improved visualizations of dengue rates and risks.

  1. Current practice and perspectives in CRO oversight based on a survey performed among members of the German Association of Research-Based Pharmaceutical Companies (vfa

    Directory of Open Access Journals (Sweden)

    Hennig, Michael

    2017-01-01

    Full Text Available In recent years, the number and scope of outsourced activities in the pharmaceutical industry have increased heavily. In addition, also the type of outsourcing has changed significantly in that time. This raises the question of whether and how sponsors retain the capability to select and to control the contract research organizations (CROs involved and what expertise still has to be present in the development department as well as other relevant departments to ensure adequate oversight, also in line with the expectations of regulators and health authorities. In order to answer these questions, a survey was conducted among the German vfa member companies. The survey describes the latest developments and experiences in outsourcing by 18 German vfa member companies. It concentrates on measures how to implement Quality Assurance (QA when performing outsourced clinical studies.This study shows that the majority of companies apply a full-outsourcing, preferred-provider model of clinical trial services, with the clinical research department playing the major role in this process. A large amount of guiding documents, processes and tools are used to ensure an adequate oversight of the services performed by the CRO(s.Finally the guiding principles for all oversight processes should be transparent communication, a clearly established expectation for quality, a precise definition of accountability and responsibility while avoiding silo mentality, and a comprehensive documentation of the oversight’s evidence. For globally acting and outsourcing sponsors, oversight processes need to be aligned with regards to local and global perspectives. This survey shows that the current implementation of oversight processes in the participating companies covers all relevant areas to ensure highest quality and integrity of the data produced by the outsourced clinical trial.

  2. Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair

    Directory of Open Access Journals (Sweden)

    Tereza Cristina Carbonari de Faria

    2013-09-01

    Full Text Available Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6 or not (Group B; n=7 were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05. Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair.

  3. 42 CFR 137.366 - May the Secretary conduct onsite project oversight visits?

    Science.gov (United States)

    2010-10-01

    ... Roles of the Secretary in Establishing and Implementing Construction Project Agreements § 137.366 May the Secretary conduct onsite project oversight visits? Yes, the Secretary may conduct onsite project... 42 Public Health 1 2010-10-01 2010-10-01 false May the Secretary conduct onsite project oversight...

  4. 75 FR 3509 - Public Company Accounting Oversight Board; Order Approving Proposed Rules on Auditing Standard No...

    Science.gov (United States)

    2010-01-21

    ...); 74 FR 57357 (November 5, 2009). II. Description Section 103 of the Act directs the Board, among other... COMMISSION Public Company Accounting Oversight Board; Order Approving Proposed Rules on Auditing Standard No..., 2009, the Public Company Accounting Oversight Board (the ``Board'' or the ``PCAOB'') filed with...

  5. 77 FR 76076 - Information Security Oversight Office; State, Local, Tribal, and Private Sector Policy Advisory...

    Science.gov (United States)

    2012-12-26

    ... RECORDS ADMINISTRATION Information Security Oversight Office; State, Local, Tribal, and Private Sector... Security Oversight Office. ACTION: Notice of meeting. SUMMARY: In accordance with the Federal Advisory... committee meeting of the State, Local, Tribal, and Private Sector Policy Advisory Committee. To discuss...

  6. 77 FR 2576 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Science.gov (United States)

    2012-01-18

    ... Release No. 34-66141/January 11, 2012] Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2012 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''),\\1\\ established the Public Company Accounting Oversight Board...

  7. 78 FR 11915 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Science.gov (United States)

    2013-02-20

    ..., Release No. 68921/February 13, 2013] Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2013 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''),\\1\\ established the Public Company Accounting Oversight Board (``PCAOB'') to...

  8. 75 FR 81684 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Science.gov (United States)

    2010-12-28

    ...; Release No. 34-63596/December 22, 2010] Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2011 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''), established the Public Company Accounting Oversight Board (``PCAOB'')...

  9. 75 FR 51280 - Oversight of Laboratory Developed Tests; Public Meeting; Reopening of the Comment Period

    Science.gov (United States)

    2010-08-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Oversight of Laboratory Developed Tests; Public Meeting... oversight of laboratory developed tests (LDTs). FDA is reopening the comment period to update comments...

  10. Creating a Learning Organization in Law Enforcement: Maturity Levels for Police Oversight Agencies

    Science.gov (United States)

    Filstad, Cathrine; Gottschalk, Petter

    2010-01-01

    Purpose: The purpose of this paper is to conceptualize a stage model for maturity levels for police oversight agencies. Design/methodology/approach: The paper is based on a literature review covering police oversight organizations and stages of growth models. Findings: As a conceptual paper, the main findings are related to the appropriateness of…

  11. 48 CFR 52.236-24 - Work Oversight in Architect-Engineer Contracts.

    Science.gov (United States)

    2010-10-01

    ... Architect-Engineer Contracts. 52.236-24 Section 52.236-24 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.236-24 Work Oversight in Architect-Engineer Contracts. As prescribed in 36.609-3, insert the following clause: Work Oversight in Architect-Engineer Contracts (APR 1984) The extent...

  12. Psychotropic Medication Management for Youth in State Care: Consent, Oversight, and Policy Considerations

    Science.gov (United States)

    Naylor, Michael W.; Davidson, Christine V.; Ortega-Piron, D. Jean; Bass, Arin; Gutierrez, Alice; Hall, Angela

    2007-01-01

    The use of psychotropic medications in youth with emotional disturbances in state custody is increasing and presents unique challenges concerning consent and oversight. We examine various means that state child welfare agencies use to provide consent for and oversight of psychotropic medications for children in state custody and describe benefits…

  13. U.S. Transportation Command Needs Further Improvements to Address Performance Concerns Over the Global Privately Owned Vehicle Contract 3

    Science.gov (United States)

    2016-02-03

    U A R Y 3 , 2 0 1 6 U.S. Transportation Command Needs Further Improvements to Address Performance Concerns Over the Global Privately Owned...USTRANSCOM) Global Privately Owned Vehicle Contract (GPC) III (HTC711-14-D-R025). Our objective was to determine whether USTRANSCOM contracting personnel...Concerns Over the Global Privately Owned Vehicle Contract III ii │ DODIG-2016-044 (Project No. D2015-D000CL-0091.000) Recommendations Table

  14. Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

    Science.gov (United States)

    2017-01-01

    requirement to include two more reports, resulting in GAO reports in 2011, 2012, and 2016. 5GAO, VA and DOD Health Care: First Federal Health ...FEDERAL HEALTH CARE CENTER VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency...Government Accountability Office Highlights of GAO-17-197, a report to congressional committees January 2017 FEDERAL HEALTH CARE CENTER VA and DOD

  15. Force Structure: Actions Needed to Improve DOD’s Ability to Manage, Assess, and Report on Global Defense Posture Initiatives

    Science.gov (United States)

    2009-07-02

    Representatives Subject: Force Structure: Actions Needed to Improve DOD’s Ability to Manage, Assess, and Report on Global Defense Posture ...as well as the fidelity of the global basing plan given the rapidly changing global security environment. GAO-09-706R Global Defense Posture ...to Manage, Assess, and Report on Global Defense Posture Initiatives 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S

  16. Commercial coral-reef fisheries across Micronesia: A need for improving management

    Science.gov (United States)

    Houk, P.; Rhodes, K.; Cuetos-Bueno, J.; Lindfield, S.; Fread, V.; McIlwain, J. L.

    2012-03-01

    A dearth of scientific data surrounding Micronesia's coral-reef fisheries has limited their formal assessment and continues to hinder local and regional management efforts. We approach this problem by comparing catch-based datasets from market landings across Micronesia to evaluate fishery status in the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Yap, and Pohnpei. Initial examinations found that calm weather and low lunar illumination predicted between 6% (Yap) and 30% (CNMI) of the variances in daily commercial landings. Both environmentally driven catch success and daily catch variability increased in accordance with reef-fish demand indices. Subsequent insight from species composition and size-at-capture data supported these findings, highlighting reduced trophic levels and capture sizes where higher human-population-per-reef-area existed. Among the 12-15 target species and/or species complexes that accounted for 70% of the harvest biomass, capture sizes were consistently smallest for CNMI and Guam, often below the reported mean reproductive sizes. Comparatively, Pohnpei has the greatest potential for reef fisheries, with a large reef area (303 km2) and a moderate human population (34,000 people). However, the estimated harvest volume of 476 mt year-1 was 8-9 times higher than other jurisdictions. Even on Yap where the reef-fish demand index was lowest (67.7 people km-2 reef habitat), many target fish were harvested below their mean reproductive sizes, including the iconic green bumphead parrotfish and humphead wrasse, as well as several other herbivores. We discuss our results with respect to the contemporary doctrine surrounding size-spectra, catch composition, and catch frequencies that afford insight into fishery pressure and status. We posit that regional catch-based policies (initially) instituted at the market level, combined with area and gear-based restrictions, represent plausible vectors for improving Micronesian fisheries.

  17. Bedding on geotextile mattresses: how much is needed to improve cow comfort?

    Science.gov (United States)

    Tucker, C B; Weary, D M

    2004-09-01

    The objective of our study was to evaluate how the amount of sawdust bedding on mattresses affects dairy cattle behavior and preferences. Eleven nonlactating, multiparous cows were housed individually in pens with access to 3 free stalls. Each stall was fitted with a geotextile mattress covered with either 0, 1, or 7.5 kg of kiln-dried sawdust. The experiment began with 7 d of acclimatization to all 3 stalls. Cows were then allowed access to only 1 of the 3 stalls at a time, each for 3 d (restriction phase). At the end of this restriction phase, cows were allowed free access to all 3 stalls for 3 d (free-choice phase). Time spent lying and the number of lying bouts increased significantly with the amount of bedding, from 12.3 +/- 0.53 h lying and 8.5 +/- 0.62 bouts per 24 h on bare mattresses to 13.8 +/- 0.53 h lying and 10.0 +/- 0.62 bouts per 24 h on mattresses with 7.5 kg of sawdust. In addition, the animals spent less time standing with only the front hooves in the stalls when more sawdust was present. When allowed free access to all 3 options, all 11 animals spent a majority of their time lying and standing in the 7.5-kg option. In conclusion, cows preferred mattresses bedded with 7.5 kg of sawdust, on which they spent more time lying down and less time standing with only the front hooves in stalls. These results indicate that more sawdust bedding improves cow comfort in stalls with geotextile mattresses.

  18. Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers' Understanding to Improve Health Care.

    Directory of Open Access Journals (Sweden)

    Akram Ahmad

    Full Text Available Japanese encephalitis (JE is a major cause of high morbidity and mortality in several states across India. However, in 2014, a sharp rise was observed in the number of cases of JE in north-eastern Assam state, and 51% of the total cases of JE in India were reported from the Assam in the same year. In this regard, a study was conducted to evaluate the knowledge and attitudes of healthcare workers in Darrang, a district of Assam highly affected by JE.A cross sectional study was conducted for 2 months among HCWs in the major district hospital of Darrang, Assam. A pre-tested, self-administered questionnaire was used to collect data from the participants. Convenience sampling approach was used to collect data from different departments of the hospitals. Descriptive and logistic regression analyses were used to express the results.The knowledge of HCWs regarding JE was poor with a mean knowledge score of 11.02±2.39 (out of 17, while their attitudes were positive with a mean attitudes score of 43.16± 2.47 (ranging from 13 to 52. Overall, 40.4% and 74.3% of participants demonstrated good knowledge and positive attitudes respectively. Cut-off score for good knowledge and positive attitudes toward JE was set as ≥12 and >40 respectively. Older participants (40-49 years and experienced workers (>10 years were significantly associated with good knowledge as compared to their referent group (p<0.05, while knowledge of nurses and other orderlies were significantly lower than physicians (p<0.01. Similar factors were associated with the positive attitudes of the participants with the exception of experience. Television was the major source of information regarding JE reported by HCWs (79%.Although the knowledge was not optimized, HCWs exhibited positive attitudes towards JE. Future research is required to design, implement and evaluate interventions to improve the knowledge of JE among HCWs.

  19. Does directly observed therapy improve tuberculosis treatment? More evidence is needed to guide tuberculosis policy.

    Science.gov (United States)

    McLaren, Zoë M; Milliken, Amanda A; Meyer, Amanda J; Sharp, Alana R

    2016-10-04

    Tuberculosis (TB) now ranks alongside HIV as the leading infectious disease cause of death worldwide and incurs a global economic burden of over $12 billion annually. Directly observed therapy (DOT) recommends that TB patients complete the course of treatment under direct observation of a treatment supporter who is trained and overseen by health services to ensure that patients take their drugs as scheduled. Though the current WHO End TB Strategy does not mention DOT, only "supportive treatment supervision by treatment partners", many TB programs still use it despite the fact that the has not been demonstrated to be statistically significantly superior to self-administered treatment in ensuring treatment success or cure. DOT is designed to promote proper adherence to the full course of drug therapy in order to improve patient outcomes and prevent the development of drug resistance. Yet over 8 billion dollars is spent on TB treatment each year and thousands undergo DOT for all or part of their course of treatment, despite the absence of rigorous evidence supporting the superior effectiveness of DOT over self-administration for achieving drug susceptible TB (DS-TB) cure. Moreover, the DOT component burdens patients with financial and opportunity costs, and the potential for intensified stigma. To rigorously evaluate the effectiveness of DOT and identify the essential contributors to both successful treatment and minimized patient burden, we call for a pragmatic experimental trial conducted in real-world program settings, the gold standard for evidence-based health policy decisions. It is time to invest in the rigorous evaluation of DOT and reevaluate the DOT requirement for TB treatment worldwide. Rigorously evaluating the choice of treatment supporter, the frequency of health care worker contact and the development of new educational materials in a real-world setting would build the evidence base to inform the optimal design of TB treatment protocol. Implementing a

  20. Real-time Responsiveness for Ethics Oversight During Disaster Research.

    Science.gov (United States)

    Eckenwiler, Lisa; Pringle, John; Boulanger, Renaud; Hunt, Matthew

    2015-11-01

    Disaster research has grown in scope and frequency. Research in the wake of disasters and during humanitarian crises--particularly in resource-poor settings--is likely to raise profound and unique ethical challenges for local communities, crisis responders, researchers, and research ethics committees (RECs). Given the ethical challenges, many have questioned how best to provide research ethics review and oversight. We contribute to the conversation concerning how best to ensure appropriate ethical oversight in disaster research and argue that ethical disaster research requires of researchers and RECs a particular sort of ongoing, critical engagement which may not be warranted in less exceptional research. We present two cases that typify the concerns disaster researchers and RECs may confront, and elaborate upon what this ongoing engagement might look like--how it might be conceptualized and utilized--using the concept of real-time responsiveness (RTR). The central aim of RTR, understood here as both an ethical ideal and practice, is to lessen the potential for research conducted in the wake of disasters to create, perpetuate, or exacerbate vulnerabilities and contribute to injustices suffered by disaster-affected populations. Well cultivated and deployed, we believe that RTR may enhance the moral capacities of researchers and REC members, and RECs as institutions where moral agency is nurtured and sustained.

  1. Barriers to Effective Deliberation in Clinical Research Oversight.

    Science.gov (United States)

    Wenner, Danielle M

    2016-09-01

    Ethical oversight of clinical research is one of the primary means of ensuring that human subjects are protected from the natural bias of researchers and research institutions in favor of experimentation. At a minimum, effective oversight should ensure that risks are minimized and reasonable in relation to anticipated benefits, protect vulnerable subjects from potential coercion or undue influence, ensure full and informed consent, and promote the equitable distribution of the risks and benefits of research. Because these assessments often involve value judgments for which there are no agreed-upon objective standards, we rely on deliberative procedures thought to have the greatest likelihood of producing the right or best outcomes. Concerns about the potential for improperly functioning IRBs to waste scarce human and institutional resources and impede biomedical progress have motivated a surge in empirical research assessing their procedures and outcomes. Yet within this literature, there has been minimal attention paid to the social scientific evidence regarding how individuals and deliberating groups make decisions, nor how those data might inform IRB practice. This essay seeks to fill that gap, locating recent empirical data on IRB composition and process within the context of data regarding what I call "deliberative pathologies," or instances when deliberation fails to live up to one or more aspect of the deliberative ideal because of systematic biases in the ways participants interact. The paper goes on to make evidence-based recommendations to reduce the vulnerability of IRB deliberations to the kinds of pathologies discussed and indicate directions for future research.

  2. 32 CFR 2004.10 - Responsibilities of the Director, Information Security Oversight Office (ISOO) [102(b)]. 1

    Science.gov (United States)

    2010-07-01

    ... Security Oversight Office (ISOO) . 1 2004.10 Section 2004.10 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NATIONAL INDUSTRIAL SECURITY PROGRAM DIRECTIVE NO. 1 Implementation and Oversight § 2004.10...

  3. 75 FR 72816 - Public Input for the Study Regarding the Oversight of Existing and Prospective Carbon Markets

    Science.gov (United States)

    2010-11-26

    ... COMMISSION Public Input for the Study Regarding the Oversight of Existing and Prospective Carbon Markets... Commission (the ``CFTC''), to conduct a study on the oversight of existing and prospective carbon markets to... to study the oversight of existing and prospective carbon markets. The interagency group is composed...

  4. Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

    Science.gov (United States)

    Strand, Albert A.; Jackson, Darryl J.

    1992-01-01

    As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring

  5. Teamwork for Oversight of Processes and Systems (TOPS). Implementation guide for TOPS version 2.0, 10 August 1992

    Science.gov (United States)

    Strand, Albert A.; Jackson, Darryl J.

    As the nation redefines priorities to deal with a rapidly changing world order, both government and industry require new approaches for oversight of management systems, particularly for high technology products. Declining defense budgets will lead to significant reductions in government contract management personnel. Concurrently, defense contractors are reducing administrative and overhead staffing to control costs. These combined pressures require bold approaches for the oversight of management systems. In the Spring of 1991, the DPRO and TRW created a Process Action Team (PAT) to jointly prepare a Performance Based Management (PBM) system titled Teamwork for Oversight of Processes and Systems (TOPS). The primary goal is implementation of a performance based management system based on objective data to review critical TRW processes with an emphasis on continuous improvement. The processes are: Finance and Business Systems, Engineering and Manufacturing Systems, Quality Assurance, and Software Systems. The team established a number of goals: delivery of quality products to contractual terms and conditions; ensure that TRW management systems meet government guidance and good business practices; use of objective data to measure critical processes; elimination of wasteful/duplicative reviews and audits; emphasis on teamwork--all efforts must be perceived to add value by both sides and decisions are made by consensus; and synergy and the creation of a strong working trust between TRW and the DPRO. TOPS permits the adjustment of oversight resources when conditions change or when TRW systems performance indicate either an increase or decrease in surveillance is appropriate. Monthly Contractor Performance Assessments (CPA) are derived from a summary of supporting system level and process-level ratings obtained from objective process-level data. Tiered, objective, data-driven metrics are highly successful in achieving a cooperative and effective method of measuring

  6. Regulatory oversight of nuclear safety in Finland. Annual report 2011

    Energy Technology Data Exchange (ETDEWEB)

    Kainulainen, E. (ed.)

    2012-07-01

    The report constitutes the report on regulatory control in the field of nuclear energy which the Radiation and Nuclear Safety Authority (STUK) is required to submit once a year to the Ministry of Employment and the Economy pursuant to Section 121 of the Nuclear Energy Decree. The report is also delivered to the Ministry of Environment, the Finnish Environment Institute, and the regional environmental authorities of the localities in which a nuclear facility is located. The regulatory control of nuclear safety in 2011 included the design, construction and operation of nuclear facilities, as well as nuclear waste management and nuclear materials. The first parts of the report explain the basics of nuclear safety regulation included as part of STUK's responsibilities, as well as the objectives of the operations, and briefly introduce the objects of regulation. The chapter concerning the development and implementation of legislation and regulations describes changes in nuclear legislation, as well as the progress of STUK's YVL Guide revision work. The section concerning the regulation of nuclear facilities contains an overall safety assessment of the nuclear facilities currently in operation or under construction. The chapter concerning the regulation of the final disposal project for spent nuclear fuel de-scribes the preparations for the final disposal project and the related regulatory activities. The section concerning nuclear non-proliferation describes the nuclear non-proliferation control for Finnish nuclear facilities and final disposal of spent nuclear fuel, as well as measures required by the Additional Protocol of the Safeguards Agreement. The chapter describing the oversight of security arrangements in the use of nuclear energy discusses oversight of the security arrangements in nuclear power plants and other plants, institutions and functions included within the scope of STUK's regulatory oversight. The chapter also discusses the national and

  7. External Police Oversight in Mexico: Experiences, Challenges, and Lessons Learned

    Directory of Open Access Journals (Sweden)

    Rubén Guzmán Sánchez

    2014-11-01

    Full Text Available After nearly 20 years of ‘reformist’ measures, the police in Mexico continues to be an ineffective, unreliable, and ‘far from citizen’ institution. The efforts made so far have faded amongst political interests and agendas; multidimensional frameworks out-dated at both conceptual and interagency levels; short-sighted competition for resources; evaluation and performance monitors that are handicapped by bureaucratic inaction; and weak transparency and accountability that perpetuate the opacity in which the police operate. In this context, the agenda of external police oversight is still at a rudimentary stage. However, there are several initiatives that have managed to push the issue to the frontier of new knowledge and promising practices. This paper outlines the experiences and challenges of—as well as the lessons learned by—the Institute for Security and Democracy (Insyde A.C., one of the most recognised think tanks in Mexico.

  8. Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

    Science.gov (United States)

    Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

    2016-07-18

    Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

  9. An LCA researcher's wish list--data and emission models needed to improve LCA studies of animal production.

    Science.gov (United States)

    Cederberg, C; Henriksson, M; Berglund, M

    2013-06-01

    The last decade has seen an increase in environmental systems analysis of livestock production, resulting in a significant number of studies with a holistic approach often based on life-cycle assessment (LCA) methodology. The growing public interest in global warming has added to this development; guidelines for carbon footprint (CF) accounting have been developed, including for greenhouse gas (GHG) accounting of animal products. Here we give an overview of methods for estimating GHG emissions, with emphasis on nitrous oxide, methane and carbon from land use change, presently used in LCA/CF studies of animal products. We discuss where methods and data availability for GHGs and nitrogen (N) compounds most urgently need to be improved in order to produce more accurate environmental assessments of livestock production. We conclude that the top priority is to improve models for N fluxes and emissions from soils and to implement soil carbon change models in LCA/CF studies of animal products. We also point at the need for more farm data and studies measuring emissions from soils, manure and livestock in developing countries.

  10. Review of nuclear data improvement needs for nuclear radiation measurement techniques used at the CEA experimental reactor facilities

    Science.gov (United States)

    Destouches, Christophe

    2016-03-01

    The constant improvement of the neutron and gamma calculation codes used in experimental nuclear reactors goes hand in hand with that of the associated nuclear data libraries. The validation of these calculation schemes always requires the confrontation with integral experiments performed in experimental reactors to be completed. Nuclear data of interest, straight as cross sections, or elaborated ones such as reactivity, are always derived from a reaction rate measurement which is the only measurable parameter in a nuclear sensor. So, in order to derive physical parameters from the electric signal of the sensor, one needs specific nuclear data libraries. This paper presents successively the main features of the measurement techniques used in the CEA experimental reactor facilities for the on-line and offline neutron/gamma flux characterizations: reactor dosimetry, neutron flux measurements with miniature fission chambers and Self Power Neutron Detector (SPND) and gamma flux measurements with chamber ionization and TLD. For each technique, the nuclear data necessary for their interpretation will be presented, the main identified needs for improvement identified and an analysis of their impact on the quality of the measurement. Finally, a synthesis of the study will be done.

  11. Review of nuclear data improvement needs for nuclear radiation measurement techniques used at the CEA experimental reactor facilities

    Directory of Open Access Journals (Sweden)

    Destouches Christophe

    2016-01-01

    Full Text Available The constant improvement of the neutron and gamma calculation codes used in experimental nuclear reactors goes hand in hand with that of the associated nuclear data libraries. The validation of these calculation schemes always requires the confrontation with integral experiments performed in experimental reactors to be completed. Nuclear data of interest, straight as cross sections, or elaborated ones such as reactivity, are always derived from a reaction rate measurement which is the only measurable parameter in a nuclear sensor. So, in order to derive physical parameters from the electric signal of the sensor, one needs specific nuclear data libraries. This paper presents successively the main features of the measurement techniques used in the CEA experimental reactor facilities for the on-line and offline neutron/gamma flux characterizations: reactor dosimetry, neutron flux measurements with miniature fission chambers and Self Power Neutron Detector (SPND and gamma flux measurements with chamber ionization and TLD. For each technique, the nuclear data necessary for their interpretation will be presented, the main identified needs for improvement identified and an analysis of their impact on the quality of the measurement. Finally, a synthesis of the study will be done.

  12. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

    Directory of Open Access Journals (Sweden)

    Backenstrass Matthias

    2006-06-01

    Full Text Available Abstract Background Osteoarthritis (OA is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. Methods We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. Results Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. Conclusion GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed.

  13. Regulatory Oversight Program, July 1, 1993--March 3, 1997. Volume 3

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    On July, 1993, a Regulatory Oversight (RO) organization was established within the US DOE, Oak Ridge Operations (ORO) to provide regulatory oversight of the DOE uranium enrichment facilities leased to the United States Enrichment Corporation (USEC). The purpose of the OR program was to ensure continued plant safety, safeguards and security while the plants were transitioned to regulatory oversight by the Nuclear Regulatory Commission (NRC). Volume 3 contains copies of two reports that document the DOE/ORO regulatory oversight inspection and enforcement history for each gaseous diffusion plant site. Each report provides a formal mechanism by which DOE/ORO could communicate the inspection and enforcement history to NRC. The reports encompass the inspection activities that occurred during July 1, 1993 through March 2, 1997.

  14. 77 FR 71803 - Guidance on Food and Drug Administration Oversight of Positron Emission Tomography Drug Products...

    Science.gov (United States)

    2012-12-04

    ... HUMAN SERVICES Food and Drug Administration Guidance on Food and Drug Administration Oversight of... Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the... surveillance processes, including application submission, review, compliance with good manufacturing...

  15. Telematics and nursing: does the German electronic Health Card improve patient care for persons with nursing needs?

    Directory of Open Access Journals (Sweden)

    Hübner, Ursula

    2006-02-01

    Full Text Available Current developments towards a German electronic Health Card raise the question whether the card is capable of improving care also for persons with special nursing needs including short-term as well as long-term care patients. The aging of the population - also in Germany - is coupled with an increase in the number of long-term care patients. They are patients who need medical as well as nursing care and who often need care provided by changing care settings (ambulatory care/home care vs. hospital during the course of their illness. Nursing Science has been recognizing the importance of an uninterrupted way of providing patient care (continuity of care as a central issue and has been developing concepts and instruments for case management and discharge management. Both approaches provide mechanisms proven under real life conditions for transferring patients safely from one to another setting. Although nursing telematics covers a wide range of topics, from semantic interoperability to telecare solutions, its primary applications, namely case management and discharge management, are only poorly supported by information and communication technology. It is therefore not surprising, that the electronic Health Card in Germany was planned without making any reference to case management and discharge management. Current concepts for the applications of the card simply ignore the scenario of transferring patients with special nursing needs between care settings. Though adjustments of the legal foundations of the electronic Health Card had been made recently, nurses will still not be able to exchange nursing summaries electronically by means of the card because nurses working in nursing homes and for ambulatory nursing services have no access rights for the data on the card. The full exploitation of the card and its potential for innovation does not only depend, however, on granting access rights to all nurses but also on issuing electronic Health

  16. Improving Care in Pediatric Neuro-oncology Patients: An Overview of the Unique Needs of Children With Brain Tumors.

    Science.gov (United States)

    Fischer, Cheryl; Petriccione, Mary; Donzelli, Maria; Pottenger, Elaine

    2016-03-01

    Brain tumors represent the most common solid tumors in childhood, accounting for almost 25% of all childhood cancer, second only to leukemia. Pediatric central nervous system tumors encompass a wide variety of diagnoses, from benign to malignant. Any brain tumor can be associated with significant morbidity, even when low grade, and mortality from pediatric central nervous system tumors is disproportionately high compared to other childhood malignancies. Management of children with central nervous system tumors requires knowledge of the unique aspects of care associated with this particular patient population, beyond general oncology care. Pediatric brain tumor patients have unique needs during treatment, as cancer survivors, and at end of life. A multidisciplinary team approach, including advanced practice nurses with a specialty in neuro-oncology, allows for better supportive care. Knowledge of the unique aspects of care for children with brain tumors, and the appropriate interventions required, allows for improved quality of life.

  17. Whistleblower Protection: DOD Needs to Enhance Oversight of Military Whistleblower Reprisal Investigations

    Science.gov (United States)

    2015-05-01

    training that is specific to conducting reprisal investigations when they are assigned to the IG, but there is no additional mandatory reprisal-specific...and Testimony Order by Phone Connect with GAO To Report Fraud, Waste, and Abuse in Federal Programs Congressional Relations Public Affairs Please Print on Recycled Paper.

  18. DOD Advertising: Better Coordination, Performance Measurement, and Oversight Needed to Help Meet Recruitment Goals

    Science.gov (United States)

    2016-05-01

    marketing mix modeling.10 Marketing mix modeling is a best practice employed by agencies to determine the most efficient and effective allocation...similar advertising functions that are not part of their unique branding, such as marketing mix modeling, they...Use sophisticated statistical modeling, such as marketing mix modeling,a to determine appropriate spending strategy Measurement • Conduct ongoing

  19. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight

    Science.gov (United States)

    2015-09-24

    17 counties. DGMC Uniform Business Office (UBO) uses MSAs to record billing and fee collection for medical and dental services from Uniformed...personnel processed new accounts, the process used by DGMC did not manage or prioritize the aging MSAs or alert clerks of delinquent accounts...have been applied to other valid requirements such as administrative, operating, and equipment costs; readiness training; or trauma consortium

  20. Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management Oversight

    Science.gov (United States)

    2014-08-13

    project focused on capture of the DD Form 2569 within BAMC to assist the working group. Also, according to the Chief of Staff, a Lean Six Sigma ... six claims were valued at $3.1 million. BAMC UBO management noted that SAMMC is not a registered TMHP provider, and these patients had to receive... six denied claims, only two account files contained evidence that BAMC personnel sent a letter to TMHP officials disputing the denial; however, each

  1. ["What you will": Results of an Empirical Analysis of the Need to Improve Work-life Balance for Physicians].

    Science.gov (United States)

    Jerg-Bretzke, L; Krüsmann, P; Traue, H C; Limbrecht-Ecklundt, K

    2016-02-15

    Study Aims: This study assessed the perceived need for clinics to improve work-life balance of physicians. Hospitals are increasingly facing demands to offer physicians working conditions that allow greater balance between family life and pursuit of career. Simultaneously, hospitals could consider this an opportunity to stand out as attractive employers. Methods: N=120 doctors of the medical faculty and N=679 medical students in their premedical and clinical training participated online. Results: The results of the Work-Family/Family-Work Conflict Scale (WFC/FWC) showed physicians to have a decreased work/life balance when starting to work professionally, especially with a child. Ninety percent of the respondents considered the following arrangements to be especially helpful: temporary work interruptions in an emergency, part-time positions or emergency childcare. The doctors also expressed their wish to be actively supported by their supervisors on the topic of work/life balance. Conclusion: This analysis on work-family balance shows the need for change in the studied samples. Based on the measures that were determined to be helpful, hospitals can make conclusions about what concrete steps of action can be taken. Additionally, WFC/FWC could be used as a standardized analysis measure to assess the load imposed on physicians by family on work place and vice versa.

  2. Creating a learning organization in law enforcement: Maturity levels for police oversight agencies

    OpenAIRE

    Filstad, Cathrine; Gottschalk, Petter

    2010-01-01

    Purpose – The purpose of this paper is to conceptualize a stage model for maturity levels for police oversight agencies. Design/methodology/approach – The paper is based on a literature review covering police oversight organizations and stages of growth models. Findings – As a conceptual paper, the main findings are related to the appropriateness of the stage model, each identified stage, and the characteristics of each stage. Research limitations/implications – An empirical...

  3. The Fukushima nuclear crisis reemphasizes the need for improved risk communication and better use of social media.

    Science.gov (United States)

    Ng, Kwan-Hoong; Lean, Mei-Li

    2012-09-01

    The potential of social media has expanded far beyond the initial function of social communication among a network of friends. It has become an increasingly important tool in risk communication to allow the dissemination of timely and accurate information to global citizens to make more informed choices regarding a particular crisis. The Fukushima nuclear crisis is an example where the potential of social media was not fully tapped. This caused undue stress and distrust of authorities. While the use of social media in this crisis could have altered significantly the level of trust in authorities and others, two additional points should be considered. One point is the use of plain language versus scientific language in order to reach a wider audience. The other is an urgent need to improve public information especially in the event of a nuclear emergency and to enhance educational efforts and action by improving radiological protection communication from regulatory bodies and international agencies. These are points that also play a large role in the use of social media.

  4. Commentary: Urgently needed: a safe place for self-assessment on the path to maintaining competence and improving performance.

    Science.gov (United States)

    Bellande, Bruce J; Winicur, Zev M; Cox, Kathleen M

    2010-01-01

    Traditional continuing medical education (CME), necessary for keeping physicians current and competent, is insufficient in translating physician practice into better patient outcomes. CME, then, must be transformed from a system of episodic interventions to a more personalized, contextual, flexible, and targeted process within a continuing professional development framework. The core of this transformation must be a formal process of physician self-assessment. Unfortunately, health care providers tend toward inaccurate self-assessment, regardless of training, specialty, or manner of self-assessment. Therefore, the development of an external validation system conducted by credible, informal peer review in a safe environment is essential. Clinicians must be able to access practice and patient data without concerns about accuracy, timeliness, confidentiality, attribution, or unintended consequences. New analytical tools are also needed to illuminate the data compilations and present them in compelling, individualized, and comparative formats. However, such developmental work will not be possible without strong community leadership coordinating a collaboration of resources and a sharing of data. Ensuring physician competence has long been an issue for medical societies, state licensing boards, and others invested in improving patient care. Now it's time to get serious. Current efforts at massive health care reform provide the perfect opportunity to fully integrate physician self-assessment and performance improvement into the larger health care system through a continuing professional development model. Practitioners in CME have been far too complacent with the current practices. A shift to a focused and dedicated sense of urgency must occur to ensure physicians' continuous learning and change.

  5. From cradle-to-grave at the nanoscale: gaps in U.S. regulatory oversight along the nanomaterial life cycle.

    Science.gov (United States)

    Beaudrie, Christian E H; Kandlikar, Milind; Satterfield, Terre

    2013-06-04

    Engineered nanomaterials (ENMs) promise great benefits for society, yet our knowledge of potential risks and best practices for regulation are still in their infancy. Toward the end of better practices, this paper analyzes U.S. federal environmental, health, and safety (EHS) regulations using a life cycle framework. It evaluates their adequacy as applied to ENMs to identify gaps through which emerging nanomaterials may escape regulation from initial production to end-of-life. High scientific uncertainty, a lack of EHS and product data, inappropriately designed exemptions and thresholds, and limited agency resources are a challenge to both the applicability and adequacy of current regulations. The result is that some forms of engineered nanomaterials may escape federal oversight and rigorous risk review at one or more stages along their life cycle, with the largest gaps occurring at the postmarket stages, and at points of ENM release to the environment. Oversight can be improved through pending regulatory reforms, increased research and development for the monitoring, control, and analysis of environmental and end-of-life releases, introduction of periodic re-evaluation of ENM risks, and fostering a "bottom-up" stewardship approach to the responsible management of risks from engineered nanomaterials.

  6. Malnutrition in older adults - urgent need for action: a plea for improving the nutritional situation of older adults.

    Science.gov (United States)

    Volkert, Dorothee

    2013-01-01

    During the past decades, malnutrition has attracted increasing scientific attention and is by now regarded as a true geriatric syndrome characterized by multifactorial causality, identified by symptoms and accompanied by frailty, disability and poor outcome. This viewpoint summarizes our present knowledge and the usual current handling of malnutrition in older people and highlights the urgent need for action in this field. Age-related changes in the complex system of appetite regulation, resulting in the so-called anorexia of aging, predispose older adults to a decrease in food intake which may lead to malnutrition, if additional risk factors like health or social problems occur. Consequently, malnutrition is widespread in the older population, notably in those who are institutionalized. Despite the fact that effective interventions are available, prevention and treatment of malnutrition do not currently receive appropriate attention. As an important first step towards better awareness, screening for malnutrition should become a mandatory integral part of the comprehensive geriatric assessment. Furthermore, practical local guidelines should be implemented in all geriatric hospital wards and nursing homes in order to improve nutritional care in the daily routine. Important to note is that reasonable nutritional management is not possible without qualified staff in adequate numbers allowing appropriate individual nutritional care. Regarding future research, studies at the cellular, metabolic and clinical levels and the linking of information from different research approaches are required to better understand the transition from good nutritional health and independence of old people to malnutrition, functional impairment and poor health. In parallel to well-designed observational and intervention studies, standardized documentation of nutritional information in daily routine would enable the uniform collection of data for research as well as for political decisions

  7. Progress in Space Weather Modeling and Observations Needed to Improve the Operational NAIRAS Model Aircraft Radiation Exposure Predictions

    Science.gov (United States)

    Mertens, C. J.; Kress, B. T.; Wiltberger, M. J.; Tobiska, W.; Xu, X.

    2011-12-01

    The Nowcast of Atmospheric Ionizing Radiation for Aviation Safety (NAIRAS) is a prototype operational model for predicting commercial aircraft radiation exposure from galactic and solar cosmic rays. NAIRAS predictions are currently streaming live from the project's public website, and the exposure rate nowcast is also available on the SpaceWx smartphone app for iPhone, IPad, and Android. Cosmic rays are the primary source of human exposure to high linear energy transfer radiation at aircraft altitudes, which increases the risk of cancer and other adverse health effects. Thus, the NAIRAS model addresses an important national need with broad societal, public health and economic benefits. The processes responsible for the variability in the solar wind, interplanetary magnetic field, solar energetic particle spectrum, and the dynamical response of the magnetosphere to these space environment inputs, strongly influence the composition and energy distribution of the atmospheric ionizing radiation field. During the development of the NAIRAS model, new science questions were identified that must be addressed in order to obtain a more reliable and robust operational model of atmospheric radiation exposure. Addressing these science questions require improvements in both space weather modeling and observations. The focus of this talk is to present these science questions, the proposed methodologies for addressing these science questions, and the anticipated improvements to the operational predictions of atmospheric radiation exposure. The overarching goal of this work is to provide a decision support tool for the aviation industry that will enable an optimal balance to be achieved between minimizing health risks to passengers and aircrew while simultaneously minimizing costs to the airline companies.

  8. Experience with Regulatory Strategies in Nuclear Power Oversight. Part 1: An International Exploratory Study. Part 2: Workshop Discussions and Conclusions

    Energy Technology Data Exchange (ETDEWEB)

    Melber, Barbara [Melber Consulting, Seattle, WA (United States); Durbin, Nancy E. [Nancy E. Durbin Consulting, Kirkland, WA (United States); Tael, Irene (ed.) [Swedish Nuclear Power Inspectorate, Stockholm (Sweden)

    2005-03-01

    and a strategy that had serious methodological and data problems. A process based strategy had a major benefit of providing in depth understanding of a licensee's performance. The main difficulties were that it was not considered effective unless the processes were linked to outcomes, and that it was complex to define and evaluate processes. The major benefit of a self assessment strategy was that it put responsibility for safety on the licensee, while the major difficulties were that it should not be used as a stand alone strategy and that it often does not have credibility with the general public. A few of the main findings regarding the experiences of using regulatory strategies for the areas of plant design and modifications, quality systems and training and qualifications included: Use of combinations of at least two, often three and at times four different strategies for specific examples of oversight issues; Less reliance on a prescriptive strategy in recent years, often moving toward more use of a process-based strategy, but return to a prescriptive strategy for action and closure when necessary; Use of a risk strategy to prioritize safety issues, activities and regulatory findings for oversight of both quality systems and plant design and modifications; Disagreements over the incorporation of a risk strategy into regulatory decision-making for plant design and modifications and attempts to balance the use of a combination of risk and prescriptive strategies for this area of oversight. Regulatory strategies were viewed as affecting: Whether the licensee or regulator takes primary responsibility for safety; How clear requirements and expectations are to licensees; Significance of safety issues identified; Expertise needed by regulators and licensees; Resources used by regulators and licensees; Flexibility given to licensees; Public credibility. Issues that emerged from examples regarding regulatory strategies: Resistance to changing regulatory strategies

  9. Experience with Regulatory Strategies in Nuclear Power Oversight. Part 1: An International Exploratory Study. Part 2: Workshop Discussions and Conclusions

    Energy Technology Data Exchange (ETDEWEB)

    Melber, Barbara [Melber Consulting, Seattle, WA (United States); Durbin, Nancy E. [Nancy E. Durbin Consulting, Kirkland, WA (United States); Tael, Irene (ed.) [Swedish Nuclear Power Inspectorate, Stockholm (Sweden)

    2005-03-01

    and a strategy that had serious methodological and data problems. A process based strategy had a major benefit of providing in depth understanding of a licensee's performance. The main difficulties were that it was not considered effective unless the processes were linked to outcomes, and that it was complex to define and evaluate processes. The major benefit of a self assessment strategy was that it put responsibility for safety on the licensee, while the major difficulties were that it should not be used as a stand alone strategy and that it often does not have credibility with the general public. A few of the main findings regarding the experiences of using regulatory strategies for the areas of plant design and modifications, quality systems and training and qualifications included: Use of combinations of at least two, often three and at times four different strategies for specific examples of oversight issues; Less reliance on a prescriptive strategy in recent years, often moving toward more use of a process-based strategy, but return to a prescriptive strategy for action and closure when necessary; Use of a risk strategy to prioritize safety issues, activities and regulatory findings for oversight of both quality systems and plant design and modifications; Disagreements over the incorporation of a risk strategy into regulatory decision-making for plant design and modifications and attempts to balance the use of a combination of risk and prescriptive strategies for this area of oversight. Regulatory strategies were viewed as affecting: Whether the licensee or regulator takes primary responsibility for safety; How clear requirements and expectations are to licensees; Significance of safety issues identified; Expertise needed by regulators and licensees; Resources used by regulators and licensees; Flexibility given to licensees; Public credibility. Issues that emerged from examples regarding regulatory strategies: Resistance to changing regulatory strategies

  10. Randomized Nutrition Education Intervention to Improve Carbohydrate Counting in Adolescents with Type 1 Diabetes Study: Is More Intensive Education Needed?

    Science.gov (United States)

    Spiegel, Gail; Bortsov, Andrey; Bishop, Franziska K.; Owen, Darcy; Klingensmith, Georgeanna J.; Mayer-Davis, Elizabeth J.; Maahs, David M.

    2012-01-01

    Background and Objectives Youth with type 1 diabetes do not count carbohydrates (CHOs) accurately, yet it is an important strategy in blood glucose control. The study objective was to determine whether a nutrition education intervention would improve CHO counting accuracy and glycemic control. Design Randomized, controlled, nutrition intervention trial recruited February 2009 to February 2010. Participants and Methods Youth (12-18 years, n=101) with type 1 diabetes were screened to identify those with poor CHO counting accuracy, using a previously developed CHO counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n=66, age=15 ± 3 yrs, 41 male, diabetes duration=6 ± 4 yrs, HbA1c=8.3 ± 1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90 minute class with a RD/CDE and twice kept three-day food records, which were used to review CHO counting progress. Main Outcome Measures CHO counting accuracy (measured as described above) and HbA1c were evaluated at baseline and three months to determine the effectiveness of the intervention. Statistical Analyses T-tests, Spearman correlations, and repeated measures models were used. Results At baseline, CHO content was over and underestimated in 16 and five of 29 food items, respectively. When foods were presented as mixed meals, participants either significantly over or underestimated 10 of the nine meals and four snacks. After three months of follow-up, HbA1c decreased in both the intervention and control groups by −0.19 ± 0.12% (p=0.12) and −0.08 ± 0.11% (p=0.51) respectively; however, the overall intervention effect was not statistically significant for change in HbA1c or CHO counting accuracy. Conclusions More intensive intervention may be required to improve adolescents’ CHO counting accuracy and nutrition management of type 1 diabetes. Further research is needed to

  11. Problems and Difficulties Encountered and Training Needs of College Students: Basis for Improving Guidance and Counseling Services

    Directory of Open Access Journals (Sweden)

    Aprilyn B. Dimalaluan

    2017-02-01

    Full Text Available Finishing college education nowadays is very challenging. These challenges come in the form of problems and difficulties that students need to overcome in order for them to finish college. Identifying these problems provides information on improving the student guidance and counseling services of the school. It helps students handle the challenges of academic life, thus giving them a better chance to survive and finish college. This study was conducted for the purpose of determining the problems and difficulties encountered by college students. This study was conducted at WPU-Quezon Campus, and a total of 300 students - enrolled during the first semester of SY 2015-2016 - were considered as respondents of the study. Descriptive statistics were employed in describing the data gathered, such as frequency counts, averages, rankings, and percentages. The data revealed that most of the problems encountered were personal related problems such as: time management, unexplainable fear of failure in exams, lack of self-confidence, poor study habits, nervousness, and lack of self-control. It was also noted that the majority of students did not seek guidance and counselling from a school counselor, instead they tried to solve their own problems. This study recommends that the student guidance and counseling services of the school should provide intervention activities, such as seminars, training, workshops, retreat and symposia, which will empower students in handling their problems.

  12. Further effort is needed to improve management of chronic pain in primary care. Results from the Arkys project

    Directory of Open Access Journals (Sweden)

    Gaetano Piccinocchi

    2016-06-01

    Full Text Available Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years had mostly chronic non-cancer pain (87.7%. In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%. Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%. NSAID prescription decreased (12.8%, while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.

  13. Recommendations for nanomedicine human subjects research oversight: an evolutionary approach for an emerging field.

    Science.gov (United States)

    Fatehi, Leili; Wolf, Susan M; McCullough, Jeffrey; Hall, Ralph; Lawrenz, Frances; Kahn, Jeffrey P; Jones, Cortney; Campbell, Stephen A; Dresser, Rebecca S; Erdman, Arthur G; Haynes, Christy L; Hoerr, Robert A; Hogle, Linda F; Keane, Moira A; Khushf, George; King, Nancy M P; Kokkoli, Efrosini; Marchant, Gary; Maynard, Andrew D; Philbert, Martin; Ramachandran, Gurumurthy; Siegel, Ronald A; Wickline, Samuel

    2012-01-01

    The nanomedicine field is fast evolving toward complex, "active," and interactive formulations. Like many emerging technologies, nanomedicine raises questions of how human subjects research (HSR) should be conducted and the adequacy of current oversight, as well as how to integrate concerns over occupational, bystander, and environmental exposures. The history of oversight for HSR investigating emerging technologies is a patchwork quilt without systematic justification of when ordinary oversight for HSR is enough versus when added oversight is warranted. Nanomedicine HSR provides an occasion to think systematically about appropriate oversight, especially early in the evolution of a technology, when hazard and risk information may remain incomplete. This paper presents the consensus recommendations of a multidisciplinary, NIH-funded project group, to ensure a science-based and ethically informed approach to HSR issues in nanomedicine, and to integrate HSR analysis with analysis of occupational, bystander, and environmental concerns. We recommend creating two bodies, an interagency Human Subjects Research in Nanomedicine (HSR/N) Working Group and a Secretary's Advisory Committee on Nanomedicine (SAC/N). HSR/N and SAC/N should perform 3 primary functions: (1) analysis of the attributes and subsets of nanomedicine interventions that raise HSR challenges and current gaps in oversight; (2) providing advice to relevant agencies and institutional bodies on the HSR issues, as well as federal and federal-institutional coordination; and (3) gathering and analyzing information on HSR issues as they emerge in nanomedicine. HSR/N and SAC/N will create a home for HSR analysis and coordination in DHHS (the key agency for relevant HSR oversight), optimize federal and institutional approaches, and allow HSR review to evolve with greater knowledge about nanomedicine interventions and greater clarity about attributes of concern.

  14. Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health

    Directory of Open Access Journals (Sweden)

    Doherty Tanya

    2012-07-01

    .8. Conclusion Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.

  15. Nurse practitioner perceptions of the impact of physician oversight on quality and safety of nurse practitioner practice.

    Science.gov (United States)

    Lowery, Bobby; Scott, Elaine; Swanson, Mel

    2016-08-01

    Nurse practitioner (NP) regulation and physician oversight (PO) of NP practice are inextricably intertwined. A flexible, well-prepared workforce is needed to meet consumer healthcare needs. All outcome studies have revealed that NPs provide safe, effective, quality care with outcomes equal to or better than that of physicians or physician assistants. Variability in state regulation of NP practice limits the full deployment of these proven healthcare providers, threatens the quality and safety of NP-delivered care, and limits consumer choice in healthcare access. The purpose of this study was to document NP perceptions of the impact of PO on the safety and quality of NP practice. A total of 1139 NP respondents completed an exploratory survey, Impact of Regulatory Requirements for Physician Oversight on Nurse Practitioner Practice. Participants were asked their perceptions of the impact of PO on patient care and NP practice. Descriptive statistics on the state of residence regulatory requirements and personal demographics were also collected. NP perceptions of the impact of PO on the safety and quality of NP practice were predicted by NP experience and state regulatory environment ranking. The results of this study have implications for educators, policy makers, and nursing advocacy groups seeking to increase access to care in U.S. Study participants perceived that requirements for PO impacted their practice and may jeopardize patient safety. An understanding of the impact of influences on regulatory processes is critical to ensuring full deployment of NPs as interprofessional leaders to meet current and future healthcare access. ©2015 American Association of Nurse Practitioners.

  16. Nursing and justice as a basic human need.

    Science.gov (United States)

    Johnstone, Megan-Jane

    2011-01-01

    This paper explores the idea that justice is a basic human need akin to those famously depicted in Maslow's hierarchy of human needs and, as such, warrants recognition as a core element in representative ideas about nursing. Early nurse theorists positioned the principles and practice of nursing as having their origins in 'universal human needs'. The principle of deriving nursing care from human needs was thought to provide a guide not only for promoting health, but for preventing disease and illness. The nursing profession has had a longstanding commitment to social justice as a core professional value and ideal, obligating nurses to address the social conditions that undermine people's health. The idea of justice as a universal human need per se and its possible relationship to people's health outcomes has, however, not been considered. One reason for this is that justice in nursing discourse has more commonly been associated with law and ethics, and the legal and ethical responsibilities of nurses in relation to individualized patient care and, more recently, changing systems of care to improve health and health outcomes. Although this association is not incorrect, it is incomplete. A key aim of this paper is to redress this oversight and to encourage a broader conceptualization of justice as necessary for human survival, health and development, not merely as a professional value, or legal or ethical principle for guiding human conduct. © 2010 Blackwell Publishing Ltd.

  17. Self-assessment/continuous improvement: Opportunity or burden?

    Energy Technology Data Exchange (ETDEWEB)

    Ryder, D.E.

    1993-02-01

    Quality assurance is defined in US Department of Energy (DOE) Order 5700.6C as ``actions that provide confidence that quality is achieved.`` Confidence is the key word in this definition. Because of a lackof confidence, Congress has mandated improved performance by DOE and its contractors. DOE Headquarters has responded, in part, by requiring increased oversight of all affected organizations. Self-assessment/continuous improvement (SA/CI) is presented in this paper as a ten-step process to help restore confidence. The SA/CI process begins when you identify your customers. SA/CI then leads to determining customer requirements and establishing performance objectives and criteria against which current processes and performance are evaluated. SA/CI should be performed by managers and supervisors at all levels and should includedirect observation of work in progress in addition to analysis of performance data. Traditional independent assessment processes such as audits and surveillances can be used to provide valuable information for performing the evaluation. SA/CI is an aggressive ``no-fault`` self-assessment process coupled with a continuous improvement process that yields truly cost-effective corrective action and a high level of confidence that process and product quality objectives have been met. This approach should provide customers the evidence needed to increase their confidence in the organization`s activities. The end result should bean improvement in the quality of work life for the organization`s employees and a significant reduction in external oversight (i.e., audits).

  18. Joint Information Environment: DOD Needs to Strengthen Governance and Management

    Science.gov (United States)

    2016-07-01

    capabilities between the existing staff and future workforce needs, including consideration of evolving program and succession needs caused by turnover and...succession needs caused by turnover and retirement ○ The department has yet to analyze the gaps in capabilities between the existing staff and...effectively established scope, cost , and implementation plans for the initiative and (2) determine the extent to which DOD is executing effective oversight

  19. 42 CFR 137.368 - Is the Secretary responsible for oversight and compliance of health and safety codes during...

    Science.gov (United States)

    2010-10-01

    ... SELF-GOVERNANCE Construction Roles of the Secretary in Establishing and Implementing Construction Project Agreements § 137.368 Is the Secretary responsible for oversight and compliance of health and... 42 Public Health 1 2010-10-01 2010-10-01 false Is the Secretary responsible for oversight and...

  20. Defense Space Acquisitions: Too Early to Determine if Recent Changes Will Resolve Persistent Fragmentation in Management and Oversight

    Science.gov (United States)

    2016-07-27

    Unified leadership and authority, Planning) 12. Change Air Force and intelligence community (IC) human resource management policies for space...Space Acquisitions: Too Early to Determine If Recent Changes Will Resolve Persistent Fragmentation in Management and Oversight The Department of...over two decades that fragmentation and overlap in DOD space acquisition management and oversight have contributed to program delays and cancellations

  1. Identification and assessment of the need to improve the operation of production systems in the metal sector enterprises

    Directory of Open Access Journals (Sweden)

    M. Górska

    2017-01-01

    Full Text Available In this paper an attempt was made to identify the areas of metal products manufacturing processes that require improvement. Determination of such areas may become a source of a lot of valuable information for the enterprise, enabling the development of its improvement directions. The results of survey allowed also to define a model of implementation importance for tasks contributing to the metal sector enterprises improvement.

  2. Evaluating oversight of human drugs and medical devices: a case study of the FDA and implications for nanobiotechnology.

    Science.gov (United States)

    Paradise, Jordan; Tisdale, Alison W; Hall, Ralph F; Kokkoli, Efrosini

    2009-01-01

    This article evaluates the oversight of drugs and medical devices by the U.S. Food and Drug Administration (FDA) using an integration of public policy, law, and bioethics approaches and employing multiple assessment criteria, including economic, social, safety, and technological. Criteria assessment and expert elicitation are combined with existing literature, case law, and regulations in an integrative historical case studies approach. We then use our findings as a tool to explore possibilities for effective oversight and regulatory mechanisms for nanobiotechnology. Section I describes oversight mechanisms for human drugs and medical devices and presents current nanotechnology products. Section II describes the results of expert elicitation research. Section III highlights key criteria and relates them to the literature and larger debate. We conclude with broad lessons for the oversight of nanobiotechnology informed by Sections I-III in order to provide useful analysis from multiple disciplines and perspectives to guide discussions regarding appropriate FDA oversight.

  3. A review on effectiveness of best management practices in improving hydrology and water quality: Needs and opportunities.

    Science.gov (United States)

    Liu, Yaoze; Engel, Bernard A; Flanagan, Dennis C; Gitau, Margaret W; McMillan, Sara K; Chaubey, Indrajeet

    2017-12-01

    Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effectiveness through time. In this paper, we review the current knowledge about BMP efficiencies, which indicates that most empirical studies have focused on short-term efficiencies, while few have explored long-term efficiencies. Most simulation efforts that consider BMPs assume constant performance irrespective of ages of the practices, generally based on anticipated maintenance activities or the expected performance over the life of the BMP(s). However, efficiencies of BMPs likely change over time irrespective of maintenance due to factors such as degradation of structures and accumulation of pollutants. Generally, the impacts of BMPs implemented in water quality protection programs at watershed levels have not been as rapid or large as expected, possibly due to overly high expectations for practice long-term efficiency, with BMPs even being sources of pollutants under some conditions and during some time periods. The review of available datasets reveals that current data are limited regarding both short-term and long-term BMP efficiency. Based on this review, this paper provides suggestions regarding needs and opportunities. Existing practice efficiency data need to be compiled. New data on BMP efficiencies that consider important factors, such as maintenance activities, also need to be collected. Then, the existing and new data need to be analyzed. Further research is needed to create a framework, as well as modeling approaches built on the framework, to simulate changes in BMP efficiencies with time. The research community needs to work together in addressing these needs and opportunities, which will assist decision makers in formulating better decisions regarding BMP

  4. Influenza epidemiology in Italy two years after the 2009-2010 pandemic: need to improve vaccination coverage.

    Science.gov (United States)

    Gasparini, Roberto; Bonanni, Paolo; Amicizia, Daniela; Bella, Antonino; Donatelli, Isabella; Cristina, Maria Luisa; Panatto, Donatella; Lai, Piero Luigi

    2013-03-01

    , never exceeding 20% of the Italian population. Among the elderly, coverage rates grew from 40% in 1999 to almost 70% in 2005-2006, but subsequently decreased, in spite of the pandemic; this trend reveals a slight, though constant, decline in compliance with vaccination. Our data confirm that 2009 pandemics had had a spread particularly important in infants and schoolchildren, and this fact supports the strategy to vaccinate schoolchildren at least until 14 y of age. Furthermore, the low levels of vaccination coverage in Italy reveal the need to improve the catch-up of at-risk subjects during annual influenza vaccination campaigns, and, if possible, to extend free vaccination to at least all 50-64-y-old subjects. Virologic and epidemiological surveillance remains critical for detection of evolving influenza viruses and to monitor the health and economic burden in all age class annually.

  5. Effects of proactive population-based nephrologist oversight on progression of chronic kidney disease: a retrospective control analysis

    Directory of Open Access Journals (Sweden)

    Lee Brian

    2012-08-01

    Full Text Available Abstract Background Benefits of early nephrology care are well-established, but as many as 40% of U.S. patients with end-stage renal disease (ESRD do not see a nephrologist before its onset. Our objective was to evaluate the effect of proactive, population-based nephrologist oversight (PPNO on chronic kidney disease (CKD progression. Methods Retrospective control analysis of Kaiser Permanente Hawaii members with CKD using propensity score matching methods. We matched 2,938 control and case pairs of individuals with stage 3a CKD for the pre-PPNO period (2001–2004 and post-PPNO period (2005–2008 that were similar in other characteristics: age, gender, and the presence of diabetes and hypertension. After three years, we classified the stage outcomes for all individuals. We assessed the PPNO effect across all stages of progression with a χ2- test. We used the z-score test to assess the proportional differences in progression within a stage. Results The progression within the post-PPNO period was less severe and significantly different from the pre-PPNO period (p = 0.027. Within the stages, there were 2.6% more individuals remaining in 3a in the post-period (95% confidence interval [CI], 1.5% to 3.8%; P value P value = 0.0017, 3a to 4/5 was 0.2% less (95% CI, 0.0% to 0.87%; P value = 0.26, and 3a to ESRD was 0.24% less (95% CI, 0.0% to 0.66%, P value = 0.10. Conclusions Proactive, population-based nephrologist oversight was associated with a statistically significant decrease in progression. With enabling health information technology, risk stratification and targeted intervention by collaborative primary and specialty care achieves population-level care improvements. This model may be applicable to other chronic conditions.

  6. Non-adherence in children with asthma reviewed : The need for improvement of asthma care and medical education

    NARCIS (Netherlands)

    Klok, Ted; Kaptein, Adrian A.; Brand, Paul L. P.

    Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients

  7. Non-adherence in children with asthma reviewed : The need for improvement of asthma care and medical education

    NARCIS (Netherlands)

    Klok, Ted; Kaptein, Adrian A; Brand, Paul L P

    2015-01-01

    Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients

  8. Improving the Productivity of Education Experiments: Lessons from a Randomized Study of Need-Based Financial Aid

    Science.gov (United States)

    Harris, Douglas N.; Goldrick-Rab, Sara

    2012-01-01

    Given scarce resources for evaluation, we recommend that education researchers more frequently conduct comprehensive randomized trials that generate evidence on how, why, and under what conditions interventions succeed or fail in producing effects. Recent experience evaluating a randomized need-based financial aid intervention highlights some of…

  9. Problems and needs for improving primary care of osteoarthritis patients : the views of patients, general practitioners and practice nurses

    NARCIS (Netherlands)

    Rosemann, T.J.; Wensing, M.J.P.; Joest, K.; Backenstrass, M.; Mahler, C.; Szecsenyi, J.

    2006-01-01

    BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients

  10. Problems and needs for improving primary care of osteoarthritis patients : the views of patients, general practitioners and practice nurses

    NARCIS (Netherlands)

    Rosemann, T.J.; Wensing, M.J.P.; Joest, K.; Backenstrass, M.; Mahler, C.; Szecsenyi, J.

    2006-01-01

    BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients

  11. Business intelligence: now, more than ever, hospitals need to identify and track key performance metrics to improve operational efficiency.

    Science.gov (United States)

    Lawrence, Daphne

    2009-02-01

    Hospitais without data warehouses can begin by using Access or Excel. ClOs shouldn't necessarily rely on enterprise vendor solutions for BI. BI commitment needs to come from the C-suite. To begin a BI initiative, CIOs should first engage any departments doing quality reporting.

  12. Adapting developing country epidemiological assessment techniques to improve the quality of health needs assessments in developed countries

    Directory of Open Access Journals (Sweden)

    Handy Deirdre

    2005-04-01

    Full Text Available Abstract Background We were commissioned to carry out three health assessments in urban areas of Dublin in Ireland. We required an epidemiologically robust method that could collect data rapidly and inexpensively. We were dealing with inadequate health information systems, weak planning data and a history of inadequate recipient involvement in health service planning. These problems had also been identified by researchers carrying out health assessments in developing countries. This paper reports our experience of adapting a cluster survey model originally developed by international organisations to assess community health needs and service coverage in developing countries and applying our adapted model to three urban areas in Dublin, Ireland Methods We adapted the model to control for socio-economic heterogeneity, to take account of the inadequate population list, to ensure a representative sample and to account for a higher prevalence of degenerative and chronic diseases. We employed formal as well as informal communication methods and adjusted data collection times to maximise participation. Results The model we adapted had the capacity to ascertain both health needs and health care delivery needs. The community participated throughout the process and members were trained and employed as data collectors. The assessments have been used by local health boards and non-governmental agencies to plan and deliver better or additional services. Conclusion We were able to carry out high quality health needs assessments in urban areas by adapting and applying a developing country health assessment method. Issues arose relating to health needs assessment as part of the planning cycle and the role of participants in the process.

  13. 42 CFR 495.366 - Financial oversight and monitoring of expenditures.

    Science.gov (United States)

    2010-10-01

    ... adoption of EHR technology, the Medicaid EHR incentive payments are paid on a voluntary basis and that... TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.366 Financial oversight and... record technology to make payment. Subject to § 495.312, 495.314, and § 495.332, the State must...

  14. 76 FR 52997 - Public Company Accounting Oversight Board; Order Approving Proposed Board Funding Final Rules for...

    Science.gov (United States)

    2011-08-24

    ...\\ 15 U.S.C. 7217(b). \\2\\ 15 U.S.C. 78s(b)(1). \\3\\ Release No. 34-64816 (Jul. 6, 2011) [76 FR 40950 (Jul... COMMISSION Public Company Accounting Oversight Board; Order Approving Proposed Board Funding Final Rules for Allocation of the Board's Accounting Support Fee Among Issuers, Brokers, and Dealers, and Other Amendments...

  15. 75 FR 11210 - Public Company Accounting Oversight Board; Order Approving Proposed Amendment to Board Rules...

    Science.gov (United States)

    2010-03-10

    .... \\1\\ See SEC Release No. 34-61032 (November 19, 2009); 74 FR 61722 (November 25, 2009). II... required in those countries. See SEC Release No. 34-61212 (December 22, 2009); 74 FR 68875 (December 29... COMMISSION Public Company Accounting Oversight Board; Order Approving Proposed Amendment to Board...

  16. 75 FR 10507 - Information Security Oversight Office; National Industrial Security Program Policy Advisory...

    Science.gov (United States)

    2010-03-08

    ... RECORDS ADMINISTRATION Information Security Oversight Office; National Industrial Security Program Policy... regulation 41 CFR 101-6, announcement is made for a meeting of the National Industrial Security Program Policy Advisory Committee. The meeting will be held to discuss National Industrial Security Program...

  17. Management process invaded Ames as the Center shifted from NACA to NASA oversight. Ames constructed

    Science.gov (United States)

    1968-01-01

    Management process invaded Ames as the Center shifted from NACA to NASA oversight. Ames constructed a review room in its headquarters building where, in the graphical style that prevailed in the 1960's, Ames leadership could review progress against schedule, budget and performance measures. Shown, in October 1965 is Merrill Mead chief of Ames' program and resources office. (for H Julian Allen Retirement album)

  18. 32 CFR 2400.19 - Declassification by the Director of the Information Security Oversight Office.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Declassification by the Director of the Information Security Oversight Office. 2400.19 Section 2400.19 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

  19. 34 CFR 1100.31 - Who is responsible for oversight of fellowship activities?

    Science.gov (United States)

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Who is responsible for oversight of fellowship activities? 1100.31 Section 1100.31 Education Regulations of the Offices of the Department of Education... services, to assume direct supervision of the fellowship activities. (b) Fellows may be assigned a...

  20. 48 CFR 936.609-3 - Work oversight in architect-engineer contracts.

    Science.gov (United States)

    2010-10-01

    ... architect-engineer contracts. 936.609-3 Section 936.609-3 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SPECIAL CATEGORIES OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Architect-Engineer Services 936.609-3 Work oversight in architect-engineer contracts. In addition to the clause at...

  1. 48 CFR 36.609-3 - Work oversight in architect-engineer contracts.

    Science.gov (United States)

    2010-10-01

    ... architect-engineer contracts. 36.609-3 Section 36.609-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SPECIAL CATEGORIES OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Architect-Engineer Services 36.609-3 Work oversight in architect-engineer contracts. The contracting...

  2. 75 FR 78779 - Order Approving Public Company Accounting Oversight Board Supplemental Budget Request To...

    Science.gov (United States)

    2010-12-16

    ... Release No. 63526/December 10, 2010] Order Approving Public Company Accounting Oversight Board Supplemental Budget Request To Establish an Office of Outreach and Small Business Liaison in 2010 The Sarbanes-Oxley Act of 2002 \\1\\ (the ``Sarbanes-Oxley Act'') established the Public Company Accounting...

  3. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What oversight procedures are planned for the EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE... procedures are planned for the EN payment systems? We use audits, reviews, studies and observation of...

  4. 78 FR 14801 - Veterinary Oversight of Antimicrobial Use in Livestock: Impact on Stakeholders; Public Meetings...

    Science.gov (United States)

    2013-03-07

    ... Resource Research Center, USDA Animal and Plant Health & Inspection Service, Veterinary Services, Centers... HUMAN SERVICES Food and Drug Administration Veterinary Oversight of Antimicrobial Use in Livestock... areas that may lack access to adequate veterinary services. The meetings are jointly sponsored by FDA...

  5. Sexual Assault: Better Resource Management Needed to Improve Prevention and Response in the Army National Guard and Army Reserve

    Science.gov (United States)

    2017-02-01

    ensure it has the staff needed to complete investigations within 3 weeks, as required by OCI guidance. Eligibility for follow-up or long-term health ...long-term mental and medical health -care services. DOD’s sexual assault prevention and response instruction requires the commander of the Army...correct or mitigate the challenges of funding behavioral health care for Army Reserve soldiers, particularly those who require coverage for trauma

  6. Understanding Health-Care Needs of Sexual and Gender Minority Veterans: How Targeted Research and Policy Can Improve Health.

    Science.gov (United States)

    Mattocks, Kristin M; Kauth, Michael R; Sandfort, Theo; Matza, Alexis R; Sullivan, J Cherry; Shipherd, Jillian C

    2014-03-01

    Given the size of the patient population of the Veterans Health Administration (VHA), it is likely the largest single provider of health care for sexual and gender minority (SGM) individuals in the United States, including lesbian, gay, bisexual, and transgender persons. However, current VHA demographic data-collection strategies limit the understanding of how many SGM veterans there are, thereby making a population-based understanding of the health needs of SGM veterans receiving care in VHA difficult. In this article, we summarize the emergent research findings about SGM veterans and the first initiatives that have been implemented by VHA to promote quality care. Though the research on SGM veterans is in its infancy, it suggests that SGM veterans share some of the health risks noted in veterans generally and also risks associated with SGM status. Some promising resiliency factors have also been identified. These findings have implications for both VHA and non-VHA systems in the treatment of SGM veterans. However, more research on the unique needs of SGM veterans is needed to fully understand their health risks and resiliencies in addition to health-care utilization patterns.

  7. Safety-Related Contractor Activities at Nuclear Power Plants. New Challenges for Regulatory Oversight

    Energy Technology Data Exchange (ETDEWEB)

    Chockie, Alan [Chockie Group International, Inc., Seattle, WA (United States)

    2005-09-15

    The use of contractors has been an integral and important part of the design, construction, operation, and maintenance of nuclear power plants. To ensure the safe and efficient completion of contracted tasks, each nuclear plant licensee has developed and refined formal contract management processes to meet their specific needs and plant requirements. Although these contract management processes have proven to be effective tools for the procurement of support and components tailored to the needs of nuclear power plants, contractor-related incidents and accidents have revealed some serious weaknesses with the implementation of these processes. Identifying and addressing implementation problems are becoming more complicated due to organizational and personnel changes affecting the nuclear power industry. The ability of regulators and licensees to effectively monitor and manage the safety-related performance of contractors will likely be affected by forthcoming organization and personnel changes due to: the aging of the workforce; the decline of the nuclear industry; and the deregulation of nuclear power. The objective of this report is to provide a review of current and potential future challenges facing safety-related contractor activities at nuclear power plants. The purpose is to assist SKI in establishing a strategy for the proactive oversight of contractor safety-related activities at Swedish nuclear power plants and facilities. The nature and role of contractors at nuclear plants is briefly reviewed in the first section of the report. The second section describes the essential elements of the contract management process. Although organizations have had decades of experience with the a contract management process, there remain a number of common implantation weaknesses that have lead to serious contractor-related incidents and accidents. These implementation weaknesses are summarized in the third section. The fourth section of the report highlights the

  8. Non-adherence in children with asthma reviewed : The need for improvement of asthma care and medical education

    NARCIS (Netherlands)

    Klok, Ted; Kaptein, Adrian A; Brand, Paul L P

    2015-01-01

    Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients i

  9. Federally Sponsored Research at Educational Institutions: A Need for Improved Accountability. Report by the U.S. General Accounting Office.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    This report discusses federally sponsored research at educational institutions and suggests ways to improve accountability for these funds. The following suggestions are made for minimizing problems presented in this report: (1) development of more definitive cost principles for both the institutions and the Federal auditors to follow; (2) more…

  10. Non-adherence in children with asthma reviewed : The need for improvement of asthma care and medical education

    NARCIS (Netherlands)

    Klok, Ted; Kaptein, Adrian A.; Brand, Paul L. P.

    2015-01-01

    Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients i

  11. Program of arithmetic improvement by means of cognitive enhancement: an intervention in children with special educational needs.

    Science.gov (United States)

    Deaño, Manuel Deaño; Alfonso, Sonia; Das, Jagannath Prasad

    2015-03-01

    This study reports the cognitive and arithmetic improvement of a mathematical model based on the program PASS Remedial Program (PREP), which aims to improve specific cognitive processes underlying academic skills such as arithmetic. For this purpose, a group of 20 students from the last four grades of Primary Education was divided into two groups. One group (n=10) received training in the program and the other served as control. Students were assessed at pre and post intervention in the PASS cognitive processes (planning, attention, simultaneous and successive processing), general level of intelligence, and arithmetic performance in calculus and solving problems. Performance of children from the experimental group was significantly higher than that of the control group in cognitive process and arithmetic. This joint enhancement of cognitive and arithmetic processes was a result of the operationalization of training that promotes the encoding task, attention and planning, and learning by induction, mediation and verbalization. The implications of this are discussed.

  12. DOD Financial Management: Additional Efforts Needed to Improve Audit Readiness of Navy Military Pay and Other Related Activities

    Science.gov (United States)

    2015-09-01

    toward achieving auditability of its financial statements . As part of that effort, the Navy in March 2013 asserted audit readiness of its...help identify areas for additional focus, and facilitate efforts to achieve DOD’s goal of financial statement auditability department-wide by... importance of addressing fundamental systems and control deficiencies, which will lead to lasting financial management improvements and, as a result

  13. Military Personnel: DOD Needs to Update General and Flag Officer Requirements and Improve Availability of Associated Costs

    Science.gov (United States)

    2014-09-01

    costs to support workforce allocation decisions, and have a thorough understanding of the implications of those costs to DOD and, on a broader scale...of GFOs and improve its ability to make sound workforce allocation decisions. View GAO-14-745. For more information, contact Brenda S. Farrell at...D.C.: November 1999); and Federal Accounting Standards Advisory Board, Statement of Federal Financial Accounting Standards No. 4: Managerial Cost

  14. Reducing maternal mortality: better monitoring, indicators and benchmarks needed to improve emergency obstetric care. Research summary for policymakers.

    Science.gov (United States)

    Collender, Guy; Gabrysch, Sabine; Campbell, Oona M R

    2012-06-01

    Several limitations of emergency obstetric care (EmOC) indicators and benchmarks are analysed in this short paper, which synthesises recent research on this topic. A comparison between Sri Lanka and Zambia is used to highlight the inconsistencies and shortcomings in current methods of monitoring EmOC. Recommendations are made to improve the usefulness and accuracy of EmOC indicators and benchmarks in the future.

  15. Coaching to vision versus coaching to improvement needs: a preliminary investigation on the differential impacts of fostering positive and negative emotion during real time executive coaching sessions.

    Science.gov (United States)

    Howard, Anita R

    2015-01-01

    Drawing on intentional change theory (ICT; Boyatzis, 2006), this study examined the differential impact of inducing coaching recipients' vision/positive emotion versus improvement needs/negative emotion during real time executive coaching sessions. A core aim of the study was to empirically test two central ICT propositions on the effects of using the coached person's Positive Emotional Attractor (vision/PEA) versus Negative Emotional Attractor (improvement needs/NEA) as the anchoring framework of a onetime, one-on-one coaching session on appraisal of 360° feedback and discussion of possible change goals. Eighteen coaching recipients were randomly assigned to two coaching conditions, the coaching to vision/PEA condition and the coaching to improvement needs/NEA condition. Two main hypotheses were tested. Hypothesis1 predicted that participants in the vision/PEA condition would show higher levels of expressed positive emotion during appraisal of 360° feedback results and discussion of change goals than recipients in the improvement needs/NEA condition. Hypothesis2 predicted that vision/PEA participants would show lower levels of stress immediately after the coaching session than improvement needs/NEA participants. Findings showed that coaching to vision/the PEA fostered significantly lower levels of expressed negative emotion and anger during appraisal of 360° feedback results as compared to coaching to improvements needs/the NEA. Vision-focused coaching also fostered significantly greater exploration of personal passions and future desires, and more positive engagement during 360° feedback appraisal. No significant differences between the two conditions were found in emotional processing during discussion of change goals or levels of stress immediately after the coaching session. Current findings suggest that vision/PEA arousal versus improvement needs/NEA arousal impact the coaching process in quite different ways; that the coach's initial framing of the

  16. Cluster sampling with referral to improve the efficiency of estimating unmet needs among pregnant and postpartum women after disasters.

    Science.gov (United States)

    Horney, Jennifer; Zotti, Marianne E; Williams, Amy; Hsia, Jason

    2012-01-01

    Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time. From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding. Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively. Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities. Published by Elsevier Inc.

  17. How Much Walking Is Needed To Improve Cardiorespiratory Fitness? An Examination of the 2007 ACSM/AHA Physical Activity Recommendations

    Science.gov (United States)

    Anton, Stephen D.; Duncan, Glen E.; Limacher, Marian C.; Martin, A. Daniel; Perri, Michael G.

    2013-01-01

    Background The 2007 American College of Sports Medicine (ACSM) and the American Heart Association (AHA) physical activity guidelines recommend adults engage in either 150 minutes of moderate intensity or 60 minutes of vigorous intensity physical activity per week to derive health benefits. Purpose In a 6-month clinical trial, we examined whether walking programs of moderate (leisurely-paced) and vigorous (fast-paced) intensity produced improvements in cardiorespiratory fitness as predicted by the ACSM/AHA guidelines. Methods Participants (N = 155) were instructed to walk 30 minutes per day on 5 or more days per week, at either a moderate or vigorous intensity level (45–55% or 65–75% of maximum heart rate reserve [HRres ], respectively). Within each condition, we categorized participants based on their mean weekly amounts of exercise as reflected in written self-monitoring logs. Fitness was assessed by a maximal graded exercise test at pre- and post-treatment. This trial was conducted in Gainesville, FL between 1999 and 2003. Results Mean minutes of walking were related to changes in cardiorespiratory fitness in the vigorous (r = .47; p = < .001) but not moderate intensity condition (r = .07; p = .52). Within the vigorous intensity condition, significantly greater improvements in fitness were achieved by participants with high and medium amounts of accumulated exercise compared with those with low amounts of exercise. Conclusions Clinically meaningful improvements in cardiorespiratory fitness were observed in participants who walked a minimum of 60 minutes per week at a fast-pace but not those who walked at a leisurely-pace. These findings support the 2007 ACSM/AHA physical activity recommendations regarding vigorous, but not moderate, intensity physical activity for cardiorespiratory fitness. PMID:21699118

  18. Training and Doctrine Command Acquisition Management and Oversight Supplement

    Science.gov (United States)

    2011-06-01

    CLM013-Work-Breakdown Structure CLM031- Improved Statement of Work ACQ265-Mission Focused Services Acquisition Army eLearning https...usarmy.skillport.com/skillportfe/main.action?content=search# CLC013-Performance-based Services Acquisition CLM031- Improved Statement of Work ACQ265-Mission...SES’s strategic issues to improve the quality of the acquisition documents generated by TRADOC personnel. Educating personnel and providing templates

  19. Improvements are needed in reporting of accuracy studies for diagnostic tests used for detection of finfish pathogens.

    Science.gov (United States)

    Gardner, Ian A; Burnley, Timothy; Caraguel, Charles

    2014-12-01

    Indices of test accuracy, such as diagnostic sensitivity and specificity, are important considerations in test selection for a defined purpose (e.g., screening or confirmation) and affect the interpretation of test results. Many biomedical journals recommend that authors clearly and transparently report test accuracy studies following the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines ( www.stard-statement.org ). This allows readers to evaluate overall study validity and assess potential bias in diagnostic sensitivity and specificity estimates. The purpose of the present study was to evaluate the reporting quality of studies evaluating test accuracy for finfish diseases using the 25 items in the STARD checklist. Based on a database search, 11 studies that included estimates of diagnostic accuracy were identified for independent evaluation by three reviewers. For each study, STARD checklist items were scored as "yes," "no," or "not applicable." Only 10 of the 25 items were consistently reported in most (≥80%) papers, and reporting of the other items was highly variable (mostly between 30% and 60%). Three items ("number, training, and expertise of readers and testers"; "time interval between index tests and reference standard"; and "handling of indeterminate results, missing data, and outliers of the index tests") were reported in less than 10% of papers. Two items ("time interval between index tests and reference standard" and "adverse effects from testing") were considered minimally relevant to fish health because test samples usually are collected postmortem. Modification of STARD to fit finfish studies should increase use by authors and thereby improve the overall reporting quality regardless of how the study was designed. Furthermore, the use of STARD may lead to the improved design of future studies.

  20. Strong gun laws are not enough: the need for improved enforcement of secondhand gun transfer laws in Massachusetts.

    Science.gov (United States)

    Braga, Anthony A; Hureau, David M

    2015-10-01

    Research suggests that an overwhelming majority of crime guns were transferred by private sellers before recovery by law enforcement. Unfortunately, most states do not regulate these transactions. This study examines whether analyses of state-level private transfer data could be used to develop interventions to reduce the supply of handguns to violent criminals. Traced Boston crime handguns first sold at Massachusetts license dealers were matched to state secondhand gun transfer data. Logistic regression and descriptive statistics were used to analyze the characteristics of recovered crime guns and in-state primary and secondary market transaction patterns. For crime handguns with records of secondary market transactions in Massachusetts, many rapidly move from private transfer to recovery by the police. Unfortunately, important transaction data on the in-state sources of nearly 63% of recovered handguns were not readily available to law enforcement agencies. Data on private transfers of guns could be used to prevent violent injuries by reducing criminal access. However, the passage of strong private transfer gun laws needs to be accompanied by investments in the vigorous enforcement of reporting requirements. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Knowledge Sharing Cultures in Finance and Insurance Companies ཿ Needs for Improving Informal Collaborative e-Learning

    Directory of Open Access Journals (Sweden)

    Erika Tanhua-Piiroinen

    2013-07-01

    Full Text Available Working life requires employees to continuously update their competences, making lifelong learning an important but challenging part of professional development. This study aims to look for solutions to uncover the tacit and implicit knowledge within the enterprise by the means of social media. Our interest is specially focused on challenges on informal learning and refining and sharing of the tacit knowledge among these expert companies. We have so far collected data from two enterprises about their current knowledge sharing habits and procedures and found out the pitfalls they have experienced in their working culture concerning finding and sharing knowledge. The main challenges (apart from lack of time, which is quite obvious result today are defects in storing information in a way that enables its easy rediscovery and the huge amount of information from which to filter the relevant pieces of knowledge. Particularly the centralized experts in an insurance company find the lack of regular vertical interaction between the decentralized claim handlers a drawback. There exists a lot of overlapping effort as they need to tell the same issues many times to various claim handlers. Taking these challenges into account new working models will be put into practice utilizing collaborative tools, like wikis and chat forums.

  2. Geo-Needs: Investigating Models for Improved Access to Geosciences at Two-Year and Minority-Serving Colleges

    Science.gov (United States)

    Her, X.; Turner, S. P.; LaDue, N.; Bentley, A. P.; Petcovic, H. L.; Mogk, D. W.; Cartwright, T.

    2015-12-01

    Geosciences are an important field of study for the future of energy, water, climate resilience, and infrastructure in our country. Geoscience related job growth is expected to steeply climb in the United States, however many of these positions will be left unfilled. One untapped population of Americans is ethnic minorities, who have historically been underrepresented in the geosciences. In 2010, the Bureau of Labor Statistics (BLS) reported that black and Hispanics only make 8.1% of geoscience related jobs, while making up nearly 30% of Americans. This pattern of underrepresentation has been attributed to 1) minority serving institutions lacking geoscience programs, 2) low interest in the outdoors due to a lack of opportunity, and 3) negative and low prestigious perceptions of geoscientists. Our project focuses specifically on the first barrier. Preliminary research suggests that only 2.5% of institutions with geoscience programs (n= 609) are also minority serving. The goals of the Geo-Needs project are to identify obstacles to and opportunities for better use of existing educational resources in two-year and minority-serving institutions, and to explore "ideal" models of resources, partnerships, and other support for geoscience faculty and students in these institutions. Four focus group meetings were held in August 2015 bringing administrators, instructors, resource providers, and education researchers together to discuss and develop these models. Activities at the meetings included small and whole group prompted discussion, guest speakers, gallery walks, and individual reflection. Content from the focus group meetings is available at the project's website: http://serc.carleton.edu/geoneeds/index.html. Findings from the meetings can be used to inform future efforts aimed toward broadening access to the geosciences at two-year and minority-serving institutions.

  3. Need for Improved Risk Communication of Fish Consumption Advisories to Protect Maternal and Child Health: Influence of Primary Informants

    Directory of Open Access Journals (Sweden)

    W. Gregory Cope

    2013-04-01

    Full Text Available Fish consumption has established benefits, including the promotion of cardiovascular health and pre- and neonatal brain and eye development, but local freshwater fish may be a source of contaminants that are especially harmful to fetuses and young children, such as the neurotoxic and developmentally toxic methylmercury and polychlorinated biphenyls. Fish consumption advisories may be issued by state health departments to limit human exposure to these and other toxicants. This study examined the efficacy of a sign designed by the North Carolina Division of Public Health that was posted along a reservoir (Badin Lake in central North Carolina, USA, for increasing anglers’ awareness of a fish consumption advisory, with a special focus on anglers who share their catch with women and children. In this study, 109 anglers were interviewed about their awareness of fish consumption advisories in general and their knowledge of the Badin Lake fish advisory in particular. Shore anglers were significantly less likely to be aware of the term “fish consumption advisory” and of the specific advisory for Badin Lake than boat anglers. Although a significant increase in knowledge of the specific fish consumption advisory was found for the entire sample of study participants after the sign intervention, a commensurate increase in knowledge was not found for a subsample of anglers who reported sharing their catch with women and children. Study findings underscore differences in fish consumption advisory awareness among subpopulations. Specifically, the study revealed the importance of characterizing the communication needs of shore anglers and anglers who share their catch with sensitive subpopulations (e.g., women and children for the creation of more targeted communications of fish consumption advisories.

  4. Improving the quality of health care in the United States of America: the need for a multi-level approach.

    Science.gov (United States)

    Mechanic, David

    2002-07-01

    Serious efforts to address quality require coordinated, multi-faceted, multi-level strategies that address the organisational environments and cultures that affect how care is provided. Most efforts over the past 50 years to improve the care provided by physicians and other clinicians have been individually rather than system based. Such individual interventions to modify physician behaviour typically have only modest effects whether considering the recognition and treatment of depression in primary care, following established practice guidelines, carrying out preventive interventions, monitoring and managing chronic illness appropriately, or managing pain and end-of-life care. It is increasingly recognised that quality of care is a property of health systems. Internal efforts to shape clinical routines, such as performance incentives and disease-management approaches, and external inducements and constraints that shape how clinical contexts are organised and function are equally relevant. Internal factors include the skills training of clinical personnel, organisational procedures and mechanisms to coordinate care and prevent errors, implementation of best practices, effective use of informational technologies and appropriate incentives. External factors include broader financial and reimbursement mechanisms, regulatory arrangements that protect access and patient rights in situations of vulnerability and performance-based contracts. The mobilisation of effective advocacy, independent and non-profit statutory watchdog organisations, and good consumer information can facilitate and reinforce quality efforts. System integration is admittedly difficult, and always incomplete, but movement toward this goal is an essential strategic objective.

  5. NASA S and MA at the Crossroads; The Role of NASA Quality Insight/Oversight for Commercial Crewed Launch Vehicles

    Science.gov (United States)

    Malone, Roy W., Jr.

    2010-01-01

    The presentation slides examine: The Journey, Current Safety and Mission Assurance (S and MA) Oversight/Insight, The Change, The Issue, Potential NASA relationship with Commercial Partners, and Commercial "X" FRR - Are you Go.

  6. Hospital Board Oversight of Quality and Patient Safety: A Narrative Review and Synthesis of Recent Empirical Research

    National Research Council Canada - National Science Library

    ROSS MILLAR; RUSSELL MANNION; TIM FREEMAN; HUW T.O. DAVIES

    2013-01-01

    .... National directives and initiatives emphasize the importance of action by boards, but the empirical basis for informing effective hospital board oversight has yet to receive full and careful review. Methods...

  7. Future needs for improvement of noise-induced hearing loss awareness training and hearing protection device practices in the South African mining industry

    CSIR Research Space (South Africa)

    Edwards, AL

    2012-08-01

    Full Text Available Institute of Mining and Metallurgy MineSAFE 2012 Anita Edwards Page 1 FUTURE NEEDS FOR IMPROVEMENT OF NOISE-INDUCED HEARING LOSS AWARENESS TRAINING AND HEARING PROTECTION DEVICE PRATICES IN THE SOUTH AFRICAN MINING INDUSTRY Authors: A... training for workers about the risks associated with noise exposure that also motivates and trains them to use Hearing Protection Devices (HPDs) in order to prevent hearing loss. The high prevalence of noise- induced hearing loss (NIHL) amongst South...

  8. Limits of “Skills And Drills” Interventions to Improving Obstetric and Newborn Emergency Response: What More Do We Need to Learn?

    OpenAIRE

    Ricca, Jim

    2016-01-01

    A “skills and drills” intervention in 4 hospitals in Karnataka, India, produced modest improvement in provider knowledge and skills but not in actual response to obstetric and newborn emergencies. We explore possible explanations, which include (1) the need for a more intensive intervention; (2) other weaknesses in the health system; and (3) behavioral or organizational barriers related to hierarchical structures, roles, and team formation.

  9. A group of Midwestern university students needs to improve their oral hygiene and sugar/pop consumption habits.

    Science.gov (United States)

    Luebke, Tami E; Driskell, Judy A

    2010-01-01

    Poor oral hygiene and sugar/pop consumption practices are detrimental to one's overall health. College women were hypothesized to have better oral hygiene habits and to consume less sugar/pop than men and that the students' habits would be different from those the students had before college. These habits of students at a Midwestern university were evaluated by sex. The volunteers included 105 men and 91 women. Three quarters of the students reported brushing their teeth at least the recommended twice daily, with women brushing their teeth more often. About a third of the students flossed at least the recommended once daily. Not quite a third of the students reported brushing and flossing their teeth more often than they did before college. More than a third reported using mouth rinses 4 or more times weekly, with 13% reporting using a fluoride-containing mouth rinse. More than 60% reported using fluoride-containing toothpaste. Slightly more than a third reported drinking fluoridated water in their younger years. A larger percentage of women than men reported that diet pop was their pop of choice. More than two thirds of the students that drank pop indicated that regular pop was their favorite. Most of the students reported consuming sugary foods more than once daily, but they indicated that most of these sugars were not sticky. Few differences were observed in oral hygiene and sugar/pop consumption habits of these college students by sex. Nutritionists and other health professionals should work cooperatively in helping individuals improve their oral hygiene and sugar/pop consumption habits. 2010 Elsevier Inc. All rights reserved.

  10. [On the need to improve the system for the prevention of falsification of food products in the Eurasian Economic Union].

    Science.gov (United States)

    Arnautov, O V; Bagryantseva, O V; Bessonov, V V

    2016-01-01

    Adulteration of food is misleading consumers about the composition of foods in order to obtain economic benefits. Olive oil, wine and other alcoholic beverages, spices, tea, fish, honey, milk and dairy products, meat products, cereal products, beverages based on fruit juices, spices, coffee are falsified with the highest frequency. In addition, sufficient data on the frequency of adulterated food products are missing not only in Russia but also in the developed countries. This is because the purpose of the manufacturer and distributors of such products is primarily an economic advantage. Therefore, the majority of incidents of falsification of food products remained undetected since their production, generally had not led to the risk of food safety, and consumers often did not notice the reduction in quality of foodstuffs. The analysis of international data and data of the Eurasian Economic Union (EAEU) has shown that, in order to improve the quality of food products and to reduce sales of adulterated food the following steps should be done: introduce the definition of falsificated food products into legislation of the EAEU; expand the list of methods for confirming the authenticity of the food and detecting the presence of substances which are not permitted for usage in the food industry; consolidate the principle of the responsibility of all participants in the treatment of food that does not comply with the mandatory requirements at the legislative level; introduce the indicators of the quality of foodstuffs in the technical regulations of the EAEU; return to the mandatory requirements for the quality of foods given in the interstate and state standards.

  11. Private security and military contractors: A troubling oversight

    DEFF Research Database (Denmark)

    Swed, Ori; Crosbie, Thomas Alexander

    2017-01-01

    Though private military and security companies (PMSCs) have been addressed extensively in the literature, little research has been done on the contractors themselves, leaving us in the dark as to who these individuals are. In this article, we focus on the critical case of the United States armed...... and concomitant evolution of the security sector, while noting a new trend that points to the need for moving from the macrosocial to the microsocial level of inquiry. Second, we indicate the challenges contractors pose to the sociological paradigm of military professionalism: These suggest a need to move from...

  12. Peer-reviewed forensic consultation in practice: multidisciplinary oversight in common expertise.

    Science.gov (United States)

    Welner, Michael; Davey, Emily E; Bernstein, Adam

    2014-09-01

    The fallibility of forensic science consultation is an ongoing and major justice concern. Prospective peer-reviewed forensic consultation has over 10 years of application in American criminal and civil courts, adapting from the traditional oversight of teaching hospitals, rules of evidence and discovery, conventions of testimony of expert witnesses, and attorneys' overall trial strategy. In systematizing heightened oversight, this process ensures greater accountability in forensic science consultation. The integration of peer reviewers' complementary expertise and experience enhances the sophistication and overall quality of assessment. Forensic examination frequently involves the interface of different specialties. Multidisciplinary peer review augments expert proficiency with that of professional peers having different vantage points from relevant scientific disciplines. This approach ensures greater sophistication of a case inquiry, built-in accountability, and streamlined processes when multiple experts are necessitated. Here, the authors present examples of several cases and the primary and secondary benefits of this collaborative, rigorous, cross-disciplinary exercise.

  13. A survey of front-line paramedics examining the professional relationship between paramedics and physician medical oversight.

    Science.gov (United States)

    Foerster, Christopher R; Tavares, Walter; Virkkunen, Ilkka; Kämäräinen, Antti

    2017-06-07

    Paramedicine is often dependent on physician medical directors and their associated programs for direction and oversight. A positive relationship between paramedics and their oversight physicians promotes safety and quality care while a strained or ineffective one may threaten these goals. The objective of this study was to explore and understand the professional relationship between paramedics and physician medical oversight as viewed by front-line paramedics. All active front-line paramedics from four municipal paramedic services involving three medical oversight groups in Ontario were invited to complete an online survey. Five hundred and four paramedics were invited to participate in the study, with 242 completing the survey (48% response rate); 66% male, 76% primary care paramedics with an average of 13 (SD=9) years of experience. Paramedics had neutral or positive perceptions regarding their autonomy, opportunities to interact with their medical director, and medical director understanding of the prehospital setting. Paramedics perceived medical directives as rigid and ambiguous. A significant amount of respondents reported a perception of having provided suboptimal patient care due to fear of legal or disciplinary consequences. Issues of a lack of support for critical thinking and a lack of trust between paramedics and medical oversight groups were often raised. Paramedic perceptions of physician medical oversight were mixed. Concerning areas identified were perceptions of ambiguous written directives and concerns related to the level of trust and support for critical thinking. These perceptions may have implications for the system of care and should be explored further.

  14. Ideal Police Oversight and Review: The Next Piece of the Community Policing Puzzle

    Science.gov (United States)

    2015-12-01

    ceiling for budgets was set at $1.5 million, twice the initial criterion, allowing six boards to be researched further. Thus, boards from Oakland...Common Sense about Police Review, 260. 80 “Office of Civil Rights and Wage Enforcement / Civilian Review Board / Civilian Board FAQs,” City of...Civil Rights and Wage Enforcement,” City of Baltimore. 85 Hunt, request for information response. 29 activities of the oversight entity, they

  15. Commentary: Oversight of engineered nanomaterials in the workplace.

    Science.gov (United States)

    Maynard, Andrew D

    2009-01-01

    Research and business investment in emerging nanotechnologies is leading to a diverse range of new substances and products. As workers are faced with handling new materials, often with novel properties, the robustness of current workplace health and safety regulatory frameworks is being brought into question. Here, 12 characteristics of the U.S. occupational safety regulatory framework identified by Choi and Ramachandran are considered in the context of emerging nanotechnologies. The assessment suggests that, as the number of new materials entering the workplace continues to increase, OSHA will need to develop flexible approaches to identifying and reducing potential risks. Relying on conventional approaches in the face of unconventional challenges will increase the probability of otherwise avoidable heath impacts. If the potential for engineered nanomaterials to cause harm is to be understood and managed, the agency will need to look at new approaches to generating, sharing, and using information.

  16. Evaluation of the orthodontic treatment need in a paediatric sample from Southern Italy and its importance among paediatricians for improving oral health in pediatric dentistry

    Science.gov (United States)

    Ierardo, Gaetano; Corridore, Denise; Di Carlo, Gabriele; Di Giorgio, Gianni; Leonardi, Emanuele; Campus, Guglielmo-Giuseppe; Vozza, Iole; Polimeni, Antonella; Bossù, Maurizio

    2017-01-01

    Background Data from epidemiological studies investigating the prevalence and severity of malocclusions in children are of great relevance to public health programs aimed at orthodontic prevention. Previous epidemiological studies focused mainly on the adolescence age group and reported a prevalence of malocclusion with a high variability, going from 32% to 93%. Aim of our study was to assess the need for orthodontic treatment in a paediatric sample from Southern Italy in order to improve awareness among paediatricians about oral health preventive strategies in pediatric dentistry. Material and Methods The study used the IOTN-DHC index to evaluate the need for orthodontic treatment for several malocclusions (overjet, reverse overjet, overbite, openbite, crossbite) in a sample of 579 children in the 2-9 years age range. Results The most frequently altered occlusal parameter was the overbite (prevalence: 24.5%), while the occlusal anomaly that most frequently presented a need for orthodontic treatment was the crossbite (8.8%). The overall prevalence of need for orthodontic treatment was of 19.3%, while 49% of the sample showed one or more altered occlusal parameters. No statistically significant difference was found between males and females. Conclusions Results from this study support the idea that the establishment of a malocclusion is a gradual process starting at an early age. Effective orthodontic prevention programs should therefore include preschool children being aware paediatricians of the importance of early first dental visit. Key words:Orthodontic treatment, malocclusion, oral health, pediatric dentistry. PMID:28936290

  17. Fiscal Year 2013 Comprehensive Oversight Plan for Southwest Asia

    Science.gov (United States)

    2012-09-26

    for selecting the Concurrent Certification Program Artisan Inspector employees to determine if the appropriate qualification criteria are met; (2...COPSWA Ref. No. SIGIR 12-012 Development Funds for Iraq Returned to the Central Bank of Iraq (1112c) 01/13/2012 625 SIGIR 12-007 Falluja Waste...Central Bank of Iraq (1112a) 10/26/2011 625 SIGIR 12-006 Iraqi Police Department Program: Opportunities for Improved Program Accountability and

  18. Federal Information. Agency Needs and Practices. Fact Sheet for the Chairman, Joint Committee on Printing, U.S. Congress.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    A questionnaire was sent to officials in 13 federal departments and 57 agencies to collect data on their information needs and practices. The survey instrument was designed to provide: (1) information to the Joint Committee on Printing needs to carry out its oversight role in federal printing and publishing management; and (2) information to…

  19. Depot Maintenance: Improvements to DODs Biennial Core Report Could Better Inform Oversight and Funding Decisions

    Science.gov (United States)

    2016-11-01

    many complex weapon systems and equipment. Recognizing the key role of the depots and the risk of overreliance on contractors, Section 2464 of...Office of the Secretary of Defense This is a work of the U.S. government and is not subject to copyright protection in the United States. The published...military depots2—public-sector facilities that are government-owned and government-operated—and private-sector contractors. Depots have a key role

  20. DEFENSE INFRASTRUCTURE: Opportunities Exist to Improve the Navy’s Basing Decision Process and DOD Oversight

    Science.gov (United States)

    2010-05-01

    Ranking Member Committee on Armed Services United States Senate The Honorable Daniel K. Inouye Chairman The Honorable Thad Cochran Ranking...underutilized facilities since the USS John F. Kennedy was retired in 2007. According to Navy officials, the Navy used its strategic dispersal

  1. Improving Oversight and Coordination of Department of Defense Programs That Address Problematic Behaviors Among Military Personnel

    Science.gov (United States)

    2017-01-01

    with an increasing representation of minorities, greater racial diversity in positions of authority, and a smaller racial wage gap .”91 Risk Factors...strategic convergence, as well as potential gaps along the prevention spectrum at which program and research efforts might be applied, with the...significant gap in DoD’s frame- work for mitigating problematic behavior. Although the Office of Diversity Management and Equal Opportunity is

  2. Going Beyond the Water’s Edge: Improving Congressional Oversight for the Department of Homeland Security

    Science.gov (United States)

    2013-03-01

    protectionism and political pandering that plague the current system.”148 Like most experts arguing for reform, Jena McNeill’s recommendations are made from a...Control Act, and adoption of several reform proposals by the Hansen Commission in 1971, 1972, and 1974.192 However, the threat of altering committee...efforts were successful in generating legislation capable of being proposed to their entire chambers without threat of committee subversion. The influence

  3. Insider Threats: DOD Should Improve Information Sharing and Oversight to Protect U.S. Installations

    Science.gov (United States)

    2015-07-01

    but does direct the department to prevent and report incidents involving violence, threats, harassment, intimidation, and other disruptive behavior ...have trained response personnel on active shooter training and piloted a workplace violence risk assessment program. However, DOD is not sharing...framework: DOD Instruction 1438.06, DOD Workplace Violence Prevention and Response Policy; DOD Instruction 2000.12, DOD Antiterrorism (AT) Program; DOD

  4. Prepositioned Materiel and Equipment: DOD Would Benefit from Developing Strategic Guidance and Improving Joint Oversight

    Science.gov (United States)

    2012-09-20

    analysis by having two analysts independently compare the prepositioned materiel and equipment information in DOD’s fiscal year 2011 report with the 12...Source: GAO analysis . We assessed five of the elements as being addressed because the information provided in the report was responsive to the...report did not include Air Force munitions, auxiliary fuel tanks, missile launchers, pylons, ejector racks, and adapters, medical stocks, fuel, and

  5. Warfighter Support: Improved Joint Oversight and Reporting on DOD’s Prepositioning Programs May Increase Efficiencies

    Science.gov (United States)

    2011-05-01

    tanks, missile launchers, pylons, ejector racks, and adapters,18 medical stocks, fuel, and Defense Logistics Agency-managed items such as rations...recommendations that balance limited resources against operational risk to the Director of Program Analysis and Evaluation, now referred to as the

  6. Designation of Contracting Officers Representatives and Oversight Framework Could Be Improved for Contracts in Afghanistan

    Science.gov (United States)

    2016-08-30

    activities involved. 22 DFARS Procedures, Guidance , and Information 201.6, “ Career Development, Contracting Authority, and Responsibilities...did not follow Defense acquisition guidelines. • An in-country representative for a U.S. Naval Sea Systems contract did not receive guidance on...Recommendations We recommend that officials from Defense Procurement and Acquisition Policy, Under Secretary of Defense for Acquisition, Technology

  7. Needs assessment and evaluation of a short course to improve faculties teaching skills at a former World Health Organization regional teacher training center

    Directory of Open Access Journals (Sweden)

    JAVAD KOJURI

    2015-01-01

    Full Text Available Introduction: In the design of educational programs, much attention has been paid to teaching methods, needs assessment, an important part of the development of educational programs, generally is neglected. Another important aspect in educational program design is assessing effectiveness. The aims of this study were to design a formal needs assessment program to define the core contents of a faculty development program, and to determine whether participation in the faculty development program reinforced new teaching skills. Methods: A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors boost their teaching skills. Needs assessment was done with nominal group technique followed by a 5-point Likert scale questionnaire. The program, imparted in workshop format, covered effective teaching methods, feedback, assessing knowledge and time management. Instruction was in the form of lectures, group discussions, case simulations, video presentations and role-plays. The program was evaluated in several phases using data triangulation and multi-item assessments of overall program quality in three major dimensions: Kirkpatrick program evaluation model, evaluation of the educational environment and qualitative analysis with open-ended questions. All participants in the study belonged to the academic staff of Shiraz University of Medical Sciences (n=396. Results: Seven main categories were derived from nominal group techniques and questionnaires. After the program, participants rated the quality of the program highly. They felt that the educational intervention was appropriate and had a positive impact on their knowledge of effective teaching methods, feedback, knowledge assessment and time management. Assessment of the effectiveness of the program showed that participants reported significant improvements in their teaching abilities. Conclusion: Our faculty development program have a significant positive

  8. Needs assessment and evaluation of a short course to improve faculties teaching skills at a former World Health Organization regional teacher training center

    Science.gov (United States)

    KOJURI, JAVAD; AMINI, MITRA; KARIMIAN, ZAHRA; DEHGHANI, MOHAMMAD REZA; SABER, MAHBOOBEH; BAZRAFCAN, LEILA; EBRAHIMI, SEDIGHEH; REZAEE, RITA

    2015-01-01

    Introduction: In the design of educational programs, much attention has been paid to teaching methods, needs assessment, an important part of the development of educational programs, generally is neglected. Another important aspect in educational program design is assessing effectiveness. The aims of this study were to design a formal needs assessment program to define the core contents of a faculty development program, and to determine whether participation in the faculty development program reinforced new teaching skills. Methods: A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors boost their teaching skills. Needs assessment was done with nominal group technique followed by a 5-point Likert scale questionnaire. The program, imparted in workshop format, covered effective teaching methods, feedback, assessing knowledge and time management. Instruction was in the form of lectures, group discussions, case simulations, video presentations and role-plays. The program was evaluated in several phases using data triangulation and multi-item assessments of overall program quality in three major dimensions: Kirkpatrick program evaluation model, evaluation of the educational environment and qualitative analysis with open-ended questions. All participants in the study belonged to the academic staff of Shiraz University of Medical Sciences (n=396). Results: Seven main categories were derived from nominal group techniques and questionnaires. After the program, participants rated the quality of the program highly. They felt that the educational intervention was appropriate and had a positive impact on their knowledge of effective teaching methods, feedback, knowledge assessment and time management. Assessment of the effectiveness of the program showed that participants reported significant improvements in their teaching abilities. Conclusions: Our faculty development program  have a significant positive effect on

  9. Improving patient education by an in-service communication training for health care providers at a cancer ward: communication climate, patient satisfaction and the need of lasting implementation.

    Science.gov (United States)

    Visser, Adriaan; Wysmans, Michel

    2010-03-01

    To show the effects of an in-service communication training for health care providers at a cancer ward, to improve the quality and quantity of the patient education, and patient satisfaction with the care received. A 3-year in-service communication training was held at a cancer ward. Pre- and post-data were collected about the quality and quantity of the communication of nurses, physicians and other health care providers (HCPs) towards patients and colleagues (n=22) as well as the satisfaction of the patients with the quality of care (n=90). The communication training raised significantly the quality and quantity of the communication towards patients and with colleagues. Also patient satisfaction with the quality of care increased. However, the long-term implementation of the benefits was proved disappointing. In-service communication training is an important means for the long-term improvement of the quality of patient education at nursing departments in hospitals. Lasting implementation of the benefits however requires attention to organizational obstacles, budgetary conditions, leadership factors at the ward, and the application of an organizationally oriented theoretical framework. Improvement of patient education at nursing wards does not only require educational means, organizational facilities and professional training, but can be improved too by in-service communication training, which increases the quality of the patient-centered care. An organizational oriented change-strategy is needed to ensure the implementation produces lasting effects. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  10. Is adaptation or transformation needed? Active nanomaterials and risk analysis

    Science.gov (United States)

    Kuzma, Jennifer; Roberts, John Patrick

    2016-07-01

    Nanotechnology has been a key area of funding and policy for the United States and globally for the past two decades. Since nanotechnology research and development became a focus and nanoproducts began to permeate the market, scholars and scientists have been concerned about how to assess the risks that they may pose to human health and the environment. The newest generation of nanomaterials includes biomolecules that can respond to and influence their environments, and there is a need to explore whether and how existing risk-analysis frameworks are challenged by such novelty. To fill this niche, we used a modified approach of upstream oversight assessment (UOA), a subset of anticipatory governance. We first selected case studies of "active nanomaterials," that are early in research and development and designed for use in multiple sectors, and then considered them under several, key risk-analysis frameworks. We found two ways in which the cases challenge the frameworks. The first category relates to how to assess risk under a narrow framing of the term (direct health and environmental harm), and the second involves the definition of what constitutes a "risk" worthy of assessment and consideration in decision making. In light of these challenges, we propose some changes for risk analysis in the face of active nanostructures in order to improve risk governance.

  11. An Evaluation of Maritime Policy in Meeting the Commercial and Security Needs of the United States

    Science.gov (United States)

    2009-01-07

    centers, and agricultural production and processing facilities throughout our nation. That network--comprised of waterways, railroads, highways...Homeland Security, Agriculture , and the Army to better align the fees with the activities they support, and to improve collections, oversight, and...French Guiana French Southern and Antarctic Territories Grenada Guadeloupe Guatemala Guyana Haiti Honduras Jamaica Latin American

  12. Cardiac arrhythmia in Wilson's disease: An oversighted and overlooked entity!

    Science.gov (United States)

    Bajaj, Bhupender Kumar; Wadhwa, Ankur; Singh, Richa; Gupta, Saurabh

    2016-01-01

    Wilson's disease is a multisystem disorder which manifests with hepatic, neurological, musculoskeletal, hematological, renal, and cardiac symptoms. The hepatic and neurological manifestations often overshadow the other system involvement including cardiac symptoms and signs, which may prove fatal. We report a case of a young female who presented with progressive parkinsonian features and dystonia for around 4 months followed 2 months later by the complaint of episodes of light-headedness. She was diagnosed to have Wilson's disease based on the presence of Kayser–Fleischer ring and laboratory parameters of copper metabolism. Electrocardiography of the patient incidentally revealed 2nd degree Mobitz type-1 atrioventricular block explaining her episodes of light-headedness. She was started on penicillamine and trihexyphenidyl. The heart block improved spontaneously. Cardiac autonomic function tests including blood pressure response to standing and heart rate response to standing were observed to be normal. We review the literature on cardiac manifestations of Wilson's disease and emphasize that patients with Wilson's disease should be assessed for cardiac arrhythmia and cardiac dysfunction as these may have therapeutic and prognostic implications. PMID:27695244

  13. Using geographical information systems to identify populations in need of improved accessibility to antivenom treatment for snakebite envenoming in Costa Rica.

    Directory of Open Access Journals (Sweden)

    Erik Hansson

    Full Text Available INTRODUCTION: Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment. METHOD/PRINCIPAL FINDINGS: Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified. CONCLUSION/SIGNIFICANCE: This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated.

  14. EXPERT PANEL OVERSIGHT COMMITTEE ASSESSMENT OF FY2008 CORROSION AND STRESS CORROSION CRACKING SIMULANT TESTING PROGRAM

    Energy Technology Data Exchange (ETDEWEB)

    BOOMER KD

    2009-01-08

    The Expert Panel Oversight Committee (EPOC) has been overseeing the implementation of selected parts of Recommendation III of the final report, Expert Panel workshop for Hanford Site Double-Shell Tank Waste Chemistry Optimization, RPP-RPT-22126. Recommendation III provided four specific requirements necessary for Panel approval of a proposal to revise the chemistry control limits for the Double-Shell Tanks (DSTs). One of the more significant requirements was successful performance of an accelerated stress corrosion cracking (SCC) experimental program. This testing program has evaluated the optimization of the chemistry controls to prevent corrosion in the interstitial liquid and supernatant regions of the DSTs.

  15. Tennessee Oversight Agreement annual report, May 31, 1994--June 30, 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-01

    The Tennessee Department of Environment and Conservation`s DOE Oversight Division (TDEC/DOE-O) is responsible for assuring the citizens of Tennessee that their health, safety and environment on the Oak Ridge Reservation are protected and that appropriate remedial action is taken to provide this protection. TDEC/DOE-O has five program sections that reflect the organizational structure of the TDEC Bureau of Environment Divisions, as well as DOE`s Environmental Safety and Health, Waste Management, and Environmental Restoration Programs.

  16. WTO oversight over bilateral agreements: from a notification to an examination process?

    DEFF Research Database (Denmark)

    Mortensen, Jens Ladefoged

    2014-01-01

    The TTIP will – like other free trade agreements (FTAs) – violate one of the cornerstones of the WTO, i.e. the Most-Favoured-Nation (MFN) principle. However, the multilateral trading system has since 1947 permitted the formation of trading blocks and preferential bilateral trading partnerships....... This contribution asks how the WTO can fulfill its task of ensuring that FTAs do not systematically undermine the multilateral trading order. It focuses on the issue of transparency in the current oversight process and discusses whether the WTO secretariat should be granted a stronger mandate to proactively...

  17. Research on Cross Border AuditOversight between China and the U.S.

    Institute of Scientific and Technical Information of China (English)

    陈瀚爵

    2014-01-01

    Companies have gone worldwide and are listed on capital markets in dif erent continents. Their auditors have fol owed them. To al ow for an ef ective global audit oversight in order to protect the investors, international co-operation is required. The disparity in laws of audit supervision and conflicts between China and the United States inflict financial damage on investors. By analyzing rudimentary reasons behind this issue and the progress both parties have done, the author then il ustrates international cooperation among other regions to make the prediction and recommendations in dealing with such conflicts.

  18. Self-assessment/continuous improvement: Opportunity or burden

    Energy Technology Data Exchange (ETDEWEB)

    Ryder, D.E.

    1993-02-01

    Quality assurance is defined in US Department of Energy (DOE) Order 5700.6C as actions that provide confidence that quality is achieved.'' Confidence is the key word in this definition. Because of a lackof confidence, Congress has mandated improved performance by DOE and its contractors. DOE Headquarters has responded, in part, by requiring increased oversight of all affected organizations. Self-assessment/continuous improvement (SA/CI) is presented in this paper as a ten-step process to help restore confidence. The SA/CI process begins when you identify your customers. SA/CI then leads to determining customer requirements and establishing performance objectives and criteria against which current processes and performance are evaluated. SA/CI should be performed by managers and supervisors at all levels and should includedirect observation of work in progress in addition to analysis of performance data. Traditional independent assessment processes such as audits and surveillances can be used to provide valuable information for performing the evaluation. SA/CI is an aggressive no-fault'' self-assessment process coupled with a continuous improvement process that yields truly cost-effective corrective action and a high level of confidence that process and product quality objectives have been met. This approach should provide customers the evidence needed to increase their confidence in the organization's activities. The end result should bean improvement in the quality of work life for the organization's employees and a significant reduction in external oversight (i.e., audits).

  19. Military Operations: DOD Needs to Address Contract Oversight and Quality Assurance Issues for Contracts Used to Support Contingency Operations

    Science.gov (United States)

    2008-09-01

    equipment, changes in host country labor laws , and paying for work to be performed multiple times. For six of the contracts we reviewed, the cost of... labor laws , and (4) having to pay for work to be performed multiple times because it did not meet required standards. First, we found that in three of...associated overhead expenses.22 Third, changes in the host country labor law resulted in additional security services contract costs. According to the

  20. Defense Health Care: Better Tracking and Oversight Needed of Servicemember Separations for Non-Disability Mental Conditions

    Science.gov (United States)

    2015-02-01

    mixes non-disability mental conditions with non-disability physical conditions, such as obesity , making it difficult to distinguish one type of...servicemembers be physically and psychologically suitable for military service. DOD policy permits an enlisted servicemember to be involuntarily separated...broad separation code. 12Examples of non-disability physical conditions for which servicemembers can be administratively separated include obesity and

  1. Personnel Security Clearances: Additional Guidance and Oversight Needed at DHS and DOD to Ensure Consistent Application of Revocation Process

    Science.gov (United States)

    2014-09-01

    foreign preference; sexual behavior; personal conduct; financial considerations; alcohol consumption; drug involvement; psychological conditions...Twitter, and YouTube. Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts . Visit GAO on the web at www.gao.gov. Contact: Website

  2. DOD and Coast Guard: Actions Needed to Increase Oversight and Management Information on Hazing Incidents Involving Servicemembers

    Science.gov (United States)

    2016-02-01

    installations selected based on available hazing and sexual assault data, among other factors; and interviewed cognizant officials. What GAO Recommends...reported incidents, and could be estimated based on survey responses, as DOD does in the case of sexual assault. Service officials said that currently... psychological in nature. Furthermore, actual or implied consent did not eliminate the culpability of the perpetrator. The military services and the Coast

  3. The Iraq Community Action Program: USAID’s Agreement with CHF Met Goals, but Greater Oversight Is Needed

    Science.gov (United States)

    2011-04-28

    sigir.mil Special Inspector General for Iraq Reconstruction Summary of Report: SIGIR 11-014 Why SIGIR Did This Study Since 2003, the U.S. Agency...that affect their communities. CAP projects include repair, rehabilitation, and renovation of sewerage systems, roads, schools, and health clinics...0 94,026 8 – Provide equipment to upgrade the electricity network 117 5,497 88,000 9 – Construct a park 460 674,160 96,845 10 – Provide transformer

  4. Recovering Servicemembers and Veterans: Sustained Leadership Attention and Systematic Oversight Needed to Resolve Persistent Problems Affecting Care and Benefits

    Science.gov (United States)

    2012-11-01

    servicemembers and veterans who suffer from traumatic brain injuries, amputations , burns, spinal cord injuries, visual impairment, and PTSD. The... amputations , spinal cord injuries, or blindness, or more than one of these. Soon after the program was initiated, the Department of Veterans Affairs...williamsonr@gao.gov In addition to the contact name above, Bonnie Anderson, Assistant Director; Mark Bird , Assistant Director; Michele Grgich, Assistant

  5. F-35 Joint Strike Fighter: Continued Oversight Needed as Program Plans to Begin Development of New Capabilities

    Science.gov (United States)

    2016-04-01

    a reduction of 88 percent since 2014. Page 15 GAO-16-390 F-35 Joint Strike Fighter • The time spent on scrap , rework, and repair in the...Nearing Completion and F-35 Program is Addressing Technical Risks 7 Manufacturing and Reliability Progress Continue 12 DOD’s Approach to Managing...F-35 Joint Strike Fighter Aircraft by Variant 14 Figure 7: Reduction in Average Monthly F-35 Joint Strike Fighter Part Shortage Occurrences at

  6. Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: a randomized controlled trial.

    Science.gov (United States)

    Lee, Li-Chin; Tsai, Alan C; Wang, Jiun-Yi; Hurng, Baai-Shyun; Hsu, Hui-Chuan; Tsai, Hsin-Jen

    2013-12-01

    Nutrition is a key element in geriatric health. Protein-energy malnutrition is common in institutionalized persons. This study examined the effectiveness of a need-based "routine screening and timely intervention" strategy in improving the nutritional status of persons living in nursing homes. A 24-week randomized, double-blind, controlled trial. A privately managed geriatric nursing home in Taiwan. Ninety-two ≥65-year old persons who were ≤25kg/m(2), >1 month residence, able to self-feed or receive oral feeding, without acute infection and non-bed-ridden. Prospective participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each subject in the intervention group was given a 50g/day soy-protein-based nutritional supplement if he/she was rated as undernourished according to the Mini Nutritional Assessment (MNA, score ≤24) and BMI ≤24kg/m(2). The supplement contained 9.5g protein, 250kcal energy and all essential micro-nutrients. The supplementation would be suspended once either one of the "at risk" condition was corrected. Nutritional rating with the MNA took place at baseline and every 4 weeks during the trial. Biochemical indicators were measured at baseline, mid-point (week-12) and end-point (week-24). Results were analyzed with the two-sample t-test, and the generalized estimating equations (GEE) controlled for demographic and health-related variables. Of the 92 subjects, 82 completed the trial; 7 withdrew and 3 died during the trial. Results showed that the need-based intervention was an effective and appropriate strategy for improving the nutritional status of persons at risk of undernourishment. The intervention significantly improved body weight, BMI, mid-arm circumference, calf circumference, and serum albumin and cholesterol concentrations at all intervals (all pnutritional intervention can be a practical and useful strategy for improving the nutritional status of persons

  7. The Critical Need to Promote Research of Aging and Aging-related Diseases to Improve Health and Longevity of the Elderly Population

    Science.gov (United States)

    Jin, Kunlin; Simpkins, James W.; Ji, Xunming; Leis, Miriam; Stambler, Ilia

    2015-01-01

    Due to the aging of the global population and the derivative increase in aging-related non-communicable diseases and their economic burden, there is an urgent need to promote research on aging and aging-related diseases as a way to improve healthy and productive longevity for the elderly population. To accomplish this goal, we advocate the following policies: 1) Increasing funding for research and development specifically directed to ameliorate degenerative aging processes and to extend healthy and productive lifespan for the population; 2) Providing a set of incentives for commercial, academic, public and governmental organizations to foster engagement in such research and development; and 3) Establishing and expanding coordination and consultation structures, programs and institutions involved in aging-related research, development and education in academia, industry, public policy agencies and at governmental and supra-governmental levels. PMID:25657847

  8. Improving education due to the need to adapt it to the requirements of the economic development and of the labor market - issues of past history and contemporary features

    Directory of Open Access Journals (Sweden)

    Cornelia Nistor

    2015-12-01

    Full Text Available Improving education has been and continues to be a necessary condition in any society. Education contributes to increase the level of civilization, to develop the individual personality, but also to increase the level of the economic development. Organization and subsequent reorganization of the Romanian education system has been pursuing desiring to adapt better it better to the labor market needs and to adapt it to the international education system. The management strategies which are applied in this area should be considered adapting it to the domestic and international labor market conditions to the new education methods and techniques, used at the international level. The new trends desiring to transform the economy into a green economy require increased investments in education, in order to train the specialists in new green areas.

  9. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Science.gov (United States)

    Phan, Pho Nh; Patel, Keyur; Bhavsar, Amar; Acharya, Vikas

    2016-01-01

    Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification) in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies - this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in other specialties and departments.

  10. Simulation of Indian summer monsoon intraseasonal oscillations in a superparameterized coupled climate model: need to improve the embedded cloud resolving model

    Science.gov (United States)

    Goswami, Bidyut B.; Mukhopadhyay, P.; Khairoutdinov, Marat; Goswami, B. N.

    2013-09-01

    The characteristic features of Indian summer monsoon (ISM) and monsoon intraseasonal oscillations (MISO) are analyzed in the 25 year simulation by the superparameterized Community Climate System Model (SP-CCSM). The observations indicate the low frequency oscillation with a period of 30-60 day to have the highest power with a dominant northward propagation, while the faster mode of MISO with a period of 10-20 day shows a stationary pattern with no northward propagation. SP-CCSM simulates two dominant quasi-periodic oscillations with periods 15-30 day and 40-70 day indicating a systematic low frequency bias in simulating the observed modes. Further, contrary to the observation, the SP-CCSM 15-30 day mode has a significant northward propagation; while the 40-70 day mode does not show prominent northward propagation. The inability of the SP-CCSM to reproduce the observed modes correctly is shown to be linked with inability of the cloud resolving model (CRM) to reproduce the characteristic heating associated with the barotropic and baroclinic vertical structures of the high-frequency and the low-frequency modes. It appears that the superparameterization in the General Circulation Model (GCM) certainly improves seasonal mean model bias significantly. There is a need to improve the CRM through which the barotropic and baroclinic modes are simulated with proper space and time distribution.

  11. Significant alterations in reported clinical practice associated with increased oversight of organ transplant center performance.

    Science.gov (United States)

    Schold, Jesse D; Arrington, Charlotte J; Levine, Greg

    2010-09-01

    In the past several years, emphasis on quality metrics in the field of organ transplantation has increased significantly, largely because of the new conditions of participation issued by the Centers for Medicare and Medicaid Services. These regulations directly associate patients' outcomes and measured performance of centers with the distribution of public funding to institutions. Moreover, insurers and marketing ventures have used publicly available outcomes data from transplant centers for business decision making and advertisement purposes. We gave a 10-question survey to attendees of the Transplant Management Forum at the 2009 meeting of the United Network for Organ Sharing to ascertain how centers have responded to the increased oversight of performance. Of 63 responses, 55% indicated a low or near low performance rating at their center in the past 3 years. Respondents from low-performing centers were significantly more likely to indicate increased selection criteria for candidates (81% vs 38%, P = .001) and donors (77% vs 31%, P < .001) as well as alterations in clinical protocols (84% vs 52%, P = .007). Among respondents indicating lost insurance contracts (31%), these differences were also highly significant. Based on respondents' perceptions, outcomes of performance evaluations are associated with significant changes in clinical practice at transplant centers. The transplant community and policy makers should practice vigilance that performance evaluations and regulatory oversight do not inadvertently lead to diminished access to care among viable candidates or decreased transplant volume.

  12. TJC: HCOs need to be on alert for HIT problems related to sociotechnical factors, take steps to improve safety culture, process, and leadership.

    Science.gov (United States)

    2015-06-01

    Noting that too many errors related to health information technology (HIT) are resulting in adverse consequences, The Joint Commission (TJC) has issued a Sentinel Event Alert, urging health care providers to take steps to improve their safety culture, approach to process improvement, and leadership in this area. In this latest alert, the accrediting agency is taking particular aim at risks posed by sociotechnical factors--or the ways in which HIT is implemented and used. Experts say that many of these risks are, in fact, exemplified at a higher level in the emergency setting, where providers are under constant pressure to see more patients and move them though the system faster. In an analysis of 3,375 sentinel events that resulted in permanent patient harm or death between January 1, 2010, and June 20, 2013, The Joint Commission (TJC) found that 120 events included HIT-related contributing factors. Many of the problems cited by TJC relate to orders or medicines being prescribed for the wrong patients. These can result from toggling errors or pop-up screens where providers are asked to click on the appropriate patient or medicine, and they mistakenly click on the wrong selection. In the ED, experts recommend the creation of a multidisciplinary performance improvement group to continuously monitor the ED information system (EDIS), recognize problems, and work with the vendor to resolve them. Also important is a quick and easy way for providers to report HIT-related problems. Experts add that emergency providers need to be fully engaged in the process of selecting HIT that they will be using, and that health care organizations should arrange for usability assessments before purchasing HIT.

  13. "I Have to Push Him with a Wheelbarrow to the Clinic": Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa.

    Science.gov (United States)

    Loeliger, Kelsey B; Niccolai, Linda M; Mtungwa, Lillian N; Moll, Anthony; Shenoi, Sheela V

    2016-08-01

    With a 19.2% HIV prevalence, South Africa has the largest HIV/AIDS epidemic worldwide. Despite a recent scale-up of public sector HIV resources, including community-based programs to expand HIV care, suboptimal rates of antiretroviral therapy (ART) initiation and adherence persist. As community stakeholders with basic healthcare training, community health workers (CHWs) are uniquely positioned to provide healthcare and insight into potential strategies to improve HIV treatment outcomes. The study goal was to qualitatively explore the self-perceived role of the CHW, unmet CHW needs, and strategies to improve HIV care in rural KwaZulu-Natal, South Africa. Focus groups were conducted in May-August 2014, with 21 CHWs working in Msinga subdistrict. Interviews were audio-recorded, transcribed, and translated from Zulu into English. A hybrid deductive and inductive analytical method borrowed from grounded theory was applied to identify emergent themes. CHWs felt they substantially contributed to HIV care provision but were inadequately supported by the healthcare system. CHWs' recommendations included: (1) sufficiently equipping CHWs to provide education, counseling, social support, routine antiretroviral medication, and basic emergency care, (2) modifying clinical practice to provide less stigmatizing, more patient-centered care, (3) collaborating with traditional healers and church leaders to reduce competition with ART and provide more holistic care, and (4) offsetting socioeconomic barriers to HIV care. In conclusion, CHWs can serve as resources when designing and implementing interventions to improve HIV care. As HIV/AIDS policy and practice evolves in South Africa, it will be important to recognize and formally expand CHWs' roles supporting the healthcare system.

  14. Needs analysis

    Institute of Scientific and Technical Information of China (English)

    黄静雅

    2009-01-01

    Though needs analysis has been seen as one of the fundamental defining characteristics of ESP,it is not unknown in GPE.it is a salient stage,especially for the task option and syllabus evaluation.In this essay,the meaning of needs,the importance of needs analysis,and the way to implement needs analysis are subject to analysis.

  15. HEALTH NEEDS

    Directory of Open Access Journals (Sweden)

    Olivera Radulovic

    2007-01-01

    Full Text Available Human needs are of great interest to different scientific fields: sociology, anthropology, psychology, medicine, economy… Malinowski, Maslow, Adler and From have largely contributed to studying the needs. While trying to define the need concept, not only one definition is acceptable. In psychology, need is defined as a lack or disorder, i.e. the necessity to dislodge this lack. It was Maslow who gave the fullest classification and explanation of human needs. If we start from the fact that need represents the lack or deficit of something, in this context health needs would indicate the lack of health, and the measurement of health needs would be the same as the measurement of health. Therefore, almost all human needs can be enumerated as health needs, i.e. those which, after being satisfied, can lead to physical, psychical and social welfare. According to WHO, health needs can be defined as scientifically settled evasions from health which require preventive, curative and probably regulative and eradicative measurements. According to the medical method used by the health service while regarding the needs, the emphasis is on morbidity, mortality, incidence, prevalence, inability, etc. Usually, when we have very low level of health culture, and the responsibility for personal health is in most of the cases unacceptable, for the health service user the curative services will have priority over preventive ones. The measurement of health needs is a complex task. The needs can be regarded through medical documentation and by perception of the needs by people in the community.

  16. Conceptualisation of socio-technical integrated information technology solutions to improve incident reporting through Maslow's hierarchy of needs: a qualitative study of junior doctors.

    Science.gov (United States)

    Yee, Kwang Chien

    2007-01-01

    Medical errors are common, especially within the acute healthcare delivery. The identification of systemic factors associated with adverse events and the construction of models to improve the safety of the healthcare system seems straightforward, this process has been proven to be much more difficult in the realism of medical practice due to the failure of the incident reporting system to capture the essential information, especially from the perspective of junior doctors. The failure of incidence reporting system has been related to the lack of socio-technical consideration for both system designs and system implementations. The main reason of non-reporting can be conceptualised through the motivation psychology model: Maslow's hierarchy of needs; in order to achieve a change in the socio-cultural domain for incident reporting. This paper presents a qualitative research methodology approach to generate contextual-rich insights into the socio-cultural and technological factors of incident reporting among junior doctors. The research illuminates the guiding principles for future socio-technical integrated information communication technology designs and implementations. Using Maslow's hierarchy of needs as the conceptual framework, the guiding principles aim to design electronic incident reporting systems which will motivate junior doctors to participate in the process. This research paper aims to make a significant contribution to the fields of socio-technical systems and medical errors management. The design and implementation of the new incident reporting system has great potential to motivate junior doctors to change the culture of incident reporting and to work towards a safer future healthcare system.

  17. Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction?

    Directory of Open Access Journals (Sweden)

    Phan PN

    2016-03-01

    Full Text Available Pho NH Phan,1 Keyur Patel,2 Amar Bhavsar,3 Vikas Acharya4 1Warwick Medical School, University of Warwick, Coventry, 2Luton and Dunstable University Hospital, Luton, 3Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, 4Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK Abstract: Junior doctors go through a challenging transition upon qualification; this repeats every time they start a rotation in a new department. Foundation level doctors (first 2 years postqualification in neurosurgery are often new to the specialty and face various challenges that may result in significant workplace dissatisfaction. The neurosurgical environment is a clinically demanding area with a high volume of unwell patients and frequent emergencies – this poses various barriers to learning in the workplace for junior doctors. We identify a number of key barriers and review ideas that can be trialed in the department to overcome them. Through an evaluation of current suggestions in the literature, we propose that learning opportunities need to be made explicit to junior doctors in order to encourage them to participate as a member of the team. We consider ideas for adjustments to the induction program and the postgraduate medical curriculum to shift the focus from medical knowledge to improving confidence and clinical skills in newly qualified doctors. Despite being a powerful window for opportunistic learning, the daily ward round is unfortunately not maximized and needs to be more learner focused while maintaining efficiency and time consumption. Finally, we put forward the idea of an open forum where trainees can talk about their learning experiences, identify subjective barriers, and suggest solutions to senior doctors. This would be achieved through departmental faculty development. These interventions are presented within the context of the neurosurgical ward; however, they are transferable and can be adapted in

  18. Systematic Quality Improvement in Medicine: Everyone Can Do It

    Directory of Open Access Journals (Sweden)

    Mark L. Zeidel

    2011-07-01

    Full Text Available In this brief review, written from the perspective of a physician-leader who has fostered the development of comprehensive quality improvement efforts at two academic medical centers, I review the need for improvement, some conceptual barriers that must be overcome, the goals of a comprehensive quality improvement (QI effort, some of the results we have obtained, and some observations on how to develop a culture of continuous improvement in an academic medical center. The mandate for quality improvement is clear; current healthcare is wasteful and error-prone, leading to excessive morbidity and mortality and unsustainably high costs. Successful quality improvement requires the abandonment of two paradigms: the craft model of medical practice and the notion that many forms of harm to patients are not preventable. I will describe how dramatic improvement has been achieved in reducing, by up to 10-fold, rates of central line infections, ventilator-associated pneumonias, peritonitis in peritoneal dialysis patients, and mortality due to cardiac arrest in hospital. I will describe as well how these methods can improve access to out-patient clinics dramatically and enhance the reliability and safety of hand-offs between covering physicians. To develop and maintain systematic quality improvement in all phases of medical care we must articulate a culture in which: everyone working at the medical center makes improvements every day; front-line staff, who know best how the work is done, are empowered to improve the processes of care; and multidisciplinary teams create the protocols that reduce variation that is due to physician preference, leaving only the variation required by the individual needs of patients. I will review as well the crucial elements of education of trainees and faculty members needed to guide and sustain a culture of quality. Finally, I will add some observations on how oversight boards and medical center leaders can help create

  19. Electronic Health Records: VA and DOD Need to Establish Goals and Metrics for Their Interoperability Efforts

    Science.gov (United States)

    2015-10-27

    ELECTRONIC HEALTH RECORDS VA and DOD Need to Establish Goals and Metrics for Their Interoperability Efforts Statement of...COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Electronic Health Records : VA and DOD Need to Establish Goals and Metrics for Their...Subcommittee on Oversight and Investigations, Committee on Veterans’ Affairs, House of Representatives October 27, 2015 ELECTRONIC HEALTH RECORDS

  20. Measuring needs

    Directory of Open Access Journals (Sweden)

    Laura Murianni

    2008-06-01

    Full Text Available The interest in measuring the health of populations, through measuring the demand and offers of health care, is deeply rooted in history. Population health indicators in use today are built upon from mortality measures from the 1500s; regular census information starting from the 1800s; civil registration records of vital statistics commencing in the 1850s; regular national surveys, which were first initiated in the 1950s; and health system and other administrative databases used widely since the 1960s. The ancient Greeks believed that the God of medicine had two daughters: Hygeia and Panacea, the first was the goddess of prevention and wellness, while the second was the goddess of treatment. Thus suggesting that people have long believed that there is more to health than health care. Today the actual concept of population health recognizes many interconnected aspects of society, the environment, and individuals all contributing to health. To increase opportunities for comparability, more valid, comprehensive and standardized ways of measuring and reporting on population health indicators are needed. The use of health indicators contributes to overall population health goals, namely improving the health populations, reducing health inequalities and measuring the performance of health care system. The objective of performance assessment is to provide governments and populations with information about the state of their health care system.

  1. 76 FR 40950 - Public Company Accounting Oversight Board; Notice of Filing of Proposed Board Funding Final Rules...

    Science.gov (United States)

    2011-07-12

    ... COMMISSION Public Company Accounting Oversight Board; Notice of Filing of Proposed Board Funding Final Rules for Allocation of the Board's Accounting Support Fee Among Issuers, Brokers, and Dealers, and Other... 2002 (the ``Act''), notice is hereby given that on June 21, 2011, the Public Company...

  2. 78 FR 12369 - United States Government Policy for Institutional Oversight of Life Sciences Dual Use Research of...

    Science.gov (United States)

    2013-02-22

    ... Public comments are sought on the entirety of the proposed United States Government Policy for... TECHNOLOGY POLICY United States Government Policy for Institutional Oversight of Life Sciences Dual Use... responsible conduct and communication of such research. The proposed Policy herein, United States...

  3. 78 FR 39021 - Privacy Act of 1974; Privacy and Civil Liberties Oversight Board; System of Records Notice

    Science.gov (United States)

    2013-06-28

    ... Request Files''. DATES: Written comments should be submitted on or before July 29, 2013. This new system... proposed creation of a system of records for FOIA and Privacy Act case files. SYSTEM OF RECORDS PCLOB--1, Freedom of Information Act and Privacy Act Files. SYSTEM NAME: Privacy and Civil Liberties Oversight...

  4. The World Bank Inspection Panel and Quasi-Judicial Oversight: In Search of the 'Judicial Spirit' in Public International Law

    NARCIS (Netherlands)

    A. Naudé Fourie (Andria)

    2009-01-01

    textabstractThis PhD dissertation conceptualizes the World Bank Inspection Panel as a mechanism of quasi-judicial review or oversight, aimed at enhancing the accountability and legitimacy of the World Bank – which is conceived as an international institution exercising public power. The author engag

  5. 78 FR 48173 - Guidance for Industry on Oversight of Clinical Investigations-A Risk-Based Approach to Monitoring...

    Science.gov (United States)

    2013-08-07

    ... Investigations--A Risk-Based Approach to Monitoring; Availability AGENCY: Food and Drug Administration, HHS... guidance for industry entitled ``Oversight of Clinical Investigations--A Risk-Based Approach to Monitoring.'' This guidance assists sponsors in developing risk-based monitoring strategies and plans for...

  6. 20 CFR 645.245 - Who is responsible for oversight and monitoring of Welfare-to-Work grants?

    Science.gov (United States)

    2010-04-01

    ... monitoring of Welfare-to-Work grants? 645.245 Section 645.245 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROVISIONS GOVERNING WELFARE-TO-WORK GRANTS General Program and Administrative Requirements § 645.245 Who is responsible for oversight and monitoring of Welfare-to-Work...

  7. Better Planning and Oversight Could Have Reduced Construction Delays and Costs at the Kabul Military Training Center

    Science.gov (United States)

    2011-10-26

    Representative CSTC-A Combined Security Transition Command - Afghanistan DNC Discrepancy and Non-Compliance DPW Department of Public Works ECC ECC...Discrepancy and Non-Compliance ( DNC ) log, stating that SIGAR Audit-12-2 Contractor Performance and Oversight / Kabul Military Training Center Page 15

  8. Hybrid library that satisfies the needs of all the citizens! ; Improving the library service through cooperation of higher-education institution libraries and public libraries ; Enthusiasm of Mr. Yasuhiro Nagata, chief librarian of Fukui prefectural library and the staff

    Science.gov (United States)

    Morita, Utako

    Hybrid library that satisfies the needs of all the citizens! ; Improving the library service through cooperation of higher-education institution libraries and public libraries ; Enthusiasm of Mr. Yasuhiro Nagata, chief librarian of Fukui prefectural library and the staff

  9. Nonverbal contention and contempt in U.K. parliamentary oversight hearings on fiscal and monetary policy.

    Science.gov (United States)

    Schonhardt-Bailey, Cheryl

    2017-01-01

    In parliamentary committee oversight hearings on fiscal policy, monetary policy, and financial stability, where verbal deliberation is the focus, nonverbal communication may be crucial in the acceptance or rejection of arguments proffered by policymakers. Systematic qualitative coding of these hearings in the 2010-15 U.K. Parliament finds the following: (1) facial expressions, particularly in the form of anger and contempt, are more prevalent in fiscal policy hearings, where backbench parliamentarians hold frontbench parliamentarians to account, than in monetary policy or financial stability hearings, where the witnesses being held to account are unelected policy experts; (2) comparing committees across chambers, hearings in the House of Lords committee yield more reassuring facial expressions relative to hearings in the House of Commons committee, suggesting a more relaxed and less adversarial context in the former; and (3) central bank witnesses appearing before both the Lords and Commons committees tend toward expressions of appeasement, suggesting a willingness to defer to Parliament.

  10. Unfinished business: ongoing ethical exceptionalism in the oversight of human pluripotent stem cell research in Canada.

    Science.gov (United States)

    Baylis, Françoise; Downie, Jocelyn

    2012-01-01

    In this article, we critically examine the arguments for and against the exceptional status given human pluripotent stem cell research in Canada (through the latest [December 2010] revision of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans), and conclude that this exceptionalism is unwarranted and ethically unsound. In our view, the three federal research granting agencies should honor their longstanding commitment that researchers, research sponsors, and Research Ethics Boards in Canada have access to "a single reference document for all research involving humans conducted under the auspices of institutions eligible for Agency funding." As well, responsibility for the development, interpretation, and implementation of Canada's research ethics guidelines should be under the authority of a single oversight body that is independent of the federal research granting Agencies.

  11. Governmental oversight of prescribing medications: history of the US Food and Drug Administration and prescriptive authority.

    Science.gov (United States)

    Plank, Linda S

    2011-01-01

    The evolution of drug regulation and awarding of prescriptive authority is a complex and sometimes convoluted process that can be confusing for health care providers. A review of the history of how drugs have been manufactured and dispensed helps explain why this process has been so laborious and complicated. Because the federal and state governments have the responsibility for protecting the public, most regulations have been passed with the intentions of ensuring consumer safety. The current system of laws and regulations is the result of many years of using the legal system to correct drug marketing that had adverse health consequences. Government oversight will continue as prescribing medications transitions to an electronic form and as health care professionals in addition to physicians seek to gain prescriptive authority.

  12. Tennessee Oversight Agreement annual report, May 13, 1993--May 12, 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-09-01

    This report discusses the activities of the Division of DOE Oversight in the areas of coordination with other State Agencies with regard to environmental restoration, corrective action, and waste management activities on the Oak Ridge Reservation; and the Division`s efforts to keep the public informed of those DOE activities that may impact their health and the environment. This report includes the status of the Division`s efforts in implementing the Tennessee Oversight Agreement (TOA). Each Program Section provides information concerning the status of its activities. The Administrative Section has been instrumental in achieving access to the ORR without prior notification to DOE and in obtaining documents and environmental, waste management, safety, and health information in a timely manner. The Environmental Restoration Program has provided in-depth document reviews and on-site coordination and monitoring of field activities required under the Federal Facility Agreement. Most notable of the activities are the investigations and planned remediation of the Lower East Fork Poplar Creek and the Watts Bar Reservoir. The Waste Management Program has audited DOE`s compliance with air, water, solid, hazardous, and mixed waste storage, treatment, and disposal regulations. Effort was focused on all three DOE Facilities on the ORR. The final portion of this report discusses the Division`s findings and recommendations. Most significant of these issues is the Division`s request to be an active participant in DOE`s prioritization of its TOA commitments. Other issues discussed include long term storage of radioactive waste and the use of environmental restoration funds. A discussion of those findings and recommendations provided in last year`s annual report and addressed by DOE are included in this report as well. All documents, logs, files, etc. supporting this report are available for review during routine business hours at the Division`s office.

  13. A social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi

    Directory of Open Access Journals (Sweden)

    Alain K. Koffi

    2015-06-01

    ANC visits, and ensure urine screening for all pregnant women. Early recognition and referrals of women with obstetric complications and interventions to promote maternal recognition of neonatal illnesses and care–seeking before the child becomes severely ill are also needed to improve newborn survival in Balaka and Salima districts of Malawi.

  14. Assessing the need for improved strategies and medication-related education to increase adherence for oral anticancer medications in the young adult oncology population.

    Science.gov (United States)

    Divakaruni, Anupama; Saylor, Elizabeth; Duffy, Alison P

    2017-01-01

    Rationale Oral anticancer medication adherence is a critical factor in optimizing cancer treatment outcomes and minimizing toxicity. Although potential adherence barriers exist, it is not well understood how these factors impact adherence. Methods This is a prospective, single-center, patient survey-based study conducted at the University of Maryland Greenebaum Comprehensive Cancer Center including 18- to 39-year-old patients who have been actively taking an oral anticancer medication for at least one month from 1 April 2013 to 1 April 2016. The primary objective of this study is to describe institutional practices for medication education and adherence monitoring practices as perceived by young adult patients at the University of Maryland Greenebaum Comprehensive Cancer Center and to describe practice consistency with recommendations from the American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards. The secondary objectives include patient-reported facilitators and barriers to oral anticancer medication adherence. Results Seventeen patients completed the survey; 24% ( n = 4) of patients denied receiving information about what to do in case of a missed dose. The most common facilitators of adherence include understanding of disease and treatment (88%, n = 15), perceived severity of illness (82%, n = 14), and use of oral anticancer medications (82%, n = 14). The most common barriers to adherence are side effects (59% n = 10), forgetfulness (47%, n = 8), and depressive symptoms (35%, n = 6). Conclusion Based on patient-reported guideline adherence, improvement is needed in including family, caregivers, and others in the education process as well as providing education about plan for missed doses and drug-drug and drug-food interactions. The strengths of the current medication education and adherence monitoring practices as perceived by the young adult patient population include education

  15. The Essential Need for Research Misconduct Allegation Audits.

    Science.gov (United States)

    Loikith, Lisa; Bauchwitz, Robert

    2016-08-01

    Nearly 90 % of allegations of biomedical research misconduct in the United States are dismissed by responsible institutions without any faculty assessment or auditable record. Recently, members of the U.S. Congress have complained that the penalties for those against whom findings of research misconduct are made are too light and that too few grant funds associated with research misconduct have been recovered for use by other researchers and taxpayers. Here we discuss the laws that empower federal agencies that can oversee investigations of biomedical research misconduct: the Office of Research Integrity (ORI) and the Office of the Inspector General (OIG), both located within the Department of Health and Human Services (HHS). Research misconduct investigations pertaining to U.S. physical sciences funded through the National Science Foundation (NSF) are overseen by the NSF's OIG. While OIGs may provide some improvement over the ORI in the handling of research misconduct, we have found that a much more serious flaw exists which undermines an ability to conduct performance audits of the effectiveness by which allegations of research misconduct are handled in the United States. Specifically, sufficient data do not need to be retained by U.S. research institutions funded by HHS or NSF to allow effective audit of why allegations of research misconduct are dismissed before being seen by faculty inquiry or investigative committees. U.S. federal Generally Accepted Government Auditing Standards (GAGAS/Yellow Book), if applied to the research misconduct oversight process, would allow a determination of whether the handling of allegations of biomedical research misconduct actually functions adequately, and if not, how it might be improved. In particular, we propose that independent, external peer review under GAGAS audit standards should be instituted without delay in assessing the performance of ORI, or any other similarly tasked federal agency, in handling allegations of

  16. Sustaining School Improvement through an External and Internal Focus: A Case Study of a High-Need Secondary School in Nepal

    Science.gov (United States)

    Gautam, Chetanath; Alford, Betty J.; Khanal, Manju

    2015-01-01

    A study of a high-need school in Nepal was conducted by members of the International School Leadership Development Network (ISLDN) using the interview protocol developed by members of the high-need school strand of ISLDN. The International School Leadership Development Network is sponsored by the University Council for Educational Administration…

  17. Experiencing the Needs and Challenges of ELLs: Improving Knowledge and Efficacy of Pre-Service Teachers through the Use of a Language Immersion Simulation

    Science.gov (United States)

    Wright-Maley, Cory; Green, Jennifer D.

    2015-01-01

    Pre-service teachers need to understand how to support ELLs in their future classrooms, yet evidence suggests that pre-service ELL training may not be as effective as we need it to be. One promising strategy for increasing pre-service teachers' efficacy and knowledge around teaching ELLs is through a shock-and-show simulation. This strategy…

  18. 1992 Annual performance report for Environmental Monitoring and Oversight at Department of Energy facilities in New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    1992-12-31

    In October 1990 an Agreement-in-Principle (AIP) was entered into between the US Department of Energy (DOE) and the State of New Mexico for the purpose of supporting State oversight activities at DOE facilities in New Mexico. The State`s lead agency for the Agreement is the New Mexico Environment Department (NMED). DOE has agreed to provide the State with resources over a five year period to support State activities in environmental oversight, monitoring, access and emergency response to ensure compliance with applicable federal, state, and local laws at Los Alamos National Laboratory (LANL), Sandia National Laboratories (SNL), the Waste Isolation Pilot Plant (WIPP), and the Inhalation Toxicology Research Institute (ITRI). The Agreement is designed to assure the citizens of New Mexico that public health, safety and the environment are being protected through existing programs; DOE is in compliance with applicable laws and regulations; DOE has made substantial new commitments; cleanup and compliance activities have been prioritized; and a vigorous program of independent monitoring and oversight by the State is underway. This report relates the quality and effectiveness of the facilities` environmental monitoring and surveillance programs. This report satisfies that requirement for the January--December 1992 time frame.

  19. Comparison of Management Oversight and Risk Tree and Tripod-Beta in Excavation Accident Analysis

    Directory of Open Access Journals (Sweden)

    Mohamadfam

    2015-01-01

    Full Text Available Background Accident investigation programs are a necessary part in identification of risks and management of the business process. Objectives One of the most important features of such programs is the analysis technique for identifying the root causes of accidents in order to prevent their recurrences. Analytical Hierarchy Process (AHP was used to compare management oversight and risk tree (MORT with Tripod-Beta in order to determine the superior technique for analysis of fatal excavation accidents in construction industries. Materials and Methods MORT and Tripod-Beta techniques were used for analyzing two major accidents with three main steps. First, these techniques were applied to find out the causal factors of the accidents. Second, a number of criteria were developed for the comparison of the techniques and third, using AHP, the techniques were prioritized in terms of the criteria for choosing the superior one. Results The Tripod-Beta investigation showed 41 preconditions and 81 latent causes involved in the accidents. Additionally, 27 root causes of accidents were identified by the MORT analysis. Analytical hierarchy process (AHP investigation revealed that MORT had higher priorities only in two criteria than Tripod-Beta. Conclusions Our findings indicate that Tripod-Beta with a total priority of 0.664 is superior to MORT with the total priority of 0.33. It is recommended for future research to compare the available accident analysis techniques based on proper criteria to select the best for accident analysis.

  20. Addressing conflicts of interest in nanotechnology oversight: lessons learned from drug and pesticide safety testing

    Science.gov (United States)

    Elliott, Kevin C.; Volz, David C.

    2012-01-01

    Financial conflicts of interest raise significant challenges for those working to develop an effective, transparent, and trustworthy oversight system for assessing and managing the potential human health and ecological hazards of nanotechnology. A recent paper in this journal by Ramachandran et al., J Nanopart Res, 13:1345-1371 (2011) proposed a two-pronged approach for addressing conflicts of interest: (1) developing standardized protocols and procedures to guide safety testing; and (2) vetting safety data under a coordinating agency. Based on past experiences with standardized test guidelines developed by the international Organization for Economic Cooperation and Development (OECD) and implemented by national regulatory agencies such as the U.S. Environmental Protection Agency (EPA) and Food and Drug Administration (FDA), we argue that this approach still runs the risk of allowing conflicts of interest to influence toxicity tests, and it has the potential to commit regulatory agencies to outdated procedures. We suggest an alternative approach that further distances the design and interpretation of safety studies from those funding the research. In case the two-pronged approach is regarded as a more politically feasible solution, we also suggest three lessons for implementing this strategy in a more dynamic and effective manner.

  1. Albinism: Improving Teacher and Caregiver Strategies for Meeting the Special Needs of Children with the Visual Disability of Ocular Albinism or Oculocutaneous Albinism (Birth to Age 14).

    Science.gov (United States)

    Ashley, Julia Robertson

    This practicum report addresses the educational needs of students with the visual disability of ocular or oculocutaneous albinism. Two booklets were developed, published, and distributed--one for regular education teachers of children with albinism and one specifically about the very young child with albinism. The booklets discuss the special…

  2. Investigating the Effectiveness of an Arts-Based and Mindfulness-Based Group Program for the Improvement of Resilience in Children in Need

    Science.gov (United States)

    Coholic, Diana; Eys, Mark; Lougheed, Sean

    2012-01-01

    We discuss preliminary findings from a study that investigated the effectiveness of a Holistic Arts-Based Group Program (HAP) for the development of resilience in children in need. The HAP teaches mindfulness using arts-based methods, and aims to teach children how to understand their feelings and develop their strengths. We assessed the…

  3. Intervening to improve teachers’ need-supportive behaviour using Self-Determination Theory : Its effects on teachers and on the motivation of students with deafblindness

    NARCIS (Netherlands)

    Haakma, Ineke; Janssen, Marleen; Minnaert, Alexander

    2017-01-01

    Research on Self-Determination Theory has shown that teachers’ need-supportive behaviour is associated with student motivation and engagement. The purpose of this study is to examine the effectiveness of an intervention aimed at increasing the motivation of students with congenital and acquired

  4. Intervening to improve teachers’ need-supportive behaviour using Self-Determination Theory : Its effects on teachers and on the motivation of students with deafblindness

    NARCIS (Netherlands)

    Haakma, Ineke; Janssen, Marleen; Minnaert, Alexander

    2017-01-01

    Research on Self-Determination Theory has shown that teachers’ need-supportive behaviour is associated with student motivation and engagement. The purpose of this study is to examine the effectiveness of an intervention aimed at increasing the motivation of students with congenital and acquired deaf

  5. Identifying needs and improving palliative care of chronically ill patients: a community-oriented, population-based, public-health approach.

    Science.gov (United States)

    Gómez-Batiste, Xavier; Martínez-Muñoz, Marisa; Blay, Carles; Espinosa, Jose; Contel, Joan C; Ledesma, Albert

    2012-09-01

    We describe conceptual innovations in palliative care epidemiology and the methods to identify patients in need of palliative care, in all settings.In middle-high-income countries, more than 75% of the population will die from chronic progressive diseases. Around 1.2-1.4% of such populations suffer from chronic advanced conditions, with limited life expectancy. Clinical status deteriorates progressively with frequent crises of needs, high social impact, and high use of costly healthcare resources. The innovative concept of patients with advanced chronic diseases and limited life prognosis has been addressed recently, and several methods to identify them have been developed. The challenges are to promote early and shared interventions, extended to all patients in need, in all settings of the social care and healthcare systems; to design and develop Palliative Care Programmes with a Public Health perspective. The first action is to identify, using the appropriate tools early in the clinical evolution of the disease, all patients in need of palliative care in all settings of care, especially in primary care services, nursing homes, and healthcare services responsible for care provision for these patients; to promote appropriate care in patients with advanced diseases with prognosis of poor survival.

  6. Exploring the Feasibility and Benefits of Arts-Based Mindfulness-Based Practices with Young People in Need: Aiming to Improve Aspects of Self-Awareness and Resilience

    Science.gov (United States)

    Coholic, Diana A.

    2011-01-01

    Research in mindfulness-based methods with young people is just emerging in the practice/research literature. While much of this literature describes promising approaches that combine mindfulness with cognitive-behavioral therapy, this paper describes an innovative research-based group program that teaches young people in need mindfulness-based…

  7. The dynamic system of parental work of care for children with special health care needs: A conceptual model to guide quality improvement efforts

    Directory of Open Access Journals (Sweden)

    Hexem Kari R

    2011-10-01

    Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.

  8. The Air Force Processes for Approving Air Force Life Cycle Management Center Single-Award Indefinite-Delivery Indefinite-Quantity Contracts Need Improvement

    Science.gov (United States)

    2016-04-29

    IDIQ contract may be used to acquire supplies and services when the exact times and quantities of future deliveries are not known at the time of...Force Processes for Approving Air Force Life Cycle Management Center Single‑Award Indefinite‑ Delivery Indefinite‑Quantity Contracts Need...0147.000) │ i Results in Brief The Air Force Processes for Approving Air Force Life Cycle Management Center Single-Award Indefinite- Delivery Indefinite

  9. Experiencing the needs and challenges of ELLs: Improving knowledge and efficacy of pre-service teachers through the use of a language immersion simulation

    Directory of Open Access Journals (Sweden)

    Cory Wright-Maley

    2015-12-01

    Full Text Available Pre-service teachers need to understand how to support ELLs in their future classrooms, yet evidence suggests that pre-service ELL training may not be as effective as we need it to be. One promising strategy for increasing pre-service teachers’ efficacy and knowledge around teaching ELLs is through a shock-and-show simulation. This strategy incorporates a Swedish-language immersion experience that simulates what it may like to be an ELL and the strategies that can help support these students. There were two phases: a lesson with limited scaffolding (shock and an extensively scaffolded lesson (show. Our participants included 87 pre-service teachers who filled out pre- and post-surveys, including closed- and open-ended questions. t-Tests were used to determine whether differences in the scores from the two surveys were significant. We analyzed qualitative data using an interpretive approach to the development of codes, categories, and themes, which we triangulated with descriptive statistics to describe the frequency of the emergent codes. Our findings suggest that shock-and-show experiences may benefit pre-service teachers’ knowledge and efficacy around ELL instruction. We theorize that the emotional component of the experience connected to the cognitive aspects may help foster greater learning among pre-service teachers concerning the difficulties and needs of ELLs.

  10. Off with their heads: the need to criminalize some forms of scientific misconduct.

    Science.gov (United States)

    Redman, Barbara K; Caplan, Arthur L

    2005-01-01

    Improvement in policy for the management of scientific misconduct has been slow. While assurance of due process at the ORI level is now in place, similar protections at the institutional level and institutional responsibility for further oversight and a workplace where the responsible conduct of research can be practiced have not yet been addressed. In contrast, policy regarding human subject protection has evolved rapidly to reflect firmer norms, with decisive priority given to subject protection over scientific or social needs. Perhaps because scientific misconduct policy has the potential to harm the careers of individual scientists and harms to individual subjects are thought to be indirect, the scientific community has been successful in blocking every move toward testing more rigorous regulation. The mantras that scientists can discipline their own, and the price of competitive science is some level of scientific misconduct are not persuasive. The standards by which science is judged should not be an exception to those governing others who deal with the public's money and have a duty to the public interest.

  11. TEACHER NEEDED

    CERN Multimedia

    2002-01-01

    Part-time teacher of primary English needed from 1st December 2002 to teach English National Curriculum (KS2) and NLS to mother tongue or good second language English-speakers aged 7-10. 4 hours contact time per week, team planning, marking and meetings. Candidates should be English mother tongue qualified teachers, confident, flexible classroom practitioners and team players. For further details and how to apply: engnat@hotmail.com or 04 50 40 82 66. Apply as soon as possible, and in any case before November 20th. English National Programme - Lycée International, Ferney-Voltaire

  12. TEACHERS NEEDED

    CERN Multimedia

    2001-01-01

    The English Language Programme of the Lycée International de Ferney-Voltaire has two teaching posts available for la rentrée 2001. 1. Part-time teacher of Primary-level English Candidates for the post need to be mother-tongue English speakers. They should have a relevant degree and teaching qualification. The post involves teaching the English curriculum to pupils who are within the French educational system. Classes take place on Tuesday afternoons at the Lycée. Team spirit necessary as teachers work as a team. Induction & training are offered. 2. Part-time teacher of Secondary-level history-geography Candididates for the post need to be mother-tongue English speakers. They should have a relevant degree in history or geography and also a strong interest in the other subject. They should have a relevant teaching qualification and be confident classroom practioners. For more information on either of these posts please contact the school office on 04.50.40.82...

  13. A Citation Tracking System to Facilitate Sponsoring Institution Oversight of ACGME-Accredited Programs.

    Science.gov (United States)

    Long, Timothy R; Poe, John D; Zimmerman, Richard S; Rose, Steven H

    2012-12-01

    The Accreditation Council for Graduate Medical Education (ACGME) requires the graduate medical education committee and the designated institutional official to ensure that citations for noncompliance with the accreditation standards and institutional trends in citations are reviewed and corrected. To describe a citation tracking system (CTS) that uses Microsoft Office Access to efficiently catalogue, monitor, and document resolution of citations. The CTS was implemented in a sponsoring institution with oversight of 133 ACGME-accredited programs. The designated institutional official and the graduate medical education committee review all program letters of notification and enter citations into the CTS. A program-correction plan is required for each citation and is entered into the database. Open citations and action plans are reviewed by the graduate medical education committee and the designated institutional official on a quarterly basis, with decisions ranging from "closing" the citation to approving the action plan in process to requiring a new or modified action plan. Citation categories and subcategories are accessed on the ACGME website and entered into the CTS to identify trends. All 236 citations received since the 2006 Mayo School of Graduate Medical Education institutional site visit were entered into the CTS. On November 22, 2011, 26 of 236 citations (11%) were in active status with ongoing action plans, and 210 (89%) citations had been resolved and were closed. The CTS uses commercially available software to ensure citations are monitored and addressed and to simplify analysis of citation trends. The approach requires minimal staff time for data input and updates and can be performed without institutional information technology assistance.

  14. Should We Enhance the Observing Systems or Improve Coordination Among the Operating Agencies: What is Needed the Most for Security--A Philosophical Discussion

    Science.gov (United States)

    Habib, Shahid

    2006-01-01

    As an integrated observing strategy, the concept of sensorweb for Earth observations is appealing in many aspects. For instance, by increasing the spatial and temporal coverage of observations from space and other vantage points, one can eventually aid in increasing the accuracy of the atmospheric models which are precursor to hurricane track prediction, volcanic eruption forecast, and trajectory path of transcontinental transport of dust, harmful nuclear and chemical plumes. In reality, there is little analysis available in terms of benefits, costs and optimized set of sensors needed to make these necessary observations. This is a complex problem that must be carefully studied and balanced over many boundaries such as science, defense, early warning, security, and surveillance. Simplistically, the sensorweb concept from the technological point of view alone has a great appeal in the defense, early warning and security applications. In fact, it can be relatively less expensive in per unit cost as opposed to building and deploying it for the scientific use. However, overall observing approach should not be singled out and aligned somewhat orthogonally to serve a particular need. On the other hand, the sensorweb should be designed and deployed to serve multiple subject areas and customers simultaneously; and can behave as directed measuring systems for both science and operational entities. Sensorweb can be designed to act as expert systems, and/or also provide a dedicated integrated surveillance network. Today, there is no system in the world that is fully integrated in terms of reporting timely multiple hazards warnings, computing the loss of life and property damage estimates, and is also designed to cater to everyone's needs. It is not an easier problem to undertake and more so is not practically solvable. At this time due to some recent events in the world, the scientific community, social scientists, and operational agencies are more cognizant and getting

  15. Improving Flexibility and Accessibility of Higher Education with Web 2.0 Technologies: Needs Analysis of Public Health Education Programs in Bulgaria

    Directory of Open Access Journals (Sweden)

    I. Sarieva

    2011-12-01

    Full Text Available The case study presented in this paper aims to address the issues related to the use of Web 2.0 technology in public health education in a particular college in Bulgaria in relation to providing flexible and accessible education consistent with the current trends in public health practices. The outcomes of the case study suggest that systematic steps are needed in order to assure effective inclusion of technology into the learning process; these steps include the completion of systematic studies of attrition rate and the reasons for student drop-out, training of administration and faculty members in effective incorporation of Web 2.0 technologies, introduction and promotion of Medicine 2.0 practices, and initiating the planning of design and development of Web 2.0 learning applications and environments in Bulgarian which is the language of instruction.

  16. Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

    Science.gov (United States)

    Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

    2017-02-01

    To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

  17. Targeting Health Care Through Preventive Work - A study of the impact of social distance on professionals’ judgments of children and families’ need of health improvements

    DEFF Research Database (Denmark)

    Møller, Marie Østergaard

    2013-01-01

    care access. The political response has been to target health services to ‘those in need of special care’ through a more intense focus on prevention. The idea is to prevent illness instead of curing it. I study the impact of these new rules on the frontline level where home nurses, pedagogues......It is widely recognized that health care is in a state of crisis. Increased public spending and a decline in support towards poor-resourced people dominate as standard explanations. In Denmark, a welfare state with universal health care, the crisis has led to an adjustment of the universal health...... and teachers interact with children and their families. A study shows that frontline workers think differently about whom to prevent from what, when and why. The degree of social distance as well as professional norms explain part of the variation in worries towards children and families, but the impact...

  18. Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

    Science.gov (United States)

    Garbers, Samantha; Heck, Craig J; Gold, Melanie A; Santelli, John S; Bersamin, Melina

    2017-01-01

    School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ(2), p LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

  19. STAFF NEEDED

    CERN Multimedia

    2001-01-01

    The English National Programme, part of the Lycée International de Ferney-Voltaire (France) needs the following staff for September 2001: A part-time teacher of primary English The post involves teaching the English curriculum to pupils who are within the French educational system: Classes take place on Tuesday afternoons at the Lycée, Team spirit necessary as teachers work as a team, Induction & training are offered. A part time teacher of senior secondary history-geography in English A part time teacher of secondary mathematics in English Teachers must be mother-tongue English speakers and have a relevant degree and/or teaching qualification. For the history-geography post, either history or geography degrees are acceptable. Please send your c.v. and a letter of application to Peter Woodburn, Head, English National Programme, Lycée International, 01216 Ferney-Voltaire, France. (Email: engnat@hotmail.com) Telephone 04 50 40 82 66 for further details of posts. Ple...

  20. 加强会计监督的法律思考%Legal Thinking of Strengthen Accounting Oversight

    Institute of Scientific and Technical Information of China (English)

    杨沫

    2011-01-01

    Accounting supervision as one of the basic functions of accounting,in accordance with national laws and policies of various financial,regulatory oversight of accounting practice,the use of proper accounting information on economic activities of a comprehensive,integrated coordination,control,supervision,and supervision to achieve greater economic efficiency.The orderly functioning of the market economy can not do without accounting supervision.Now,with the deepening of economic reform,but also requires a strong accounting supervision.However,for various reasons,showing a weakening trend of the accounting oversight,resulting in the economic sphere and the economic behavior of non-standard criminal after another,therefore,to strengthen accounting oversight becomes increasingly important.%会计监督作为会计的基本职能之一,是依照国家法律和各项财经政策、规章制度对会计工作实行的监督,其利用正确的会计信息对经济活动进行全面、综合地协调、控制、监督、督促,以达到提高经济效益的目的。市场经济的有序运作离不开会计监督。目前,随着经济体制改革的深化,更需要强有力的会计监督。然而,由于种种原因,会计监督呈现出弱化态势,致使经济领域中不规范的经济行为与违法犯罪层出不穷,因此,强化会计监督就显得日益重要。

  1. Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy

    Directory of Open Access Journals (Sweden)

    West Cheri E

    2011-06-01

    Full Text Available Abstract Background This study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC placement had on institution-wide central line associated bloodstream infections (CLABSI. We therefore investigated the rate of CLABSI per 1,000 line days during the 12 months before and after implementation of the policy. Methods This is a retrospective analysis of prospectively collected data at an academic medical center with four adult ICUs and a pediatric ICU. All patients undergoing non-tunneled CVC placement were included in the study. Data was collected on CLABSI, line days, and serious adverse events in the year prior to and following policy implementation on 9/01/08. Results A total of 813 supervised central lines were self-reported by residents in four departments. Statistical analysis was performed using paired Wilcoxon signed rank tests. There were reductions in median CLABSI rate (3.52 vs. 2.26; p = 0.015, number of CLBSI per month (16.0 to 10.0; p = 0.012, and line days (4495 vs. 4193; p = 0.019. No serious adverse events reported to the Pennsylvania Patient Safety Authority. Conclusions Implementation of a new CVC resident oversight and credentialing policy has been significantly associated with an institution-wide reduction in the rate of CLABSI per 1,000 central line days and total central line days. No serious adverse events were reported. Similar resident oversight policies may benefit other teaching institutions, and support concurrent organizational efforts to reduce hospital acquired infections.

  2. Improving behaviour in self-testing (IBIS: Study on frequency of use, consequences, information needs and use, and quality of currently available consumer information (protocol

    Directory of Open Access Journals (Sweden)

    de Vries Nanne K

    2010-08-01

    Full Text Available Abstract Background Self-tests are available to consumers for more than 25 conditions, ranging from infectious diseases to cardiovascular risk factors. Self-tests are defined as in-vitro tests on body materials such as blood, urine, faeces, or saliva that are initiated by consumers to diagnose a particular disorder or risk factor without involving a medical professional. In 2006, 16% of a sample of Dutch Internet users had ever used at least one self-test and 17% intended to use a self-test in the future. The objectives of this study are to determine (1 the frequency of self-test use, (2 the consumers' reasons for using or not using a self-test, (3 the information that is used by self-testers in the different self-test stages and the consumers' interpretation of the quality of this information, (4 the consumers' response to self-test results in terms of their confidence in the result, reassurance by the test result, and follow-up behaviour, (5 the information consumers report to need in the decision making process of using or not using a self-test, and in further management on the basis of the self-test result, and (6 the quality of the currently available consumer information on a selected set of self-tests. Methods Mixed methods study with (1 a cross-sectional study consisting of a two-phase Internet-questionnaire, (2 semi-structured interviews with self-testers and consumers who intend to use a self-test, and (3 the assessment of the quality of consumer information of self-tests. The Health Belief Model and the Theory of Planned Behaviour will serve as the theoretical basis for the questionnaires and the interview topic guides. Conclusions The self-testing area is still in a state of flux and therefore it is expected that self-test use will increase in the future. To the best of our knowledge, this is the first study which combines quantitative and qualitative research to identify consumers' information needs and use concerning self

  3. Is adjunctive naturopathy associated with improved glycaemic control and a reduction in need for medications among type 2 Diabetes patients? A prospective cohort study from India.

    Science.gov (United States)

    Bairy, Srinivas; Kumar, Ajay M V; Raju, Msn; Achanta, Shanta; Naik, Balaji; Tripathy, Jaya P; Zachariah, Rony

    2016-08-17

    With an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. 'Integrated Naturopathy and Yoga'(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients. In this prospective cohort study with a 3 month follow-up, DM patients consecutively admitted to a hospital in India from May-October 2014 for either 15 or 30 days were offered INY - a package of vegetarian diet with no added oil, sugar and salt, yoga-based exercise, patient counselling and rest. A 'favourable outcome' was defined as glycaemic control (glycosylated hemoglobin (HbA1c) < 7 % or absolute reduction by 1 %) along with at least 50 % reduction in antidiabetes medication at 3 months relative to baseline. Compliance to diet was scored by self-report on a scale of 0-10 and categorized into poor (0-5), moderate (6-8) and excellent (9-10). Of 101 patients with 3-month follow-up data, 65(65 %) achieved a favourable outcome - with 19(19 %) stopping medication while sustaining glycemic control. Factors associated with favourable outcome were baseline HbA1c and compliance to diet, which showed a significant linear relationship with mean HbA1c reductions of 0.4 %, 1.1 % and 1.7 % in relation to poor, moderate and excellent dietary compliance respectively. INY, adjunctive to pharmacotherapy, was associated with a significant beneficial effect on glycaemic control and reduced the overall need for antidiabetes medications. These early results are promising. Further studies with long-term follow-up and using more rigorous randomized controlled trial designs are needed.

  4. Improving behaviour in self-testing (IBIS): Study on frequency of use, consequences, information needs and use, and quality of currently available consumer information (protocol).

    Science.gov (United States)

    Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; Dinant, Geert-Jan; Ronda, Gaby; van der Weijden, Trudy

    2010-08-03

    Self-tests are available to consumers for more than 25 conditions, ranging from infectious diseases to cardiovascular risk factors. Self-tests are defined as in-vitro tests on body materials such as blood, urine, faeces, or saliva that are initiated by consumers to diagnose a particular disorder or risk factor without involving a medical professional. In 2006, 16% of a sample of Dutch Internet users had ever used at least one self-test and 17% intended to use a self-test in the future. The objectives of this study are to determine (1) the frequency of self-test use, (2) the consumers' reasons for using or not using a self-test, (3) the information that is used by self-testers in the different self-test stages and the consumers' interpretation of the quality of this information, (4) the consumers' response to self-test results in terms of their confidence in the result, reassurance by the test result, and follow-up behaviour, (5) the information consumers report to need in the decision making process of using or not using a self-test, and in further management on the basis of the self-test result, and (6) the quality of the currently available consumer information on a selected set of self-tests. Mixed methods study with (1) a cross-sectional study consisting of a two-phase Internet-questionnaire, (2) semi-structured interviews with self-testers and consumers who intend to use a self-test, and (3) the assessment of the quality of consumer information of self-tests. The Health Belief Model and the Theory of Planned Behaviour will serve as the theoretical basis for the questionnaires and the interview topic guides. The self-testing area is still in a state of flux and therefore it is expected that self-test use will increase in the future. To the best of our knowledge, this is the first study which combines quantitative and qualitative research to identify consumers' information needs and use concerning self-testing, and the consumers' actual follow-up behaviour based

  5. Measles incidence rate and a phylogenetic study of contemporary genotype H1 measles strains in China: is an improved measles vaccine needed?

    Science.gov (United States)

    Shi, Jingwei; Zheng, Jingtong; Huang, Honglan; Hu, Yu; Bian, Jiang; Xu, Deqi; Li, Fan

    2011-12-01

    The incidence of measles in China has increased over the last decade. To evaluate the genetic variation of measles strains, 16 measles wild-type virus strains were isolated from 14 vaccinated cases and 2 nonvaccinated cases in Jilin Province during 2005-2006, and their nucleoprotein (N) and hemagglutinin (H) genes were amplified by RT-PCR. The amplified products were sequenced and compared with the Edmonston virus and the existing vaccine strains (Changchun-47 and Shanghai-191). The results showed that the variation rate between the vaccine and wild-type strains was 9.8-12.0% in the N gene and 5.9-6.9% in the H gene, respectively. In addition, cross-neutralization assays revealed that although sera obtained from infants following primary vaccination effectively neutralized vaccine strains, the capacity in neutralizing H1 wild-type measles virus isolates was decreased fourfold. Antigenic ratios testing revealed that the antigenic relatedness between wild-type measles viruses and existing vaccine strains was notably low. These data suggest that the increased incidence of measles in Jilin Province may be attributed to the antigenic drift between wild-type and vaccine strains. Our findings strengthen the recommendation of supplemental immunization with existing vaccines and also strongly suggest a need for developing new vaccines to better control measles virus outbreaks.

  6. Reduced Need for Rescue Antiemetics and Improved Capacity to Eat in Patients Receiving Acupuncture Compared to Patients Receiving Sham Acupuncture or Standard Care during Radiotherapy

    Science.gov (United States)

    Steineck, Gunnar; Börjeson, Sussanne

    2017-01-01

    Objective. To evaluate if consumption of emesis-related care and eating capacity differed between patients receiving verum acupuncture, sham acupuncture, or standard care only during radiotherapy. Methods. Patients were randomized to verum (n = 100) or sham (n = 100) acupuncture (telescopic blunt sham needle) (median 12 sessions) and registered daily their consumption of antiemetics and eating capacity. A standard care group (n = 62) received standard care only and delivered these data once. Results. More patients in the verum (n = 73 of 89 patients still undergoing radiotherapy; 82%, Relative Risk (RR) 1.23, 95% Confidence Interval (CI) 1.01–1.50) and the sham acupuncture group (n = 79 of 95; 83%, RR 1.24, CI 1.03–1.52) did not need any antiemetic medications, as compared to the standard care group (n = 42 out of 63; 67%) after receiving 27 Gray dose of radiotherapy. More patients in the verum (n = 50 of 89; 56%, RR 1.78, CI 1.31–2.42) and the sham acupuncture group (n = 58 of 94 answering patients; 62%, RR 1.83, CI 1.20–2.80) were capable of eating as usual, compared to the standard care group (n = 20 of 63; 39%). Conclusion. Patients receiving acupuncture had lower consumption of antiemetics and better eating capacity than patients receiving standard antiemetic care, plausible by nonspecific effects of the extra care during acupuncture. PMID:28270851

  7. Leveraging human oversight and intervention in large-scale parallel processing of open-source data

    Science.gov (United States)

    Casini, Enrico; Suri, Niranjan; Bradshaw, Jeffrey M.

    2015-05-01

    The popularity of cloud computing along with the increased availability of cheap storage have led to the necessity of elaboration and transformation of large volumes of open-source data, all in parallel. One way to handle such extensive volumes of information properly is to take advantage of distributed computing frameworks like Map-Reduce. Unfortunately, an entirely automated approach that excludes human intervention is often unpredictable and error prone. Highly accurate data processing and decision-making can be achieved by supporting an automatic process through human collaboration, in a variety of environments such as warfare, cyber security and threat monitoring. Although this mutual participation seems easily exploitable, human-machine collaboration in the field of data analysis presents several challenges. First, due to the asynchronous nature of human intervention, it is necessary to verify that once a correction is made, all the necessary reprocessing is done in chain. Second, it is often needed to minimize the amount of reprocessing in order to optimize the usage of resources due to limited availability. In order to improve on these strict requirements, this paper introduces improvements to an innovative approach for human-machine collaboration in the processing of large amounts of open-source data in parallel.

  8. Incorporating measures of time-varying emissions to enhance top-down BC emissions: what is done well, what needs improvement, and what are the consequences

    Science.gov (United States)

    Cohen, J. B.; Xi, X.; Wang, C.

    2012-12-01

    Black Carbon (BC) and other absorbing aerosols uniquely impact the climate system by both scattering and absorbing solar radiation, leading to simultaneous heating and cooling of the climate system. A critical understanding of the emissions, processing, transport, and removal of these aerosols are necessary to increase our understanding of their impacts on climate system. However, BC is tricky to model: it has a mostly anthropogenic origin that is highly variable in both space and time. Furthermore, its atmospheric chemical and physical processing involves interaction with third-party chemical species. Finally, there is a strong correlation between uncertainty in prediction of the primary removal mechanism, precipitation, and those regions having the highest emissions, such as Monsoon regions of Asia. Recent work using a coupled climate/radiation/aerosol/urbanization model, data of BC concentrations and remotely sensed AAODs from more than 100 different sites, and a Kalman Filter, has lead to an average estimate of the BC average and uncertainty range of emissions. These average results ranged from about 200% to 300% the emissions currently used by the IPCC, AEROCOM, and GFED. The differences in the modeled concentrations, AAODs, radiative forcings, and climate response between these annual average different emissions levels, as well as the error bounds associated with the Kalman Filter emissions has been explored and will be summarized. Additionally, since absorbing aerosols are regionally and temporally non-uniform, an improved comparison between these differences will be highlighted using an additional data source: MISR AOD and a new analysis technique to mathematically constrain and identify unique temporally and spatially varying properties. These new constraints will be further combined with model runs under the different emissions scenarios to test the impacts of both annual average as well as more realistic cases of large-scale, season-to-season, and year

  9. Consensus recommendations for improvement of unmet clinical needs--the example of chronic graft-versus-host disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Olivieri, Jacopo; Manfredi, Lucia; Postacchini, Laura; Tedesco, Silvia; Leoni, Pietro; Gabrielli, Armando; Rambaldi, Alessandro; Bacigalupo, Andrea; Olivieri, Attilio; Pomponio, Giovanni

    2015-07-01

    Consensus recommendations are used to improve the methodology of research about rare disorders, but their uptake is unknown. We studied the uptake of consensus recommendations in steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Although in 2006 the National Institutes of Health (NIH) cGVHD consensus project produced recommendations for clinical trials, guidelines have emphasised the scarcity of valuable evidence for all tested interventions. We searched Medline (PubMed) between Jan 1, 1998, and Oct 1, 2013, for non-randomised studies of systemic treatment for SR-cGVHD. To measure adherence to NIH recommendations, we applied a 61 item checklist derived from the NIH consensus document. We did a meta-analysis to measure pooled effect size for overall response rate (ORR) and meta-regression analyses to measure the effect of deviations from NIH recommendations on pooled effect size. We included 82 studies related to nine interventions. Conformity to NIH recommendations was evenly low across the analysed timeframe (1998-2013), and did not change significantly after publication of NIH recommendations. The pooled effect size for ORR for systemic treatment of SR-cGVHD was 0.66 (95% CI 0.62-0.70). Increased adherence to NIH recommendations in a score of items defining correct response assessment was associated with a significant reduction in ORR (-4.2%, 95% CI -6.6 to -1.9; p=0.001). We recorded no significant association between ORR and sets of items related to correct diagnostic definition of SR-cGVHD (change in ORR -3.1%, 95% CI -7.7 to 1.5), specification of primary intervention (0, -3.8 to 3.6), or concomitant treatments (-1.6%, -5.4 to 2.3). The score of items defining correct response assessment increased after publication of NIH recommendations. Our findings show evidence of bias in the reported efficacy of treatment of SR-cGVHD. The overall effect of NIH recommendations in scientific literature is scarce; however, NIH recommendations improved

  10. Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol.

    Science.gov (United States)

    Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, Jean Paul; Trottier, Jean-Guy; Ouellet, Jean; Lortie, Gilles; Plant, Jeff; Morris, Judy; Chauny, Jean Marc; Lauzier, François; Légaré, France

    2016-04-20

    Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009-2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Placebo for depression: we need to improve the quality of scientific information but also reject too simplistic approaches or ideological nihilism.

    Science.gov (United States)

    Cipriani, Andrea; Geddes, John R

    2014-06-25

    The placebo response plays a major role in psychiatry, particularly in depression. A new network meta-analysis investigates whether the effects of placebo vary in studies comparing fluoxetine and venlafaxine, two widely prescribed antidepressants. Even though data from this article indicate that the effects of placebos do not differ, publication bias cannot be ruled out. The authors use their finding to criticise the paradigm of evidence-based medicine, questioning whether there is anything certain in psychiatry and, more precisely, in the field of antidepressant treatment for major depression. This study stimulates the debate about validity of scientific knowledge in medicine and highlights the importance of considering things from a different perspective. However, the authors' view should be considered with caution. As clinicians, we make decisions every day, integrating individual clinical expertise and patients' preferences and values with the best, up-to-date research data. The quality of scientific information must be improved, but we still think that valid conclusions to help clinical practice can be drawn from a critical and cautious use of the best available, if flawed, evidence.

  12. Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation

    Science.gov (United States)

    Larijani, Houman Hadad

    2015-01-01

    Anecdotal evidence suggests lack of dentist knowledge and uncertainty about how clinical practice can be improved when dealing with victims of sexual violence. This systematic review presents a synthesis of the available literature, which examined the association between dental fear and a history of sexual violence victimisation. All studies indicated, to various degrees, that dental fear is associated with a history of sexual violence victimisation. The analysis identified several common themes including a perception of lack of control, avoidance behaviours, experiences of flashbacks, feelings of embarrassment, difficulties with the physical proximity to the dentist, the sex of the dentist reminding patients of the perpetrator, being placed into a horizontal body position, the specific impact of fellatio, the smell of latex, experienced lack of knowledge of dental professionals leading to insensitive treatment as well as revictimisation experiences, and the occurrence of disproportionate dental problems among patients who had experienced event(s) of sexual violence. All these themes are discussed in detail. Specific strategies are offered to assist dental practitioners in providing sensitive treatment for patients with a history of sexual violence. Additionally, several suggestions are made that may assist both researchers and dental practitioners alike. PMID:25663839

  13. The Forecast Scenarios of Development of the National Economy in the Context of the Need to Improve the «Cost of Living»

    Directory of Open Access Journals (Sweden)

    Kulakov Gennady T.

    2017-04-01

    Full Text Available The article is aimed at elaborating and materialization of the forecast scenarios of development of the national economy in the context of substantiating the feasibility of improving the «cost of living» being the equivalent of the liability of public authorities for the value of human life. The article researches the phenomenon of the «cost of living» in the context of sustainable innovative development of a socially oriented development of economy as an axis for developing its forecast scenarios. Focus has been set on complementarity of the terms of «cost of living» and «sustainable development» in the context of satisfying vital interests of the population of Ukraine. It has been suggested that wages accounting as an equivalent to the «cost of living» should not be included with costs but with the value added, however, the growth rate of wages must not outpace the growth rate of labor productivity. For the first time on the basis of the interdisciplinary and intersectoral approach, as well as the index method, have been elaborated baseline scenarios of development of the national economy on the basis of the upgraded human development index: pessimistic, realistic, and optimistic forecasts.

  14. Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation.

    Science.gov (United States)

    Larijani, Houman Hadad; Guggisberg, Marika

    2015-01-01

    Anecdotal evidence suggests lack of dentist knowledge and uncertainty about how clinical practice can be improved when dealing with victims of sexual violence. This systematic review presents a synthesis of the available literature, which examined the association between dental fear and a history of sexual violence victimisation. All studies indicated, to various degrees, that dental fear is associated with a history of sexual violence victimisation. The analysis identified several common themes including a perception of lack of control, avoidance behaviours, experiences of flashbacks, feelings of embarrassment, difficulties with the physical proximity to the dentist, the sex of the dentist reminding patients of the perpetrator, being placed into a horizontal body position, the specific impact of fellatio, the smell of latex, experienced lack of knowledge of dental professionals leading to insensitive treatment as well as revictimisation experiences, and the occurrence of disproportionate dental problems among patients who had experienced event(s) of sexual violence. All these themes are discussed in detail. Specific strategies are offered to assist dental practitioners in providing sensitive treatment for patients with a history of sexual violence. Additionally, several suggestions are made that may assist both researchers and dental practitioners alike.

  15. Planning law and public health at an impasse in Australia: the need for targeted law reforms to improve local food environments to reduce overweight and obesity.

    Science.gov (United States)

    Mills, Caroline

    2014-09-01

    Australia's high rates of overweight and obesity, and the associated increased population risk of non-communicable diseases, pose a challenge to policymakers across sectors beyond the health portfolio. In the last decade, strategies to promote healthy lifestyles and address non-communicable diseases have increasingly interested urban planners in Australia and internationally. However, Australian planning laws continue to operate largely without regard to public health goals, thus limiting the ability of communities to shape healthy built environments. In recent years, local governments have increasingly taken on responsibility for improving public health through community-based initiatives; however, their efforts are hindered by their limited capacity to influence planning priorities under current State-legislated planning schemes. This article considers the emerging body of research exploring the impact of urban planning on health and non-communicable diseases in Australia. It is contended that planning law in Australia is out of step with the evidence of planning's potential impact on health, and reforms are required to ensure consistency with public health priorities.

  16. Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation

    Directory of Open Access Journals (Sweden)

    Houman Hadad Larijani

    2015-01-01

    Full Text Available Anecdotal evidence suggests lack of dentist knowledge and uncertainty about how clinical practice can be improved when dealing with victims of sexual violence. This systematic review presents a synthesis of the available literature, which examined the association between dental fear and a history of sexual violence victimisation. All studies indicated, to various degrees, that dental fear is associated with a history of sexual violence victimisation. The analysis identified several common themes including a perception of lack of control, avoidance behaviours, experiences of flashbacks, feelings of embarrassment, difficulties with the physical proximity to the dentist, the sex of the dentist reminding patients of the perpetrator, being placed into a horizontal body position, the specific impact of fellatio, the smell of latex, experienced lack of knowledge of dental professionals leading to insensitive treatment as well as revictimisation experiences, and the occurrence of disproportionate dental problems among patients who had experienced event(s of sexual violence. All these themes are discussed in detail. Specific strategies are offered to assist dental practitioners in providing sensitive treatment for patients with a history of sexual violence. Additionally, several suggestions are made that may assist both researchers and dental practitioners alike.

  17. Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care.

    Science.gov (United States)

    Sader, Elie; Yee, Philip; Hodaie, Mojgan

    2017-02-01

    Neurosurgery in low-income countries is faced with multiple challenges. Although the most common challenges include infrastructure and physical resource deficits, an underemphasized barrier relates to the methods and components of surgical training. The role of important aspects, including didactic surgical training, surgical decision-making, workshops, conferences, and assessment methods, has not been duly studied. Knowledge of these issues is a crucial step to move closer to strengthening surgical capacity in low-income countries. We designed an online survey to assess self-perceived and objectively measured barriers to neurosurgical training in various Sub-Saharan African countries. Key outcomes included perception toward adequacy of neurosurgery training and barriers to neurosurgical training at each individual site. Only 37% of responders felt that their training program adequately prepared them for handling incoming neurosurgical cases. Top perceived limitations of neurosurgery training included lack of physical resources (25% of all responses), lack of practical workshops (22%), lack of program structure (18%), and lack of topic-specific lectures (10%). Our results show that most responders believe their training program is inadequate and are interested in improving it through international collaborations. This implies that activities directed at strengthening surgical capacity must address this important necessity. One important strategy is the use of online educational tools. In consideration of the observed limitations in care, resources, and training, we recommend a phased approach to neurosurgical growth in low-income settings. Copyright © 2016. Published by Elsevier Inc.

  18. Forced traffic in automatic milking systems effectively reduces the need to get cows, but alters eating behavior and does not improve milk yield of dairy cattle.

    Science.gov (United States)

    Bach, A; Devant, M; Igleasias, C; Ferrer, A

    2009-03-01

    Eighty-five lactating Holstein dairy cows in loose housing conditions in 2 symmetrical pens, each containing 28 feeding places, 3 waterers, and 1 automatic milking system (AMS), were used to evaluate the effects of the traffic type imposed on lactating cows through an AMS on milking frequency, feeding behavior, and milk production. The study was a crossover design with 2 periods and 2 treatments. Each period lasted 3 mo, with 1 mo of adaptation within each period. All cows were fed a partial mixed ration twice daily and up to 3 kg/d of a concentrate during the visits to the AMS. Treatments consisted of allowing free traffic of cows throughout the pen or forcing cows to pass through the AMS to access the feed troughs (forced traffic). Individual eating behavior and feed consumption were continuously monitored throughout the study using a computerized system. Individual milk production was recorded at each milking, and milk composition was recorded monthly. In addition, the number of cows brought to the AMS was recorded. The number of daily meals was less, whereas meal duration and meal size were greater with forced traffic (6.6 +/- 0.3 meals/d, 20.4 +/- 0.65 min/meal, and 2.7 +/- 0.09 kg/meal, respectively) than with free traffic (10.1 +/- 0.3 meals/d, 15.7 +/- 0.65 min/meal, and 1.8 +/- 0.09 kg/meal, respectively). Total dry matter intake (21.1 +/- 0.5 and 20.4 +/- 0.58 kg/d, respectively) and milk production (29.8 +/- 0.79 and 30.9 +/- 0.79 kg/d, respectively) were similar in the 2 systems. The number of voluntary and total daily milkings was greater with forced traffic (2.4 +/- 0.04 and 2.5 +/- 0.06 milkings/d, respectively) than with free traffic (1.7 +/- 0.06 and 2.2 +/- 0.04 milkings/d, respectively). Forced traffic improved the number of voluntary milkings, but altered milk quality and eating behavior of dairy cattle.

  19. Nutrition training in medical and other health professional schools in West Africa: the need to improve current approaches and enhance training effectiveness

    Directory of Open Access Journals (Sweden)

    Roger Sodjinou

    2014-07-01

    Full Text Available Background: Health professionals play a key role in the delivery of nutrition interventions. Improving the quality of nutrition training in health professional schools is vital for building the necessary human resource capacity to implement effective interventions for reducing malnutrition in West Africa. This study was undertaken to assess the current status of nutrition training in medical, nursing and midwifery schools in West Africa. Design: Data were collected from 127 training programs organized by 52 medical, nursing, and midwifery schools. Using a semi-structured questionnaire, we collected information on the content and distribution of nutrition instruction throughout the curriculum, the number of hours devoted to nutrition, the years of the curriculum in which nutrition was taught, and the prevailing teaching methods. Simple descriptive and bivariate analyses were performed. Results: Nutrition instruction occurred mostly during the first 2 years for the nursing (84%, midwifery (87%, and nursing assistant (77% programs and clinical years in medical schools (64%. The total amount of time devoted to nutrition was on average 57, 56, 48, and 28 hours in the medical, nursing, midwifery, and nursing assistant programs, respectively. Nutrition instruction was mostly provided within the framework of a dedicated nutrition course in nursing (78%, midwifery (87%, and nursing assistant programs (100%, whereas it was mainly embedded in other courses in medical schools (46%. Training content was heavily weighted to basic nutrition in the nursing (69%, midwifery (77%, and nursing assistant (100% programs, while it was oriented toward clinical practice in the medical programs (64%. For all the programs, there was little focus (<6 hours contact time on public health nutrition. The teaching methods on nutrition training were mostly didactic in all the surveyed schools; however, we found an integrated model in some medical schools (12%. None of the

  20. Whistleblower Protection: DOD Has Improved Oversight for Reprisal Investigations, but Can Take Additional Actions to Standardize Process and Reporting

    Science.gov (United States)

    2016-09-07

    percentage points at the 95 percent confidence interval. 20 Project Management Institute, Inc. A Guide to the Project Management Body of Knowledge ( PMBOK ...Guide), Fifth Edition, 2013. The Project Management Institute’s Guide to Project Management Body of Knowledge ( PMBOK ® Guide) provides guidelines for...and controlled, and closed. PMBOK is a trademark of Project Management Institute, Inc. Page 13 GAO-16-860T enterprise system. This plan

  1. Defense Logistics Agency Could Improve Its Oversight of the Maintenance, Repair, and Operations Prime Vendor Contract for Korea (Redacted)

    Science.gov (United States)

    2012-10-19

    not adequately review and approve deli very orders with airfreight charges. DLA Troop Support C&E contract management officials stated that...Directorate personnel wi ll identify, ana lyze, and evaluate deli very orders issued after May I0, 20 J0, where the cl istribution fee exceeded the contra cl...orAS for the deli very orders. In accordance with the FAR adequate competition provisions, we verified that the contracting onicer ensured that the

  2. Why budget accountability fails? The elusive links between parliaments and audit agencies in the oversight of the budget

    Directory of Open Access Journals (Sweden)

    CARLOS SANTISO

    2015-09-01

    Full Text Available ABSTRACTParliaments and audit agencies have critical and complementary roles in the oversight of the budget and the enforcement of government accountability. Yet, the nexus between parliaments and audit agencies is one of the weakest links in the accountability chain, generating an accountability gap in the budget process. This articles analyses the interactions between parliaments and audit agencies in the oversight of government finances during the latter stages of the budget process. Using proxies to evaluate the quality of those linkages, such as the follow-up to audit findings and the discharge of government, it shows important dysfunctions in the interactions between parliaments and audit agencies due to a combination of technical capacity constraints and political economy disincentives. It suggests that the effective functioning of the system of checks and balances in public budgeting critically hinges on the agility of the linkages between accountability institutions. As such, the failure of budget accountability is due to systemic dysfunctions in the systems of accountability, rather than the failure of an individual accountability institution acting in isolation. In addition, the effectiveness of the horizontal accountability architecture depends on the political economy incentives shaping the budget process, which are generated by the interactions between the choice of institutional design and budget rules, with the degree of political competition and electoral rules.

  3. Centralized HIV Program Oversight: An Investigation of a Case Series of New HIV Infections among US Army Soldiers, 2012 to 2013.

    Science.gov (United States)

    Pacha, Laura A; Hakre, Shilpa; Myles, Otha; Sanders-Buell, Eric E; Scoville, Stephanie L; Kijak, Gustavo H; Price, Michael W; Mody, Rupal M; Liu, Ying; Miller, Shana L; Pham, Phuc T; Michael, Nelson L; Kim, Jerome H; Peel, Sheila A; Tovanabutra, Sodsai; Jagodzinski, Linda L; Cersovsky, Steven B; Scott, Paul T

    2015-11-01

    Centralized HIV program oversight and repeal of the Department of Defense policy "Don't Ask Don't Tell" permitted characterization of HIV transmission among soldiers assigned to a large US Army base continental United States from 2012 to 2013. An investigation of a greater than expected number of new HIV infections among soldiers was initiated to characterize transmission and identify opportunities to disrupt transmission and deliver services.All soldiers who were assigned to the base at the time of their first positive HIV test and who had their first positive HIV test in 2012 or in the first 6 months of 2013 and who had a clinical genotype available for analysis were eligible for inclusion in the investigation.All patients (n = 19) were men; most were black (52%) and less than 30 years old (64%). Fifteen of the 19 patients participated in in-depth interviews. Eighty percent were men who have sex with men who reported multiple sex partners having met through social and electronic networks. All were subtype B infections. Significant knowledge gaps and barriers to accessing testing and care in the military healthcare system were identified. Most (58%) belonged to transmission networks involving other soldiers.This investigation represents an important step forward in on-going efforts to develop a comprehensive understanding of transmission networks in the Army that can inform delivery of best practices combination prevention services. The Army is developing plans to directly engage individuals in key affected populations most at risk for HIV infection to identify and address unmet needs and expand delivery and uptake of prevention services. Further investigation is underway and will determine whether these findings are generalizable to the Army.

  4. Taking the wrong path: learning from oversights, misconceptions, failures and mistakes in conservation.

    Directory of Open Access Journals (Sweden)

    Isabelle Brajer

    2009-04-01

    Full Text Available Misunderstandings, misconceptions and errors in action, opinion, or judgement caused by poor reasoning, carelessness, or insufficient knowledge affecting both the practical and theoretical aspects of our profession are illustrated by a series of case stories from wall painting conservation in Denmark. Past mistakes have aided progress by demonstrating the need for improvement in various areas, such as quality control, documentation, communication and decision-making.  Malentendus, idées fausses et erreurs dans l’intervention, opinion ou jugement reposant sur un mauvais raisonnement, ou encore négligence ou insuffisance des connaissances touchant  à la fois les aspects pratiques et théoriques de notre profession sont illustrés par une série de cas empruntés à la conservation de la peinture murale au Danemark. Les erreurs du passé ont  favorisé un progrès en démontrant la nécessité d’améliorations dans divers domaines, tels que le contrôle de la qualité, la documentation, la communication et la prise de décision.

  5. Future needs for biomedical transducers

    Science.gov (United States)

    Wooten, F. T.

    1971-01-01

    In summary there are three major classes of transducer improvements required: improvements in existing transducers, needs for unexploited physical science phenomena in transducer design, and needs for unutilized physiological phenomena in transducer design. During the next decade, increasing emphasis will be placed on noninvasive measurement in all of these areas. Patient safety, patient comfort, and the need for efficient utilization of the time of both patient and physician requires that noninvasive methods of monitoring be developed.

  6. Ethical Oversight of Student Data in Learning Analytics: A Typology Derived from a Cross-Continental, Cross-Institutional Perspective

    Science.gov (United States)

    Willis, James E.; Slade, Sharon; Prinsloo, Paul

    2016-01-01

    The growth of learning analytics as a means to improve student learning outcomes means that student data is being collected, analyzed, and applied in previously unforeseen ways. As the use of this data continues to shape academic and support interventions, there is increasing need for ethical reflection on "operational" approvals for…

  7. Fine coal measurement needs for improved control

    Energy Technology Data Exchange (ETDEWEB)

    Firth, B.; O' Brien, M. [CSIRO, Brisbane, Qld. (Australia). Division of Energy Technology

    2010-07-01

    The monitoring and management of fine coal circuits in coal preparation plants is limited in current practice. As part of the Australian Coal Association Research Program (ACARP) Intelligent Plant Project (C11069), the relationships between the main operational and control factors for the unit operations and the circuit and the performance indicators have been identified. The unit operations examined included desliming (hydrocyclones and sieve bends), small coal cleaning (spirals and hydraulic separators), flotation, and dewatering (vacuum filters, centrifuges, and thickeners). These relationships were then used to assist in the identification of the important parameters to be measured and the preferred level of accuracy required to be useful. An important issue was the interconnection between the various unit operations and the potential impact of an upstream problem on the subsequent performance of downstream units. Analysis with the relationships showed that the flow rate of respective feed slurries and the solids content were found to be significant variables. This article will discuss this analysis and provide some case studies.

  8. Afghanistan’s High office of Oversight: Personal Asset Declarations of High Ranking Afghan Government Officials Are Not Consistently Registered and Verified

    Science.gov (United States)

    2016-09-19

    and location (inside or outside Afghanistan; list country if outside Afghanistan) Source of income Personal Effects (if valued at more than 3,000...SIGAR Special Inspector General for Afghanistan Reconstruction AFGHANISTAN’S HIGH OFFICE OF OVERSIGHT: PERSONAL ASSET...registration and complaints directorates collect declarations of personal assets from public officials of the Afghan government, receive complaints from

  9. Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

    Science.gov (United States)

    Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A

    2017-04-07

    Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of

  10. Industry and the profession of medicine: balancing appropriate relationships with the need for innovation.

    Science.gov (United States)

    Lewin, Jack; Arend, Thomas E

    2011-09-01

    Much has been made over the last few years about conflicts of interest in the health care community's relationships with industry members, including individual physicians, academic medical centers, and professional organizations. Not only has the Department of Justice (DOJ) been investigating questionable relationships, but House and Senate Oversight Committees have also weighed in on real and perceived conflicts. Most recently, the Physician Payments Sunshine Act of 2010 requires companies to begin recording any physician payments, including stock options, research grants, knickknacks, consulting fees, and travel to medical conferences that are worth more than ten dollars in 2012 and report them on March 31, 2013. To date, the American College of Cardiology (ACC) has developed and instituted one of the most stringent policies in the medical community to ensure that support from industry has no influence on any of its clinical documents. Furthermore, the need for the ACC's "Principles for Relationships with Industry," the organization's guide in nine key operational areas, are critical given that, when it comes to industry, properly managed partnerships are absolutely essential to maintaining scientific progress in cardiology and other specialties. The ACC relies on industry funding to advance cardiovascular research, as well as cardiovascular workforce training, practitioner diversity, medical education, and life-long learning. Without this funding, the ACC's ability to provide meaningful, unbiased education and to improve quality of care would be far more limited than that which is currently offered to its members and, ultimately, patients. Rather than restricting industry funding for such activities, the focus should instead be on transparency and actively and appropriately managing industry relationships. Ethical and appropriate partnerships with industry can prove beneficial in funding of education, research, and quality improvement activities. In addition

  11. Ensuring the safety of living kidney donors and recipients in China through ethics committee oversight: an early experience.

    Science.gov (United States)

    Lei, Z; Lulin, M; Guoliang, W; Xiaofei, H

    2008-09-01

    In 2007, the Regulation on Human Organ Transplantation was enacted in China requiring the establishment of ethics committees to oversee living donor organ transplantation and establishing specific requirements that must be met. We established an Ethics Committee on Organ Transplantation at Peking University Third Hospital, and described its composition, its methods and operating procedures in the examination and approval of living-related donor kidney transplantation (LRDKT) and our initial experience. All 60 proposed cases of LRDKT were presented to the Ethics Committee for discussion, among which 53 cases were approved and seven cases were disapproved due to a variety of reasons that are discussed. The Ethics Committee on Organ Transplantation plays an important role in the ethical oversight of living-related donor organ transplantation in order to ensure to the greatest extent possible the safety, rights and interests of donors and recipients.

  12. The impact of masculinity on safety oversights, safety priority and safety violations in two male-dominated occupations

    DEFF Research Database (Denmark)

    Nielsen, Kent; Hansen, Claus D.; Bloksgaard, Lotte;

    2015-01-01

    outcomes, whereas trait-based theories do not show strong associations with safety outcomes. Implications The association between norm-based masculinity and safety measures might be used in tailoring and developing new preventive measures that specifically address masculinity and male role norms....... and safety violations in two male-dominated occupations using both a trait-based and a norm-based approach to masculinity. Methods Questionnaires covering trait-based (Bem Sex Role Inventory, BSRI) and norm-based (Male Role Norms Inventory – Revised, MRNI-R) measures of masculinity, three safety......-related context factors (safety leadership, commitment of the safety representative, and safety involvement) and three safety-related outcome factors (safety violations, safety oversights and safety priority) were administered twice 12 months apart to Danish ambulance workers (n = 1157) and slaughterhouse workers...

  13. Mort User's Manual: For use with the Management Oversight and Risk Tree analytical logic diagram

    Energy Technology Data Exchange (ETDEWEB)

    Knox, N.W.; Eicher, R.W.

    1992-02-01

    This report contains the User's Manual for MORT (Management Oversight and Risk Tree), a logic diagram in the form of a work sheet'' that illustrates a long series of interrelated questions. MORT is a comprehensive analytical procedure that provides a disciplined method for determining the causes and contributing factors of major accidents. Alternatively, it serves as a tool to evaluate the quality of an existing system. While similar in many respects to fault tree analysis, MORT is more generalized and presents over 1500 specific elements of an ideal universal'' management program for optimizing environment, safety and health, and other programs. This User's Manual is intended to be used with the MORT diagram dated February 1992.

  14. Research on the Improvement of Tutorial System Based on Dimensions of Learning Needs and Learning Motivation%基于学生需求和学习动机维度的导师制工作完善研究

    Institute of Scientific and Technical Information of China (English)

    张革; 张爽; 房宏君

    2015-01-01

    通过设计大学生学习动机和学习需求调研问卷,并以北京联合大学972份问卷调查的实测数据为基础,探测出导师制工作下大学生学习动机和学习需求的构成情况。研究结果表明:学生学习动机由实现顺利就业、注重他人评价、争取评优奖励和学习专业知识四个维度构成;学习需求动机由职涯规划、技能提升、提高自信心三个维度构成;并以研究成果为依据,结合高校导师制工作开展情况,提出了改进本科生导师制的相关的建议,为本科生导师制的完善提供参考。%The paper detects the composition of university students' learning motivation and learning needs through the questionnaires about university students' learning motivation and learning demand, which is based on 972 students in Beijing union university. The results show that the students learning motivation consists of four dimensions:Successful employment, paying attention to the evaluation of others, learning professional knowledge and winning rewards for outstanding persons. The learning needs motivation consists of three dimensions:career planning, skills upgrading and improving confidence. Fin-ally, the paper proposed the Suggestions for improving the undergraduates' tutorial system, combining with the actual of tu-torial system in colleges and universities. The research provides reference for the improvement of the tutorial system through its research findings.

  15. Military Personnel: Oversight Framework and Evaluations Needed for DOD and the Coast Guard to Help Increase the Number of Female Officer Applicants

    Science.gov (United States)

    2015-11-01

    we convened a forum to identify and discuss useful practices and lessons learned from private and public sector organizational mergers , acquisitions ...Implementation Steps to Assist Mergers and Organizational Transformations, GAO-03-669 (Washington, D.C.: July 2, 2003). To identify key practices...respective ROTC programs to measure the quality, demography, and resources of each unit to monitor and assess the performance, growth , and progress of

  16. SUPPORTING CONGRESSIONAL OVERSIGHT: Framework for Considering Budgetary Implications of Selected GAO Work

    Science.gov (United States)

    2001-03-01

    Independent Contractor Tax Compliance 299 Expand the Use of IRS’ TIN-Matching Program 301 Appendix IV: Options Listed by Budget Function 303 Appendix...Improve the Efficiency of Federal ProgramsImprove Independent Contractor Tax Compliance The Internal Revenue Service (IRS) enforces tax laws and rules...classifying workers if businesses are to voluntarily comply. In addition, improved tax compliance could be gained by requiring businesses to (1

  17. 76 FR 38463 - SAFE Mortgage Licensing Act: Minimum Licensing Standards and Oversight Responsibilities

    Science.gov (United States)

    2011-06-30

    ... attorneys and law firms. The overwhelming majority of the comments were directed to various types of... of this analogy, HUD is clarifying in this final rule that the offer need not be capable of...

  18. There is Need for Improvement of Quality Improvement

    DEFF Research Database (Denmark)

    Knudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Mainz, Jan

    on uniformity in use and report of QI methods, with updated guidelines such as the SQUIRE 2.0. The aim of this paper is to investigate whether the recently published QI studies are conducted according to key principles of the PDSA method. Methods: A systematic literature search was performed in the Pub...

  19. There is need for improvement of Quality Improvement

    DEFF Research Database (Denmark)

    Knudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Mainz, Jan

    . The scientific literature indicates that the PDSA method have not been used properly. However, in the recent years there has been an increased focus on uniformity in use and report of QI methods, with updated guidelines such as the SQUIRE 2.0. The aim of this paper is to investigate whether the recently...

  20. Comprehensive Oversight Plan for Southwest Asia and Surrounding Areas. FY 2010 Update

    Science.gov (United States)

    2010-02-01

    projects funded, and assess capabilities and progress of MoH to implement accountability procedures. SIGAR PLANNED AFGHANISTAN U.S. and other donor...organizations have effectively met the protection, food , and other assistance needs of Afghanistan’s Internally Displaced Persons (IDP) populations, 2...determine whether 1) U.S. government and international organizations have effectively met the protection, food , and other assistance needs of Afghanistan’s

  1. Identifying discharge practice training needs.

    Science.gov (United States)

    Lees, L; Emmerson, K

    A training needs analysis tool was developed to identify nurses' discharge training needs and to improve discharge practice. The tool includes 49 elements of discharge practice subdivided into four areas: corporate, operational, clinical and nurse-led discharge. The tool was disseminated to 15 wards on two hospital sites with assistance from the practice development team. Analysis of discharge training is important to assess discharge training needs and to identify staff who may assist with training.

  2. Joint Information Environment: DOD Needs to Strengthen Governance and Management

    Science.gov (United States)

    2016-10-25

    implementing JRSS to enable the single security architecture. The effort, which is managed by the Defense Information Systems Agency (DISA), involves...18Defense Information Systems Agency, Information Services Acquisition Oversight and Management , DISA Instruction 610-225-2 (Feb. 19, 2015) and...24Defense Information Systems Agency, Information Services Acquisition Oversight and Management , DISA Instruction

  3. An Independent Oversight Body for Quality Assurance Review in the Philippines

    OpenAIRE

    World Bank

    2009-01-01

    The paper is part of a program to provide support to a major recommendation in the Philippine Review of Standards and Codes on Accounting and Auditing (ROSC-A&A). The ROSC-A&A brought out that there were major improvements in the accounting and auditing scene since the last assessment made in 2001. Substantially complete improvements include the adoption of the international standards for ...

  4. 77 FR 75689 - Public Company Accounting Oversight Board; Order Granting Approval of Proposed Rules on Auditing...

    Science.gov (United States)

    2012-12-21

    ... risks; Information about the nature and extent of specialized skill or knowledge needed in the audit... alone, while others expressed a view that both the accountant and management should share the... Board of the American Institute of Certified Public Accountants (``ASB'') and observed that the...

  5. Grounded Theory: Managing the Challenge for Those Facing Institutional Review Board Oversight

    Science.gov (United States)

    O'Connor, Mary Katherine; Netting, F. Ellen; Thomas, M. Lori

    2008-01-01

    The authors examine one of the earliest systematic forms of qualitative inquiry to identify some of the boundaries needed in grounded theory designs to provide a small corner of clarity in the discourse about what is acceptable science from the Institutional Review Board (IRB) perspective. Beginning with an overview of grounded theory research as…

  6. No need for speed.

    Science.gov (United States)

    Boland, Lori L; Hagstrom, Steve G

    2012-07-01

    Confirmation by a nursing home resident's physician is frequently required prior to transport from the facility to a hospital. So in cases for which the need to transport isn't truly urgent but the assigned priority is lights and siren, EMS often rush to the scene only to wait while physician confirmation is obtained. With the protocol in place, routine response for non-urgent transport needs means that confirmation from the physician is often already being sought or has been received by the time the ambulance arrives. This theoretically places the crew "back in service" sooner. Reducing unnecessary lights-and-siren ambulance response in communities employing this type of response model can improve use of EMS resources. For example, some community-level EMS protocols in the Allina Health EMS service area have local police and fire dispatched to all medical 9-1-1 calls. In non-emergent situations for which the protocol is now used, police and fire are no longer dispatched in situations they would previously have been dispatched concurrent with an unnecessary emergent response. The Allina Health Skilled Facility Ambulance Response Program provides an example of how EMS agencies can partner successfully with skilled-nursing facilities to promote the most appropriate use of ambulance services and effectively reduce the frequency of unnecessary emergent response. Limiting the use of lights-and-siren arrival to only those situations for which it's truly warranted improves safety and benefits nursing home residents by alleviating anxiety and disruption.

  7. Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya.

    Science.gov (United States)

    Alexander, Kelly T; Dreibelbis, Robert; Freeman, Matthew C; Ojeny, Betty; Rheingans, Richard

    2013-09-01

    Water, sanitation, and hygiene (WASH) programs in schools have been shown to improve health and reduce absence. In resource-poor settings, barriers such as inadequate budgets, lack of oversight, and competing priorities limit effective and sustained WASH service delivery in schools. We employed a cluster-randomized trial to examine if schools could improve WASH conditions within existing administrative structures. Seventy schools were divided into a control group and three intervention groups. All intervention schools received a budget for purchasing WASH-related items. One group received no further intervention. A second group received additional funding for hiring a WASH attendant and making repairs to WASH infrastructure, and a third group was given guides for student and community monitoring of conditions. Intervention schools made significant improvements in provision of soap and handwashing water, treated drinking water, and clean latrines compared with controls. Teachers reported benefits of monitoring, repairs, and a WASH attendant, but quantitative data of WASH conditions did not determine whether expanded interventions out-performed our budget-only intervention. Providing schools with budgets for WASH operational costs improved access to necessary supplies, but did not ensure consistent service delivery to students. Further work is needed to clarify how schools can provide WASH services daily.

  8. Generating Local Needs through Technology

    DEFF Research Database (Denmark)

    á Rogvi, Sofie; Juul, Annegrete; Langstrup, Henriette

    2016-01-01

    The rhetoric of need is commonplace in discourses of technology and innovation, as well as in global health. Users are said to have a need for innovative technology, and citizens in resource-poor regions to have a need for improved healthcare. In this article we follow a global health technology......—more specifically, a piece of software for monitoring diabetes quality—from Denmark, where it was developed, to Jakarta, Indonesia, where it was introduced in 2012–13. Using ethnographic material, we show how the need for a specific technology is constituted through the very process of moving a technology from one...

  9. Animal Research, the 3Rs, and the "Internet of Things": Opportunities and Oversight in International Pharmaceutical Development.

    Science.gov (United States)

    Niemi, Steven M; Davies, Gail F

    2016-12-01

    Stages of drug (and vaccine) discovery and evaluation that involve laboratory animals increasingly occur via scientific collaborations across national borders and continents. Many of these research collaborations are between asset-rich institutions and others in less wealthy parts of the world. The care and use of laboratory animals in geographically disparate locations introduces new complexities, such as different oversight requirements and available resources, as well as diverse organizational and cultural milieus. These complexities can hamper the effectiveness of local animal welfare committees and regulatory compliance, as well as compromise good science and animal welfare. At the same time, new technologies are becoming available that offer greater transparency in how these collaborations and their animal subjects are faring in real time that, in turn, can enable progress towards the 3 Rs. The focus of this essay is to identify potential rewards and risks stemming from new techniques for producing and connecting data in preclinical pharmaceutical development and consider how further social scientific investigations have the potential to enhance the benefits of international research collaborations for both human health and animal welfare.

  10. How can nanobiotechnology oversight advance science and industry: examples from environmental, health, and safety studies of nanoparticles (nano-EHS)

    Science.gov (United States)

    Wang, Jing; Asbach, Christof; Fissan, Heinz; Hülser, Tim; Kuhlbusch, Thomas A. J.; Thompson, Drew; Pui, David Y. H.

    2011-04-01

    Nanotechnology has great potential to transform science and industry in the fields of energy, material, environment, and medicine. At the same time, more concerns are being raised about the occupational health and safety of nanomaterials in the workplace and the implications of nanotechnology on the environment and living systems. Studies on environmental, health, and safety (EHS) issues of nanomaterials have a strong influence on public acceptance of nanotechnology and, eventually, affect its sustainability. Oversight and regulation by government agencies and non-governmental organizations (NGOs) play significant roles in ensuring responsible and environmentally friendly development of nanotechnology. The EHS studies of nanomaterials can provide data and information to help the development of regulations and guidelines. We present research results on three aspects of EHS studies: physico-chemical characterization and measurement of nanomaterials; emission, exposure, and toxicity of nanomaterials; and control and abatement of nanomaterial releases using filtration technology. Measurement of nanoparticle agglomerates using a newly developed instrument, the Universal NanoParticle Analyzer (UNPA), is discussed. Exposure measurement results for silicon nanoparticles in a pilot scale production plant are presented, as well as exposure measurement and toxicity study of carbon nanotubes (CNTs). Filtration studies of nanoparticle agglomerates are also presented as an example of emission control methods.

  11. 75 FR 82417 - Public Company Accounting Oversight Board; Order Approving Proposed Rules on Auditing Standards...

    Science.gov (United States)

    2010-12-30

    ...; AS No. 9, Audit Planning; AS No. 10, Supervision of the Audit Engagement; AS No. 11, Consideration of... the interim standards reflect: Improvements that the PCAOB has observed in the audit methodologies of... for assessing and responding to fraud risks are an integral part of the audit process rather than a...

  12. Need for improving quality of operating structures and processes for better ARV adherence for patients with HIV/AIDS in Tanzania and other African countries:an experi-ence from Tanzania

    Institute of Scientific and Technical Information of China (English)

    Irunde H; Nsimba SED; Comoro CJ

    2009-01-01

    Objective:The study was carried out in order to determine the following objectives:(1)To determine the pro-portion of patients who state achieving or not achieving optimal adherence to antiretroviral therapy (ART)in selected Care and Treatment Sites in Arusha and Dares Salaam regions in Tanzania.(2)To identify factors such as structural,cultural or disease related contributing to sub-optimal adherence to antiretroviral (ARVs). (3)To assess quality of operating structures and processes for provision of antiretroviral (ARVs)in the select-ed healthcare facilities.(4)To document suggestions and proposals for improving ART adherence among ARV users.Methods:Data from 7 studied facilities (3 public and 4 private /or faith based)includes 207 interviews from ARV users,28 staff interview staff,26 observations during consultations,8 focus group discussions,10 key informant interviews,and stock checks in 6 facilities.The study design was a cross-sectional using both qualitative and quantitative data collection techniques.Quantitative data were collected by using an adherence tool check list,while qualitative data were obtained using a consultation observation checklist,semi-structured interviews,focus group discussions (FGDs)and key informant interviews.Results:There were slight varia-tions in the quality of operating structures and processes in the two studied regions.However results indicate that ARV adherence in Arusha region was comparatively similar to that of Dares Salaam.The composite adher-ence for one month in seven facilities was 90 % and only 21 % of ARV users achieved optimal adherence. Conclusion:The overall mean composite adherence rate of 90 % in the two areas surveyed is encouraging. More efforts to improve the quality and processes of operating structures in our study facilities and others in Tanzania are needed to ensure optimal adherence among the larger group (79 %)of ARV users who are cur-rently taking less than the critical 95 % of their medications.

  13. Improving the implementation of health workforce policies through governance: a review of case studies

    Directory of Open Access Journals (Sweden)

    Shaw Daniel MP

    2011-04-01

    Full Text Available Abstract Introduction Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH, which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC. Methods We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. Results and discussion In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy

  14. Beyond Measure: New Approaches to Analyzing Congressional Oversight of Homeland Security

    Science.gov (United States)

    2015-03-01

    Constitution. From the requirement for Congress to appropriate money before the executive branch can spend it, to the advice and consent given by the...addressed and improve bills. a. Recommendation 14 The homeland security committees should take any parliamentary actions that will help them secure... parliamentary actions that will help them secure larger jurisdiction over homeland security topics. 101 APPENDIX B. HURRICANE KATRINA HEARINGS Date

  15. Generics Substitution, Bioequivalence Standards, and International Oversight: Complex Issues Facing the FDA.

    Science.gov (United States)

    Bate, Roger; Mathur, Aparna; Lever, Harry M; Thakur, Dinesh; Graedon, Joe; Cooperman, Tod; Mason, Preston; Fox, Erin R

    2016-03-01

    The regulations for assessing the quality of generic drugs and their bioequivalence to innovator products are outdated and need to be substantially modernized. There are multiple reasons why these changes are needed, including: (i) the regulations remain largely unchanged since the passage of the Hatch-Waxman Act in 1984; (ii) medication therapies have become substantially more complex over the three decades since the passage of the Act; (iii) a switch from an innovator drug to a generic drug, or switching from one generic to another, is not a benign process - there is substantial clinical professional judgment involved and in some instances these decisions should be better informed; and (iv) pharmaceutical ingredients for finished products, whether innovator or generic, are from multiple sources of supply, adding variability in their production, and which may not be accounted for in specification tolerances. When these elements are viewed together, they clearly suggest that more transparency of responsible manufacturers in product labels and updated standards for bioequivalence are required.

  16. History, organization, and oversight of the accredited dosimetry calibration laboratories by the AAPM

    Energy Technology Data Exchange (ETDEWEB)

    Rozenfeld, M. [St. James Hospital and Health Centers, Chicago Heights, IL (United States)

    1993-12-31

    For more than 20 years, the American Association of Physicists in Medicine (AAPM) has operated an accreditation program for secondary standards laboratories that calibrate radiation measuring instruments. Except for one short period, that program has been able to provide the facilities to satisfy the national need for accurate calibrations of such instruments. That exception, in 1981, due to the combination of the U.S. Nuclear Regulatory Commission (NRC) requiring instrument calibrations by users of cobalt-60 teletherapy units and the withdrawal of one of the three laboratories accredited at that time. However, after successful operation as a Task Group of the Radiation Therapy Committee (RTC) of the AAPM for two decades, a reorganization of this structure is now under serious consideration by the administration of the AAPM.

  17. Improving access to new diagnostics through harmonised regulation: priorities for action

    OpenAIRE

    Ruth McNerney; Kimberly Sollis; Peeling, Rosanna W

    2014-01-01

    A new generation of diagnostic tests is being developed for use at the point of care that could save lives and reduce the spread of infectious diseases through early detection and treatment. It is important that patients in developing countries have access to these products at affordable prices and without delay. Regulation of medical products is intended to ensure safety and quality whilst balancing the need for timely access to beneficial new products. Current regulatory oversight of diagno...

  18. Adults Need Vaccines, Too!

    Science.gov (United States)

    ... turn JavaScript on. Feature: Adult Vaccinations Adults Need Vaccines, Too! Past Issues / Summer 2015 Table of Contents ... of the millions of adults not receiving the vaccines you need? What vaccines do you need? All ...

  19. Meeting the Needs for Radiation Protection: Diagnostic Imaging.

    Science.gov (United States)

    Frush, Donald P

    2017-02-01

    :• innovative and cooperative cross-disciplinary institutional/practice oversight of and guidance for the use of diagnostic imaging (e.g., radiology, surgical specialties, cardiologists, and intensivists);• initiatives providing practical benchmarks (e.g., dose index registries);• comprehensive (consisting of access, integrity, metrology, analytics, informatics) and effective and efficient dose monitoring programs;• collaboration with industry;• improved use of imaging, such as through decision support combined with evidence-based appropriateness for imaging use;• integration with e-health such as medical records;• education, including information extending beyond the medical imaging community that is relevant to patients, public, and providers and administration;• identification of opportunities for alignment with salient media and advocacy organizations to deliver balanced information regarding medical radiation and risk;• open lines of communication between medical radiation experts and appropriate bodies such as the U.S. Environmental Protection Agency, the U.S. Food and Drug Administration, and the Joint Commission to assure appropriate guidance on documents and actions originating from these organizations; and• increased grant funding to foster translational work that advances understanding of low-level radiation and biological effects.

  20. ASSEMBLED PRODUCTS: THE KEY TO MORE EFFECTIVE COMPETITION AND ANTITRUST OVERSIGHT IN HEALTH CARE.

    Science.gov (United States)

    Sage, William M

    2016-01-01

    This Article argues that recent calls for antitrust enforcement to protect health insurers from hospital and physician consolidation are incomplete. The principal obstacle to effective competition in health care is not that one or the other party has too much bargaining power, but that they have been buying and selling the wrong things. Vigorous antitrust enforcement will benefit health care consumers only if it accounts for the competitive distortions caused by the sector's long history of government regulation. Because of regulation, what pass for products in health care are typically small process steps and isolated components that can be assigned a billing code, even if they do little to help patients. Instead of further entrenching weakly competitive parties engaged in artificial commerce, antitrust enforcers and regulators should work together to promote the sale of fully assembled products and services that can be warranted to consumers for performance and safety. As better products emerge through innovation and market entry, competition may finally succeed at lowering medical costs, increasing access to treatment, and improving quality of care.

  1. Cardiac arrhythmia in Wilson′s disease: An oversighted and overlooked entity!

    Directory of Open Access Journals (Sweden)

    Bhupender Kumar Bajaj

    2016-01-01

    Full Text Available Wilson's disease is a multisystem disorder which manifests with hepatic, neurological, musculoskeletal, hematological, renal, and cardiac symptoms. The hepatic and neurological manifestations often overshadow the other system involvement including cardiac symptoms and signs, which may prove fatal. We report a case of a young female who presented with progressive parkinsonian features and dystonia for around 4 months followed 2 months later by the complaint of episodes of light-headedness. She was diagnosed to have Wilson's disease based on the presence of Kayser–Fleischer ring and laboratory parameters of copper metabolism. Electrocardiography of the patient incidentally revealed 2nd degree Mobitz type-1 atrioventricular block explaining her episodes of light-headedness. She was started on penicillamine and trihexyphenidyl. The heart block improved spontaneously. Cardiac autonomic function tests including blood pressure response to standing and heart rate response to standing were observed to be normal. We review the literature on cardiac manifestations of Wilson's disease and emphasize that patients with Wilson's disease should be assessed for cardiac arrhythmia and cardiac dysfunction as these may have therapeutic and prognostic implications.

  2. Oversight role of the Independent Monitoring Board of the Global Polio Eradication Initiative.

    Science.gov (United States)

    Rutter, Paul D; Donaldson, Liam J

    2014-11-01

    The Global Polio Eradication Initiative (GPEI) established its Independent Monitoring Board (IMB) in 2010 to monitor and guide its progress toward stopping polio transmission globally. The concept of an IMB is innovative, with no clear analogue in the history of the GPEI or in any other global health program. The IMB meets with senior program officials every 3-6 months. Its reports provide analysis and recommendations about individual polio-affected countries. The IMB also examines issues affecting the global program as a whole. Its areas of focus have included escalating the level of priority afforded to polio eradication (particularly by recommending a World Health Assembly resolution to declare polio eradication a programmatic emergency, which was enacted in May 2012), placing greater emphasis on people factors in the delivery of the program, encouraging innovation, strengthening focus on the small number of so-called sanctuaries where polio persists, and continuous quality improvement to reach every missed child with vaccination. The IMB's true independence from the agencies and countries delivering the program has enabled it to raise difficult issues that others cannot. Other global health programs might benefit from establishing similar independent monitoring mechanisms.

  3. CMS oversight, OPOs and transplant centers and the law of unintended consequences.

    Science.gov (United States)

    Howard, Richard J; Cornell, Danielle L; Schold, Jesse D

    2009-01-01

    The Health Resources and Services Administration launched collaboratives with the goals of increasing donation rates, increasing the number of organs transplanted, eliminating deaths on the waiting list and improving outcomes. The Center for Medicare and Medicaid Services (CMS) recently published requirements for organ procurement organizations (OPOs) and transplant centers. Failure to meet CMS performance measures could result in OPOs losing their service area or transplant centers losing their CMS certification. CMS uses analyses by the Scientific Registry of Transplant Recipients (SRTR) to evaluate a transplant center's performance based on risk-adjusted outcomes. However, CMS also uses a more liberal (one-sided) statistical test rendering more centers likely to qualify as low performing. Furthermore, the SRTR model does not incorporate some important patient variables in its statistical model which may result in biased determinations of quality of care. Cumulatively, there is much unexplained variation for transplant outcomes as suggested by the low predictive ability of survival models compared to other disease contexts. OPOs and transplant centers are unlikely to quietly accept their elimination. They may take certain steps that can result in exclusion of candidates who might otherwise benefit from transplantation and/or result in fewer transplants through restricted use of organs thought to carry higher risk of failure. CMS should join with transplant organizations to ensure that the goals of the collaborative are not inhibited by their performance measures.

  4. Marketing Regulatory Oversight of Advanced Therapy Medicinal Products (ATMPs) in Europe: The EMA/CAT Perspective.

    Science.gov (United States)

    Salmikangas, Paula; Schuessler-Lenz, Martina; Ruiz, Sol; Celis, Patrick; Reischl, Ilona; Menezes-Ferreira, Margarida; Flory, Egbert; Renner, Matthias; Ferry, Nicolas

    2015-01-01

    With the release of Regulation 1394/2007, a new framework for gene and cell therapy medicinal products and tissue-engineered products was established in the European Union. For all three product classes, called advanced therapy medicinal products, a centralised marketing authorisation became mandatory. The European Medicines Agency (EMA) together with its Committee for Advanced Therapies, Committee for Human Medicinal Products and the network of national agencies is responsible for scientific evaluation of the marketing authorisation applications. For a new application, data and information relating to manufacturing processes and quality control of the active substance and the final product have to be submitted for evaluation together with data from non-clinical and clinical safety and efficacy studies. Technical requirements for ATMPs are defined in the legislation, and guidance for different products is available through several EMA/CAT guidelines. Due to the diversity of ATMPs, a tailored approach for regulating these products is considered necessary. Thus, a risk-based approach has been introduced for ATMPs allowing flexibility for the regulatory requirements. Since the regulatory framework for ATMPs was established, five products have been licenced in the European Union. However, the pipeline of new ATMPs is much bigger, as seen from the significant numbers of different products discussed by the CAT in scientific advice and classification procedures. In 2013, a public consultation on the ATMP Regulation was conducted by the European Commission, and the results were published in 2014. The report proposes several improvements for the current framework and established procedures for the regulation of ATMPs.

  5. VA Disability Benefits: Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions

    Science.gov (United States)

    2017-03-01

    person at the Board’s central office in Washington D.C.— 4 percent in fiscal 2015 and 6 percent in fiscal year 2016, according to VA—the appeal is...assessments, as well as through data-driven human capital management to improve its ability to maximize the value of human capital investments while...help Congress make informed oversight, policy, and funding decisions. GAO’s commitment to good government is reflected in its core values of

  6. SUMMARY AND RECOMMENDATIONS OF THE EXPERT PANEL OVERSIGHT COMMITTEE MEETING ON DOUBLE-SHELL TANK CORROSION MONITORING AND TESTING HELD AUGUST 4-5 2008

    Energy Technology Data Exchange (ETDEWEB)

    BOOMER KD

    2009-01-08

    The Expert Panel Oversight Committee (EPOC) on Double-Shell Tank Corrosion Monitoring and Testing has been overseeing the Fiscal Year FY 2008 experimental program being performed at CC Technologies (CCT) to optimize the chemistry control for corrosion limits in Double-Shell Tanks (DSTs). The EPOC met at the M & D Professional Services Conference Facility on August 4 and 5, 2008 to discuss various aspects of that responsibility including FY 2009 planning. Formal presentations were made to update the EPOC on the these subjects.

  7. Evaluation of Self-Ratings for Health Information Behaviour Skills Requires More Heterogeneous Sample, but Finds that Public Library Print Collections and Health Information Literacy of Librarians Needs Improvement

    Directory of Open Access Journals (Sweden)

    Carol Perryman

    2016-03-01

    Full Text Available Objective – To understand public library users’ perceptions of ability to locate, evaluate, and use health information; to identify barriers experienced in finding and using health information; and to compare self-ratings of skills to an administered instrument. Design – Mixed methods. Setting – Main library and two branches of one public library system in Florida. Subjects – 20 adult library users purposively selected from 131 voluntary respondents to a previously conducted survey (Yi, 2014 based on age range, ethnicity, gender, and educational level. Of the 20, 13 were female; 11 White, 8 Black, 1 Native American; most had attained college or graduate school education levels (9 each, with 2 having graduated from high school. 15 respondents were aged 45 or older. Methods – Intensive interviews conducted between April and May 2011 used critical incident technique to inquire about a recalled health situation. Participants responded to questions about skill self-appraisal, health situation severity, information seeking and assessment behaviour, use of information, barriers, and outcome. Responses were compared to results of the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA test, administered to participants. Main Results – On a scale of 100, participants’ S-TOFHLA scores measured at high levels of proficiency, with 90% rating 90 points or above. Self-ratings of ability to find health information related to recalled need were ”excellent” (12 participants or “good” (8 participants. Fourteen participants did not seek library assistance; 12 began their search on the Internet, 5 searched the library catalogue, and 3 reported going directly to the collection. Resource preferences were discussed, although no frequency descriptions were provided. 90% of participants self-rated their ability to evaluate the quality of health information as “good” or “excellent.” Participants selected authority

  8. Oversight framework over oocyte procurement for somatic cell nuclear transfer: comparative analysis of the Hwang Woo Suk case under South Korean bioethics law and U.S. guidelines for human embryonic stem cell research.

    Science.gov (United States)

    Kim, Mi-Kyung

    2009-01-01

    We examine whether the current regulatory regime instituted in South Korea and the United States would have prevented Hwang's potential transgressions in oocyte procurement for somatic cell nuclear transfer, we compare the general aspects and oversight framework of the Bioethics and Biosafety Act in South Korea and the US National Academies' Guidelines for Human Embryonic Stem Cell Research, and apply the relevant provisions and recommendations to each transgression. We conclude that the Act would institute centralized oversight under governmental auspices while the Guidelines recommend politically-independent, decentralized oversight bodies including a special review body for human embryonic stem cell research at an institutional level and that the Guidelines would have provided more vigorous protection for the women who had undergone oocyte procurement for Hwang's research than the Act. We also suggest additional regulations to protect those who provide oocytes for research in South Korea.

  9. Health care need

    DEFF Research Database (Denmark)

    Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

    2006-01-01

    The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

  10. What is needed to incorporate clinical pharmacogenetic tests into the practice of psychopharmacotherapy?

    Science.gov (United States)

    de Leon, Jose; Spina, Edoardo

    2016-01-01

    This editorial considers two questions in psychopharmacotherapy: 1) What is needed to market pharmacogenetic tests in the US, since the US appears to lead other countries? and 2) What is needed for US-marketed pharmacogenetic tests to be incorporated by prescribers into long-term practice? US marketing of pharmacogenetic tests requires 1) understanding the pharmacological complexity of drug response, 2) modifying the oversight of non-FDA regulatory agencies, 3) clarifying the FDA's role and 4) promoting innovative marketing. The incorporation of pharmacogenetic tests into long-term practice requires 1) not jeopardizing pharmacogenetic testing by short-sighted marketing of non-validated tests, 2) educating prescribers about benefits, 3) educating patients about limitations and 4) considering the differences between isolated testing and generalized testing incorporating big data.

  11. Absolute biological needs.

    Science.gov (United States)

    McLeod, Stephen

    2014-07-01

    Absolute needs (as against instrumental needs) are independent of the ends, goals and purposes of personal agents. Against the view that the only needs are instrumental needs, David Wiggins and Garrett Thomson have defended absolute needs on the grounds that the verb 'need' has instrumental and absolute senses. While remaining neutral about it, this article does not adopt that approach. Instead, it suggests that there are absolute biological needs. The absolute nature of these needs is defended by appeal to: their objectivity (as against mind-dependence); the universality of the phenomenon of needing across the plant and animal kingdoms; the impossibility that biological needs depend wholly upon the exercise of the abilities characteristic of personal agency; the contention that the possession of biological needs is prior to the possession of the abilities characteristic of personal agency. Finally, three philosophical usages of 'normative' are distinguished. On two of these, to describe a phenomenon or claim as 'normative' is to describe it as value-dependent. A description of a phenomenon or claim as 'normative' in the third sense does not entail such value-dependency, though it leaves open the possibility that value depends upon the phenomenon or upon the truth of the claim. It is argued that while survival needs (or claims about them) may well be normative in this third sense, they are normative in neither of the first two. Thus, the idea of absolute need is not inherently normative in either of the first two senses.

  12. Who Needs Heart Surgery?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. Who Needs Heart Surgery? Heart surgery is used to treat ... will work with you to decide whether you need heart surgery. A cardiologist specializes in diagnosing and ...

  13. Circuito Quirúrgico Informatizado: Una herramienta para la mejora de la atención al paciente quirúrgico Improving the Care level on a surgery-needed patient through a Computer-Aided Surgery Cares Program

    Directory of Open Access Journals (Sweden)

    Luis Fuentes Cebada

    2007-11-01

    Full Text Available El Programa de Atención al Paciente Quirúrgico en el Hospital Puerta del Mar (Cádiz surge con el objetivo de personalizar la atención y garantizar la continuidad de cuidados y la seguridad de nuestros pacientes en cada una de las unidades por las que va desarrollándose la actividad quirúrgica. Este programa se soporta en una herramienta informática que es el circuito quirúrgico, la cual ha sido diseñada siguiendo la metodología de mejora continua y la participación desde el inicio de los profesionales enfermeros como actores de su desarrollo e implantación. En sólo ocho meses se ha conseguido que más del 55 % de los pacientes intervenidos quirúrgicamente disponga de un registro informatizado en el que se valoran, diagnostican, planifican y abordan los aspectos relacionados con la propia intervención quirúrgica como una parte añadida a las respuestas humanas que la misma ocasiona tanto a él como a su familia. Todo ello haciendo uso de las taxonomías enfermeras NANDA, NOC y NIC, con un enfoque holístico, centrado en la persona como agente y receptor de cuidados. Acompaña a este registro un sistema de información desde el que se explotan aspectos tales como la prevalencia diagnóstica enfermera, intervenciones realizadas, alergias, profilaxis antibiótica administrada, etc.The Surgery-needed Care Program, currently under test at the Puerta del Mar Hospital in Cadiz, has been conceived with the aim of both tuning the care level to each individual patient and, at the same time, to secure a continuous assistance through all the units involved in the surgery process. It is based on a computer tool so called Surgery Program. This computer application has been designed on the basis of continually-improving approach while counting with the enrolment, from the very first phases, of nurses in the affected units both in development and set-up steps. After just eight months running this Program, we have been able to create a digital

  14. High frequency and poor prognosis of late childhood BCR-ABL-positive and MLL-AF4-positive ALL define the need for advanced molecular diagnostics and improved therapeutic strategies in pediatric B-ALL in Pakistan.

    Science.gov (United States)

    Iqbal, Zafar; Akhtar, Tanveer; Awan, Tashfin; Aleem, Aamer; Sabir, Noreen; Rasool, Mahmood; Absar, Muhammad; Akram, Afia M; Shammas, Masood A; Shah, Ijaz H; Khalid, Muhammad; Taj, Abid S; Jameel, Abid; Alanazi, Abdullah; Gill, Ammara T; Hashmi, Jamil Amjad; Hussain, Akhtar; Sabar, Muhammad Farooq; Khalid, Ahmad M; Qazi, Mehmood Hussain; Karim, Sajjad; Siddiqi, Muhammad Hassan; Mahmood, Aamir; Iqbal, Mudassar; Saeed, Anjum; Irfan, Muhammad Imran

    2015-10-01

    one of the unique findings in our study. The results presented here highlight the need for mandatory inclusion of molecular testing for pediatric ALL patients in clinical decision making, together with the incorporation of tyrosine kinase inhibitors, as well as hematopoietic stem cell transplantation facilities, to improve treatment outcome for patients in developing countries.

  15. Climbing the Needs Pyramids

    Directory of Open Access Journals (Sweden)

    J. C. Lomas

    2013-08-01

    Full Text Available Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self-transcendence. Yet how adults can purposefully ascend Maslow’s pyramid through satisfying unfilled needs remains elusive. This brief article challenges this on the theory’s 70th anniversary by presenting a new image of the needs hierarchy, based on ecological design principles to support adults’ purposeful endeavors to climb the needs pyramid.

  16. Information Needs/Relevance

    OpenAIRE

    Wildemuth, Barbara M.

    2009-01-01

    A user's interaction with a DL is often initiated as the result of the user experiencing an information need of some kind. Aspects of that experience and how it might affect the user's interactions with the DL are discussed in this module. In addition, users continuously make decisions about and evaluations of the materials retrieved from a DL, relative to their information needs. Relevance judgments, and their relationship to the user's information needs, are discussed in this module. Draft

  17. Climbing the Needs Pyramids

    OpenAIRE

    J. C. Lomas

    2013-01-01

    Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self...

  18. Climbing the Needs Pyramids

    OpenAIRE

    J. C. Lomas

    2013-01-01

    Abraham Maslow’s theory of human adult motivation is often represented by a pyramid image showing two proposals: First, the five needs stages in emergent order of hierarchical ascension and second, a percentage of the adult population suggested to occupy each needs tier. Specifically, Maslow proposed that adults would be motivated to satisfy their unfilled needs until they reached the hierarchy’s apex and achieved self...

  19. Priority knowledge needs. Summary

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-07-01

    This report gives an overview of the knowledge needs identified during the work on the scientific basis for the management plan. The overview includes knowledge needs identified in: the impact assessments for various sectors; the reports on the vulnerability of particularly valuable areas; proposed indicators for a monitoring system; cumulative environmental effects; conflicting interests and the need for coordination; and the report on analysis of population and, economic activity and ecosystem services. In addition, the working group has identified several additional knowledge needs. The present report summarises the 2010 status report and describes new developments since its publication.(Author)

  20. O perfil de saúde cardiovascular dos idosos brasileiros precisa melhorar: estudo de base populacional The profile of cardiovascular health of elderly brazilian people needs to improve: a population-based study

    Directory of Open Access Journals (Sweden)

    Janaina Caldeira Pereira

    2008-07-01

    cardiovascular diseases in the elderly is scarce. OBJECTIVE: To estimate the prevalence and clustering of risk factors and investigate their association with ischemic heart disease (IHD in elderly people. METHODS: All subjects >60 years of age participating in the "Inquérito domiciliar sobre comportamentos de risco e morbidade referida de doenças e agravos não transmissíveis" (Household Survey on Risk Behaviors and Reported Morbidity of Non Transmissible Diseases and Health Conditions carried out by the Ministry of Health, in 2002/2003 in 15 capitals and the Federal District were included. The prevalence of risk factors (smoking, alcohol consumption, lack of physical activity, inappropriate diet, and obesity and reported morbidity (hypertension, hypercholesterolemia, and diabetes was assessed, as well as the association between IHD and clustering of these factors using the Poisson regression model. RESULTS: Elderly individuals represented 13.4% (3,142/23,457, 59.4% women and 40.6% men. The mean age of the participants was 69.5 years. Approximately 50% of participants reported having hypertension, 33% hypercholesterolemia, and 18% diabetes. Smoking and hypercholesterolemia dropped significantly with age. Hypertension, physical inactivity, obesity, and hypercholesterolemia were more prevalent among women. Clustering of two or more factors was observed in 71.3% of the elderly, and diminished with age. Elderly subjects with IHD had a four-fold higher prevalence of clusters with four or more factors (PR=4.1; 95% CI: 2.6-6.4. CONCLUSION: The relationship between IHD and a larger clustering of risk factors probably represents a greater accumulated risk throughout life, but it also indicates the need to improve the risk profile of these elderly people.