British Columbia has seen record levels of activities in the oil and gas sector. Upstream petroleum processes include exploration, well completion and production. Site contamination can occur during all of these activities, resulting in potential environmental and human health impacts. Although well operators are responsible by law for site restoration, there is a potential risk that some operators will not fulfill their responsibilities, thereby leaving the province liable for the site restoration costs. In British Columbia, the BC Oil and Gas Commission (OGC) is responsible for managing these risks through oversight activities designed to ensure that industry meets its obligations. The OGC also manages the orphan sites reclamation fund. This report presented an audit of the OGC in order to determine if it is providing adequate oversight of upstream oil and gas site contamination risks. The audit examined whether the agency responsibilities are clear and whether the OGC is fully aware of the environmental and financial risks associated with upstream oil and gas site contamination. The audit also examined if the OGC has established appropriate procedures to oversee the risks and to inform the public of how effectively site contamination risks are being managed. The report presented the audit background, audit expectations, findings, conclusions and recommendations. It was concluded that the OGC's oversight of the environmental and financial risks associated with oil and gas site contamination needs improving. tabs., figs.
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
Contracting Letter 1 Background 3 The Extent to Which VA Used IAAs Is Unknown Due to Incomplete Information 10 Management of the Award and Oversight...of IAAs Varied, and in Some Cases Did Not Comply with Policy 13 VA Obligated Over $244 Million to FFRDCs with Significant Increases for Two VA...Documentation among Selected IAA Orders 14 Table 2: Veterans Affairs Obligations to Federally Funded Research and Development Centers, Fiscal
PREPOSITIONED STOCKS Marine Corps Needs to Improve Cost Estimate Reliability and Oversight of Inventory Systems for...REPORT DATE SEP 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Prepostioned Stocks : Marine Corps Needs to...Senate September 2015 PREPOSITIONED STOCKS Marine Corps Needs to Improve Cost Estimate Reliability and Oversight of Inventory Systems for
clerk stations and a lack of privacy curtains in examination rooms, as required by VHA policy. GAO also found weaknesses in VHA’s oversight of the...VHA officials said not all facilities require onsite gynecologists and facilities may authorize gynecological services from non-VA providers. They...does not have such measures for women veterans’ sex-specific care, such as mammography, maternity care, or gynecology . VHA’s data show poor
soldier’s complaints, and geographic dispersion. While the results from these visits are not generalizable, they provide useful information on WTU...contingency planning, and the need for control activities such as the management of human capital to maintain a continuity of needed skills and abilities...issued a report assessing efforts to reduce mental health care stigma within the Department of Defense. See GAO, Human Capital : Additional Actions Needed
the OSINT [open source intelligence] program.” Task Order Terms Not Well Defined and the Problem Was Previously Reported Task order terms...Kuwait Need Stronger Management and Administration,” June 30, 2011 DoD IG Report No. D-2010-059, “Contingency Contracting: A Framework for Reform
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
WHISTLEBLOWER PROTECTION DOD Needs to Enhance Oversight of Military Whistleblower Reprisal Investigations Report...00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Whistleblower Protection: DOD Needs to Enhance Oversight of Military Whistleblower Reprisal...Government Accountability Office Highlights of GAO-15-477, a report to congressional requesters May 2015 WHISTLEBLOWER PROTECTION DOD
Finkelstein, Jonathan A.; Brickman, Andrew L.; Capron, Alexander; Ford, Daniel E.; Gombosev, Adrijana; Greene, Sarah M; Iafrate, R. Peter; Kolaczkowski, Laura; Pallin, Sarah; Pletcher, Mark J.; Staman, Karen L.; Vazquez, Miguel A.; Sugarman, Jeremy
Pragmatic research that compares interventions to improve the organization and delivery of health care may overlap, in both goals and methods, with quality improvement (QI) activities. When activities have attributes of both research and QI, confusion often arises about what ethical oversight is, or should be, required. For routine QI, in which the delivery of health care is modified in minor ways that create only minimal risks, oversight by local clinical or administrative leaders utilizing institutional policies may be sufficient. However, additional consideration should be given to activities that go beyond routine, local QI to first determine whether such non-routine activities constitute research or QI and, in either case, to ensure that independent oversight will occur. This should promote rigor, transparency, and protection of patients’ and clinicians’ rights, well-being, and privacy in all such activities. Specifically, we recommend: 1. Health care organizations should have systematic policies and processes for designating activities as routine QI, non-routine QI, or QI research, and determining what oversight each will receive. 2. Health care organizations should have formal and explicit oversight processes for non-routine QI activities that may include input from institutional QI experts, health services researchers, administrators, clinicians, patient representatives, and those experienced in the ethics review of health care activities. 3. QI research requires review by an IRB; for such review to be effective, IRBs should develop particular expertise in assessing QI research. 4. Stakeholders should be included in the review of non-routine QI and QI-related research proposals. Only by doing so will we optimally leverage both pragmatic research on health care delivery and local implementation through QI as complementary activities for improving health. PMID:26374685
Fiscella, Kevin; Tobin, Jonathan N; Carroll, Jennifer K; He, Hua; Ogedegbe, Gbenga
Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. Minimal risk projects should entail minimal oversight including waivers for informed consent for both QI and QIR projects. Minimizing the burdens of conducting QIR, while ensuring minimal safeguards for QI projects, is needed to restore this imbalance in oversight. Potentially, such ethical oversight could be provided by the integration of Institutional Review Boards and Clinical Ethical Committees, using a more integrated and streamlined approach such as a two-step process involving a screening review, followed by a review by committee trained in QIR. Standards for such ethical review and training in these standards, coupled with rapid review cycles, could facilitate an appropriate level of oversight within the context of creating and sustaining learning health care systems. We argue that QI and QIR are not reliably distinguishable. We advocate for approaches that improve protections for QI participants while minimizing over-protection for participants in QIR through reasonable ethical oversight that aligns risk to participants in both QI and QIR with the needs of a learning health care system.
Andolsek, Kathryn M; Fortune, Rhea F; Nagler, Alisa; Stancil, Chrystal; Kuhn, Catherine; McNeill, Diana
The Accreditation Council for Graduate Medical Education (ACGME) requires programs to engage annually in program evaluation and improvement. We assessed the value of creating educational competency committees (ECCs) that use successful elements of 2 established processes-institutional special reviews and institutional oversight of annual program evaluations. The ECCs used a template to review programs' annual program evaluations. Results were aggregated into an institutional dashboard. We calculated the costs, sensitivity, specificity, and predictive value by comparing programs required to have a special review with those that had ACGME citations, requests for a progress report, or a data-prompted site visit. We assessed the value for professional development through a participant survey. Thirty-two ECCs involving more than 100 individuals reviewed 237 annual program evaluations over a 3-year period. The ECCs required less time than internal reviews. The ECCs rated 2 to 8 programs (2.4%-9.8%) as "noncompliant." One to 13 programs (1.2%-14.6%) had opportunities for improvement identified. Institutional improvements were recognized using the dashboard. Zero to 13 programs (0%-16%) were required to have special reviews. The sensitivity of the decision to have a special review was 83% to 100%; specificity was 89% to 93%; and negative predictive value was 99% to 100%. The total cost was $280 per program. Of the ECC members, 86% to 95% reported their participation enhanced their professional development, and 60% to 95% believed the ECC benefited their program. Educational competency committees facilitated the identification of institution-wide needs, highlighted innovation and best practices, and enhanced professional development. The cost, sensitivity, specificity, and predictive value indicated good value.
Oversight, Resources, and Collaboration Lack of Leadership and Oversight Has Limited DOD’s and VA’s Ability to Effectively Manage Programs for...RECOVERING SERVICEMEMBERS AND VETERANS Sustained Leadership Attention and Systematic Oversight Needed to Resolve...Persistent Problems Affecting Care and Benefits Report to Congressional Committees November 2012 GAO-13-5 Don’t have a QR code reader
designated to work closely with its advertising agency in monitoring and analyzing performance across key areas. • Officials from the Army, which has the... advertising funds across different types of advertising (e.g., television, print, Internet , etc.), which was a key planning best practice cited by...DOD ADVERTISING Better Coordination, Performance Measurement, and Oversight Needed to Help Meet Recruitment Goals
Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S
Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.
below), which would qualify it as a major defense acquisition program in its own right . F-35 Joint Strike Fighter Block 4 Development Costs Increase...F-35 JOINT STRIKE FIGHTER Continued Oversight Needed as Program Plans to Begin Development of New Capabilities...Accountability Office Highlights of GAO-16-390, a report to congressional committees April 2016 F-35 JOINT STRIKE FIGHTER Continued Oversight
Bokov, Dmitry; Byers, Kenneth R.
As the Russian State regulatory agency responsible for oversight of nuclear material control and accounting (MC and A), Gosatomnadzor of Russia (GAN) determines the status of the MC and A programs at Russian facilities. Last year, GAN developed and implemented their Nuclear Material Measurement Program Plan which documents current non-destructive assay (NDA) measurement capability in all regions of GAN; provides justification for upgrades to equipment, procedures and training; and defines the inspector-facility operator interface as it relates to NDA measurement equipment use. This Program Plan has helped to give the GAN inspection measurements more legal and official status as an oversight tool, and has also helped to improve other GAN MC and A oversight activities. These improvements include developing a tamper-indicating device program, conducting NDA workshops at specific Russian nuclear facilities to better train MC and A inspectors, and developing training evaluation programs. The Program is an important tool to address the GAN role in oversight of the Russian Federal Information System nuclear material database. This paper describes the feedback received from the GAN regional offices on the implementation of the Program Plan during its first year in operation and how the Program Plan has affected other GAN inspection activities to improve MC and A oversight.
WHISTLEBLOWER PROTECTION DOD Has Improved Oversight for Reprisal Investigations, but Can Take Additional Actions to...House of Representatives September 7, 2016 WHISTLEBLOWER PROTECTION DOD Has Improved Oversight for Reprisal Investigations, but Can Take Additional...improve its tracking of the timeliness of military whistleblower reprisal investigations in response to recommendations that GAO made in 2012 and 2015
.... Over the past few years, a number of reports and incidents have indicated that there are problems-including computer security and the control of foreign visitors-at DOE's facilities and laboratories...
Cohen, Cynthia B; Cohen, Peter J
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.
Young, C.; Hensley, J.
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.
they believed the newly contracted system, Armed Forces Billing and Collection Utilization Solution ( ABACUS ),11 would improve the process to manage...tentative launch date for ABACUS is September 8, 2015, and five resource management staff received ABACUS training. 15 DGMC wrote off the debt because...delinquent accounts or alert MSA clerks when follow up was needed. The Commander stated that ABACUS will identify accounts that are delinquent to allow
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.
Goldenberg, Neil A; Spyropoulos, Alex C; Halperin, Jonathan L; Kessler, Craig M; Schulman, Sam; Turpie, Alexander G G; Skene, Allan M; Cutler, Neal R; Hiatt, William R
Standards for clinical trial design, execution, and publication have increased in recent years. However, the current structure for interaction among the pharmaceutical sponsor funding a drug or device development program, the contract research organization (CRO) that typically assists in executing the trial, regulatory agencies, and academicians, provides inadequate leadership and oversight of the development process. Conventional academic steering committees are not provided with the independent infrastructure by which to verify statistical analyses and conclusions regarding safety and efficacy. We propose an alternative approach centered on partnerships between CROs and university-based academic research organizations (AROs). In this model, the ARO takes responsibility for processes that address journal requirements and regulatory expectations for independent academic oversight (including oversight of Steering Committee and Data and Safety Monitoring Board activities), whereas the CRO provides infrastructure for efficient trial execution, site monitoring, and data management. The ARO engages academic experts throughout the trial process and minimizes conflicts of interest in individual industry relationships via diversification of sponsors, agents, and therapeutic areas. Although numerous models can be entertained, the ARO-CRO model is uniquely structured to meet the demand for greater assurance of integrity in clinical trials and the needs of each stakeholder in the process.
Bozin, B.; Kavsek, D.
The nuclear oversight function is used at the Krsko NPP constructively to strengthen safety and improve performance. Nuclear safety is kept under constant examination through a variety of monitoring techniques and activities, some of which provide an independent review. The nuclear oversight function at the Krsko NPP is accomplished by Quality and Nuclear Oversight Division (SKV). SKV has completed its mission through a combination of compliance, performance and effectiveness-based assessments. The performance-based assessment is an assessment using various techniques (observations, interviews, walk-downs, document reviews) to assure compliance with standards and regulations, obtain insight into performance, performance trends and also to identify opportunities to improve effectiveness of implementation. Generally, the performance-based approach to oversight function is based on some essential elements. The most important one which is developed and implemented is an oversight program (procedure). The program focuses on techniques, activities and objectives commensurate with their significance to plant operational safety. These techniques and activities are: self-assessments, assessments, audits, performance indicators, monitoring of corrective action program (CAP), industry independent reviews (such as IAEA's OSART and WANO Peer Review), industry benchmarking etc. Graded approach is an inherent product of a performance based program and ranking process. It is important not only to focus on the highest ranked performance based attributes but to lead to effective utilization of an oversight program. The attributes selected for oversight need to be based on plant specific experience, current industry operating experience, supplier's performance and quality issues. Collaboration within the industry and effective utility oversight of processes and design activities are essential for achieving good plant performance. So the oversight program must integrate relevant
Reactor safety, protecting the public health and safety, and protecting the environment must always be the nuclear regulator's top priorities. Enabling the use of nuclear power for the benefit of society, while protecting the public and the environment requires the regulator to balance many factors. In addition, the regulator is only one part of the overall government that must consider many factors as it carries out its societal responsibilities. Some of the factors that must be balanced and the practical impacts on how the regulator carries out its responsibilities will be addressed. The first International Conference on Effective Regulatory Systems, held in Moscow, Russian Federation, in 2006, focused on safety and security challenges with a goal of improving regulatory effectiveness through cooperation and sharing of information and best practices. The challenge of meeting both safety and security objectives is one example of potentially competing programmes that must be balanced. Other balances that must be evaluated include the benefits of safety improvements compared to the cost of implementation, the use of deterministic and probabilistic approaches, communication openness balanced with the protection of information that could be used for detrimental purposes, and timeliness of regulatory decision making balanced with the need to perform quality work in support of oversight responsibilities. A balanced and integrated approach to regulatory oversight is vital to ensuring that the regulatory body remains effective in its mission to enable the use of nuclear power while protecting the public and the environment. This concept is applicable to nations beginning a nuclear programme as well as established and experienced regulatory bodies. (author)
Shabani, Mahsa; Dove, Edward S; Murtagh, Madeleine; Knoppers, Bartha Maria; Borry, Pascal
Discussions regarding responsible genomic data sharing often center around ethical and legal issues such as the consent, privacy, and confidentiality of individuals, families, and communities. To ensure the ethical grounds of genomic data sharing, oversight by both research ethics and Data Access Committees (DACs) across the research lifecycle is warranted. In this article, we review these oversight practices and argue that they reveal a compelling need to clarify the scope of ethical considerations by oversight bodies and to delineate core elements such as "objectionable" data uses. Ethical oversight of genomic data sharing would be considerably improved if the relevant ethical considerations by research ethics and DACs were coordinated. We therefore suggest several mechanisms to achieve greater clarification of ethical considerations by these committees, as well as greater communication and coordination between both to ensure robust and sustained ethical oversight of genomic data sharing.
Report #15-P-0001, October 6, 2014. If oversight of the EPA’s fleet is not improved, the $6 million-per-year program could be ineffective and inefficient in supporting the agency’s mission and reporting data to the federal system.
improve conflict -management skills within dating relationships and to shift the social norms of the school to increase peer-based social sanctions for...of service members and their families—behaviors that DoD calls problematic. After nearly two decades of persistent conflict and facing declining...definitions that distinguish hazing from bullying , and establish policies and procedures for reducing the incidence of both kinds of problematic
Woods, William; Mittal, Anu; Neumann, John; Williams, Cheryl; Candon, Sharron; Sterling, Suzanne; Wade, Jacqueline; Zwanzig, Peter
..., and (2) agency oversight processes used to ensure that FFRDCs are well-managed. GAO's work is based on a review of documents and interviews with officials from eight FFRDCs sponsored by the departments of Defense (DoD), Energy (DOE...
Center officials cited an emerging threat whereby clones —exact copies of electronic parts not supplied by the original equipment manufacturer—are...for using American Express, Discover Card , MasterCard, Visa, check, or money order. Call for additional information. Connect with GAO on Facebook
requirements for VHA Choice provider agreements to be similar to the Choice contractors’ requirements to avoid any advantages or disadvantages of...medical facility—rather than the contractors—review Choice physicians’ credentials. GAO found that VHA did not require its staff to verify licenses ...submitted by physicians against the issuing source; rather, they review copies of the licenses . Federal internal control standards state that management
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).
Report #2005-P-00023, September 14, 2005. EPA’s Office of Environmental Information (OEI) did not sufficiently oversee information technology projects to ensure they met planned budgets and schedules.
Office of the Deputy Chief of Naval Operations ( Fleet Readiness and Logistics), Fleet Readiness Division • Commander, Navy Installations Command...Tracy Barnes, Ronald Bergman, Justin Fisher , Chaneé Gaskin, Amie Lesser, Geoffrey Peck, Michael Silver, Cheryl Weissman, and Nell Williams made key
Farrell, Brenda S; Wasleski, Marilyn K; Chan, Joanna; Davis, Pawnee A; Harms, K. N; Johnson, Wesley A; La Due Lake, Ronald; Miller, Amanda K; Weissman, Cheryl A
.... Though not required to do so, the Coast Guard has established a similar policy. This statement addresses implementation and oversight of DoD's and the Coast Guard's programs to prevent and respond to sexual assault incidents...
Currently, pharmaceutical companies' utilization of foreign clinical trial data is a ubiquitous and indispensable aspect of gaining approval to market drugs in the United States. Cost benefits, a larger pool of ready volunteer subjects, and greater efficiency in clinical testing are some of the reasons for conducting clinical trials overseas. Despite these advantages, lack of proper oversight may have serious public health implications regarding the integrity of clinical research, ethical treatment of human subjects, and drug safety. Due to the expansive global nature of foreign clinical trials, there are concerns with the FDA's ability to monitor and regulate these trials. This article examines the FDA's oversight of foreign clinical trials and the agency's limitations regulating these trials. In addition to looking at steps the FDA is taking to address these limitations, the article examines other potential regulatory and cooperative actions that can be taken to effectively monitor foreign clinical trials and to ensure data integrity and patient safety.
Fiscella, Kevin; Tobin, Jonathan N.; Carroll, Jennifer K.; He, Hua; Ogedegbe, Gbenga
Background Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. Discussion Minimal risk projects should entai...
Wolf, Susan M.; Jones, Cortney
The basic procedures and rules for oversight of U.S. human subjects research have been in place since 1981. Certain types of human subjects research, however, have provoked creation of additional mechanisms and rules beyond the Department of Health & Human Services (DHHS) Common Rule and Food and Drug Administration (FDA) equivalent. Now another emerging domain of human subjects research—nanomedicine—is prompting calls for extra oversight. However, in 30 years of overseeing research on human beings, we have yet to specify what makes a domain of scientific research warrant extra oversight. This failure to systematically evaluate the need for extra measures, the type of extra measures appropriate for different challenges, and the usefulness of those measures hampers efforts to respond appropriately to emerging science such as nanomedicine. This article evaluates the history of extra oversight, extracting lessons for oversight of nanomedicine research in human beings. We argue that a confluence of factors supports the need for extra oversight, including heightened uncertainty regarding risks, fast-evolving science yielding complex and increasingly active materials, likelihood of research on vulnerable participants including cancer patients, and potential risks to others beyond the research participant. We suggest the essential elements of the extra oversight needed. PMID:23226969
Wolf, Susan M.; Jones, Cortney M.
The basic procedures and rules for oversight of U.S. human subjects research have been in place since 1981. Certain types of human subjects research, however, have provoked creation of additional mechanisms and rules beyond the Department of Health & Human Services (DHHS) Common Rule and Food and Drug Administration (FDA) equivalent. Now another emerging domain of human subjects research—nanomedicine—is prompting calls for extra oversight. However, in 30 years of overseeing research on human beings, we have yet to specify what makes a domain of scientific research warrant extra oversight. This failure to systematically evaluate the need for extra measures, the type of extra measures appropriate for different challenges, and the usefulness of those measures hampers efforts to respond appropriately to emerging science such as nanomedicine. This article evaluates the history of extra oversight, extracting lessons for oversight of nanomedicine research in human beings. We argue that a confluence of factors supports the need for extra oversight, including heightened uncertainty regarding risks, fast-evolving science yielding complex and increasingly active materials, likelihood of research on vulnerable participants including cancer patients, and potential risks to others beyond the research participant. We suggest the essential elements of the extra oversight needed.
Wolf, Susan M.; Jones, Cortney M.
The basic procedures and rules for oversight of U.S. human subjects research have been in place since 1981. Certain types of human subjects research, however, have provoked creation of additional mechanisms and rules beyond the Department of Health and Human Services (DHHS) Common Rule and Food and Drug Administration (FDA) equivalent. Now another emerging domain of human subjects research—nanomedicine—is prompting calls for extra oversight. However, in 30 years of overseeing research on human beings, we have yet to specify what makes a domain of scientific research warrant extra oversight. This failure to systematically evaluate the need for extra measures, the type of extra measures appropriate for different challenges, and the usefulness of those measures hampers efforts to respond appropriately to emerging science such as nanomedicine. This article evaluates the history of extra oversight, extracting lessons for oversight of nanomedicine research in human beings. We argue that a confluence of factors supports the need for extra oversight, including heightened uncertainty regarding risks, fast-evolving science yielding complex and increasingly active materials, likelihood of research on vulnerable participants including cancer patients, and potential risks to others beyond the research participant. We suggest the essential elements of the extra oversight needed.
The federal-aid highway program : provides about $33 billion a year to : states for highway projects. The : federal government provides : funding for and oversees this : program, while states largely : choose and manage the projects. : As requested, ...
Ramachandran, Gurumurthy; Wolf, Susan M.; Paradise, Jordan; Kuzma, Jennifer; Hall, Ralph; Kokkoli, Efrosini; Fatehi, Leili
Federal oversight of nanobiotechnology in the U.S. has been fragmented and incremental. The prevailing approach has been to use existing laws and other administrative mechanisms for oversight. However, this “stay-the-course” approach will be inadequate for such a complex and convergent technology and may indeed undermine its promise. The technology demands a new, more dynamic approach to oversight. The authors are proposing a new oversight framework with three essential features: (a) the oversight trajectory needs to be able to move dynamically between “soft” and “hard” approaches as information and nano-products evolve; (b) it needs to integrate inputs from all stakeholders, with strong public engagement in decision-making to assure adequate analysis and transparency; and (c) it should include an overarching coordinating entity to assure strong inter-agency coordination and communication that can meet the challenge posed by the convergent nature of nanobiotechnology. The proposed framework arises from a detailed case analysis of several key oversight regimes relevant to nanobiotechnology and is informed by inputs from experts in academia, industry, NGOs, and government.
Fergus, I.E., Christopher, R.K.
This paper addresses recent changes to the independent oversight and enforcement programs within the U.S. Department of Energy (DOE) and applications to criticality safety. DOE's Office of Oversight (Oversight hereafter), in the Office of Environment, Safety, and Health (EH), independently evaluates whether management systems ensure adequate protection of the worker, public, and environment. Oversight has adopted a new approach to performing evaluations based on the guiding principles for safety management identified by the Secretary of Energy. The principles Oversight evaluates are line management responsibility for safety and health, comprehensive requirements, and competence commensurate with responsibilities. Recently, the DOE codified the implementation of integrated safety management, further expounding on these basic guiding principles and Oversight's role. The Office of Enforcement and Investigations in EH (Enforcement hereafter) is responsible for enforcement, and relevant documents describe its role. This paper briefly discusses criticality safety aspects of the twin initiatives of Oversight and Enforcement
Campisi, John A.
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.
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...recognized as leaders in our field. For more information about whistleblower protection, please see the inside back cover. I N T E G R I T Y E F F I C...Management - Retrograde From Southwest Asia ,” February 1, 2013 Army Audit Agency Report A-2011-0077-ALL, “Follow-up Audit of Retrograde Operations
Inspector General of the Department of Defense,400 Army Navy Drive,Arlington,VA,22202-4704 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING...11-14 (Contract No. W912ER-10-C-0044). The purpose of the project was to construct four concrete masonry unit barracks (phases 11-14) to provide
Fatehi, Leili; Hall, Ralph F
Synthetic biology (SB) is expected to create tremendous opportunities in a wide range of areas, including in foods, therapeutics, and diagnostics subject to regulatory oversight by the United States Food and Drug Administration. At the same time, there is substantial basis for concern about the uncertainties of accurately assessing the human health and environmental risks of such SB products. As such, SB is the latest in a string of emerging technologies that is the subject of calls for new approaches to regulation and oversight that involve "thinking ahead" to anticipate governance challenges upstream of technological development and adopting oversight mechanisms that are both adaptive to new information about risks and reflexive to performance data and feedback on policy outcomes over time. These new approaches constitute a marked departure from the status quo, and their development and implementation will require considerable time, resources, and reallocation of responsibilities. Furthermore, in order to develop an appropriate oversight response, adaptive or otherwise, there is first a need to identify the specific types and natures of applications, uncertainties, and regulatory issues that are likely to pose oversight challenges. This article presents our vision for a Productive Oversight Assessment (POA) approach in which the abilities and deficits of an oversight system are evaluated with the aim of enabling productive decisions (i.e., timely, feasible, effective for achieving desired policy outcomes) about oversight while also building capacity to facilitate broader governance efforts. The value ofPOA is two-fold. First, it will advance the development of a generalizable approach for making productive planning and decision-making about the oversight of any given new technology that presents challenges and uncertainties for any given oversight system whose policy goals are implicated by that technology. Second, this effort can enhance the very processes
In this report GAO reviews the Nuclear Regulatory Commission's management process for evaluating nuclear powerplant designs and sites and makes recommendations for improvements. The report also discusses the Commission staff's perspective on the adequacy of the licensing process, Commission staff's ability to raise dissenting technical opinions without experiencing adverse personnel actions, and administration's proposed legislation to streamline the licensing process
Full Text Available Women and men globally are delaying the birth of their first child. In the UK, the average age of first conception in women is 29 years. Women experience age-related fertility decline so it is important that men and women are well-informed about this, and other aspects of fertility. A group of UK stakeholders have established the Fertility Education Initiative to develop tools and information for children, adults, teachers, parents and healthcare professionals dedicated to improving knowledge of fertility and reproductive health.
Alicia Hanzeliková Pogrányivá
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
Zull, Lawrence M.; Yeniscavich, William
The Defense Nuclear Facilities Safety Board (Board) is an independent federal agency established by Congress in 1988 to provide nuclear safety oversight of activities at U.S. Department of Energy (DOE) defense nuclear facilities. The activities under the Board's jurisdiction include the design, construction, startup, operation, and decommissioning of defense nuclear facilities at DOE sites. This paper reviews the Board's safety oversight of decommissioning activities at DOE sites, identifies the safety problems observed, and discusses Board initiatives to improve the safety of decommissioning activities at DOE sites. The decommissioning of former defense nuclear facilities has reduced the risk of radioactive material contamination and exposure to the public and site workers. In general, efforts to perform decommissioning work at DOE defense nuclear sites have been successful, and contractors performing decommissioning work have a good safety record. Decommissioning activities have recently been completed at sites identified for closure, including the Rocky Flats Environmental Technology Site, the Fernald Closure Project, and the Miamisburg Closure Project (the Mound site). The Rocky Flats and Fernald sites, which produced plutonium parts and uranium materials for defense needs (respectively), have been turned into wildlife refuges. The Mound site, which performed R and D activities on nuclear materials, has been converted into an industrial and technology park called the Mound Advanced Technology Center. The DOE Office of Legacy Management is responsible for the long term stewardship of these former EM sites. The Board has reviewed many decommissioning activities, and noted that there are valuable lessons learned that can benefit both DOE and the contractor. As part of its ongoing safety oversight responsibilities, the Board and its staff will continue to review the safety of DOE and contractor decommissioning activities at DOE defense nuclear sites
Kuzma, Jennifer; Kuzhabekova, Aliya
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.
Knudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Mainz, Jan
published QI studies are conducted according to key principles of the PDSA method. Method A systematic literature search was performed in the PubMed, Embase and CINAHL databases for PDSA-based studies, published in English in peer-reviewed journals in 2015-2016. Empirical studies using PDSA to improve......-scale, incremental testing. Detailed results will be presented. Conclusion In spite of a substantial growth in QI studies in recent years, it does not seem like authors report in a consistent and thorough way in accordance with the method. This variation may compromise the internal and external validity of the PDSA...
Humbel Haag, Claudia
Claudia Humbel Haag presented developments in ENSI approach to safety culture oversight. ENSI has developed a definition/understanding of Safety Culture and a concept of how to perform oversight of Safety Culture. ENSI defines safety culture in the following way: Safety Culture comprises the behaviour, world views (in the sense of conceptualisations of reality and explanation models), values (in the sense of aims and evaluation scales), and features of the physical environment (specifically, the nuclear power plant and the documents used) which are shared by many members of an organization, in as much as these are of significance to nuclear safety. A model of the accessibility of safety culture was presented ranging from the observable (external aspects of safety culture), to aspects that are accessible by asking questions, through to aspects that are not accessible (internal part of safety culture). ENSI considers observable aspects through the existing systematic safety assessment compliance program. Aspects that are observable by asking questions will be addressed by additional oversight activities outside the systematic assessment program. Aspects that are not accessible are addressed by helping the licensee to re-think its safety culture through proactive discussions on safety culture. Reports are issued to the licensee on assumptions and observations identified through the discussions. The conclusions of the presentation emphasised the importance of basing any interventions in this area on a solid understanding of the concept of safety culture. ENSI safety culture oversight principles were also described. These include licensee responsibility for safety, and the need for the regulator to critically review their own activities to ensure a positive influence on the licensee
General Accounting Office, Washington, DC.
This report identifies improvements needed in administration of the guaranteed student loan program. Improvements needed are based on the fact that that lenders are not informed when student borrowers drop out of school. Alternatives for providing lenders with timely information on enrollment terminations are indicated. Additional administrative…
OFFICE OF THE SPECIAL INSPECTOR GENERAL FOR IRAQ RECONSTRUCTION AGENCIES NEED IMPROVED FINANCIAL DATA REPORTING FOR PRIVATE SECURITY...SUBTITLE Agencies Need Improved Financial Data Reporting for Private Security Contractors 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...IMPROVED FINANCIAL DATA REPORTING FOR PRIVATE SECURITY CONTRACTORS What SIGIR Found DoD, DoS, and USAID have not been required to
.... The only truth learned throughout this process is that defense acquisition does need oversight and that there is no cookie cutter pattern for oversight that will fit all types of acquisition programs equally well...
Rohayati, Y.; Wulandari, S.
The study aims to analyze training needs for MSMEs in the area of Kabupaten Bandung by selecting the case of MSMEs joined in Association for Agricultural Product Process, focusing on marketing as the main topic of the training. The needs analysis was required to improve training participation and effectiveness. Both aspects are important to notice since making MSMEs participate in training is not an easy task. Similarly, the needs analysis was carried out to anticipate participants’ thoughts that the training does not give any benefits for them or is ineffective because it does not meet their needs although it was actually to help MSMEs improve their marketing knowledge expected to lead to their success. This research involved 100 MSMEs with business ages starting from less than five years to more than 15 years. Those involved MSMEs were dominated by MSMEs targeting local marketing areas. The data were collected by survey and judgmental sampling technique. By conducting a descriptive analysis, it can be concluded that the needs of SMEs on marketing training materials should focus on improving marketing skills such as product development, sales, and use of marketing media as well as discussing legal aspects such as the need for certification and product brand. The results of the study also concluded that there is a need for training that is supplemented by making visits to more successful SMEs as well as practices with on the job training methods.
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...e DODIG-2016-068 (Project No. D2015-D000RC-0137.000) │ i Results in Brief DoD’s Efforts to Consolidate Data Centers Need Improvement Visit us at...www.dodig.mil March 29, 2016 Objective Our audit objective was to determine whether selected DoD Components were effectively consolidating their data
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.
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.
Paradise, Jordan; Wolf, Susan M; Kuzma, Jennifer; Kuzhabekova, Aliya; Tisdale, Alison W; Kokkoli, Efrosini; Ramachandran, Gurumurthy
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.
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
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. © 2014 The Authors. Developing World Bioethics published by John Wiley & Sons Ltd.
Full Text Available Background and purpose: Undergraduate education presents a period of transition and growth and requires the ability to adapt to many life changes. Many applicants admitted to a nursing program, but high rates of attrition have been experienced. This study is an attempt to assess the nursing students’ need on their nursing education.Methods: Focus groups were used to investigate nursing student’s perceptions and views on nursing education. The sample consisted of 120 nursing students selected randomly. They were arranged in 12 groups of 10 students. The data analysis of recorded and observed data reached five major themes.Results: Five major themes emerged from data. The quality of clinical nursing instruction, confidence development in nursing practice and training, Iranian social perception of nursing profession, professional socialization through role development and improved clinical expectation and improved study skills.Conclusion: The result of this study helped to identify nursing students’ perception and determined their educational needs.Key words: NURSING EDUCATION, CLINICAL NURSING, NURSING PROFESSION, SOCIAL PERCEPTION
Long, T.; Davey, E.C.
The Darlington Nuclear Generating Station (DNGS) is located approximately 40 kilometers east of Toronto, Ontario on the coast of Lake Ontario. The station consists of four 935 MW(e) pressurized heavy water CANDU type units with a nominal power output of 850 MW(e) per unit. The station was designed and is operated by Ontario Hydro and provides electricity to meet the commercial, industrial and residential needs for 3 million people. Units 1 and 2 began commercial operation in 1990, followed by Unit 3 in 1991 and Unit 4 in 1992. Since commissioning in 1991, the station has continually achieved annual production of greater than 80% of capacity. At Darlington, as in most other industrial enterprises, the plant annunciation systems play a key role in supporting operations staff in supervising and controlling plant operations to achieve both safety and production objectives. This paper will summarize the information needs of operations staff for annunciation of changing plant conditions, describe the operational experience with current plant annunciation systems, discuss areas for annunciation improvement, and outline some of the initiatives being taken to improve plant annunciation in the future. (author). 8 refs, 2 figs, 1 tab
Pontoppidan, Caroline Aggestam
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...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Oversight. 330.611 Section 330.611 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, SELECTION, AND... Employees § 330.611 Oversight. OPM provides advice and assistance to agencies in implementing their Career...
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
Weiss, K J; Kowalkowski, M A; Treviño, R; Cabrera-Meza, G; Thomas, E J; Kaplan, H C; Profit, J
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
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
van Diggele C
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
Rweyemamu, M M; Litamoi, J; Palya, V; Sylla, D
Contagious bovine pleuropneumonia (CBPP) vaccines are routinely used only in Africa. The vaccines are usually produced from one of two strains (T1/44 and KH3J), each of which has a streptomycin-resistant variant. The necessity for a 'master seed strain' is evident. At least one manufacturer in Africa produces a broth culture vaccine, while others produce a freeze-dried product. A standardised manufacturing protocol needs to be developed, together with in-process and final product quality control procedures. Some CBPP vaccine manufacturing procedures do not allow sufficient leeway for the execution of typical quality control practices. For example, it is difficult to perform batch testing on broth culture vaccine, as the vaccine is produced in its final container. Quality control test results from the Pan African Veterinary Vaccine Centre (PANVAC) are analysed in terms of causes of batch failure and indicators for process development. Taking potency as an example, most vaccine batches tested by PANVAC pass only at the limit of the OIE minimum requirement of 10(7) colony-forming units per dose. To improve the titre of the vaccine, it will be necessary to modify the manufacturing process, either by increasing mycoplasma yield during the culture phase or by minimising losses during downstream processes, especially freeze-drying. Data on inactivated vaccines are scarce. Duration of the immunity achieved with live CBPP vaccines is relatively short, in comparison with other live vaccines. Data may be required on the molecular basis of virulence and immunogenicity, as well as on the molecular immunology of CBPP, to enable the development of improved vaccines.
Meurs, A.P.H. van; Seck, A.
It would be logical to assume that many governments in the world would have more favorable fiscal terms for gas than for oil in order to stimulate gas development. The economics of gas is often less attractive than oil. In many countries gas markets are limited, often causing delays in gas development or restricting the level of production. Expensive gas pipeline and distribution systems need to be installed in order to deliver gas from the fields to markets. Prices for gas at the wellhead are usually lower than for oil on an energy equivalent basis. Gas is a desirable fuel for environmental reasons. Domestic gas development could result in a lower level of oil imports or increased oil exports. Low cost gas could be used in many ways to stimulate the development of certain industries. Finally, improved terms for gas could result in better overall petroleum exploration economics which often results in the discovery of more oil as well as gas. However, a comparative analysis of the government take for oil and for gas for the same concessions and contracts indicates that most governments still require identical fiscal terms for gas and oil. Only a few governments are stimulating gas development with more attractive fiscal terms
Government Accountability Office, 2005
After Operation Desert Storm and the end of the Cold War, Congress began to reevaluate the focus of U.S. military activities and proposed using some military assets and training to help address critical domestic challenges such as drugs, poverty, and unemployment. In particular, some policymakers saw an opportunity to use the military's…
Army Facilities Management ” (Feb. 12, 2008); and Army Memorandum, “Interim Policy Change on Relocatable Buildings for Paragraphs 6-13 through 6...17 in AR 420-1, Army Facilities Management ” (Feb. 19, 2008). Page 8 GAO-09-585 Defense Infrastructure uses funds from its Military
... 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 within...
This is the final report on Federal Transit Administration's (FTA) controls over its Project Management Oversight (PMO) Program. This report reflects Office of Inspector General's (OIG) consideration of information provided in FTA's May 29, 1997, rep...
Poultry business is a job opportunity for numerous for earning income and livelihood but if handled carelessly could become a nightmare to investors and practitioners. Therefore, the need to ascertain the ... Questionnaire was used in gathering the information needed from the respondents. The finding revealed that 85.5%, ...
Nanotechnology is touted as a transformative technology in that it is predicted to improve many aspects of human life. There are hundreds of products in the market that utilize nanostructures in their design, such as composite materials made out of carbon or metal oxides. Potential risks to consumers, to the environment, and to workers from the most common passive nanomaterial—carbon nanotubes—are emerging through scientific research. Newer more active nanostructures—such as cancer therapies and targeted drug systems—are also increasing in use and are raising similar risk concerns. Governing the risks to workers is the subject of this commentary. The Occupational Safety and Health Act of 1970 grants the Occupational Safety and Health Administration the legal authority to set occupational health standards to insure that no worker suffers material impairment of health from work. However, setting a standard to protect workers from nanotechnology risks may occur some time in the future because the risks to workers have not been well characterized scientifically. Alternative risk governances—such as dynamic oversight through stakeholder partnerships, “soft law” approaches, and national adoption of international consensus standards—are evaluated in this article.
Nanotechnology is touted as a transformative technology in that it is predicted to improve many aspects of human life. There are hundreds of products in the market that utilize nanostructures in their design, such as composite materials made out of carbon or metal oxides. Potential risks to consumers, to the environment, and to workers from the most common passive nanomaterial—carbon nanotubes—are emerging through scientific research. Newer more active nanostructures—such as cancer therapies and targeted drug systems—are also increasing in use and are raising similar risk concerns. Governing the risks to workers is the subject of this commentary. The Occupational Safety and Health Act of 1970 grants the Occupational Safety and Health Administration the legal authority to set occupational health standards to insure that no worker suffers material impairment of health from work. However, setting a standard to protect workers from nanotechnology risks may occur some time in the future because the risks to workers have not been well characterized scientifically. Alternative risk governances—such as dynamic oversight through stakeholder partnerships, "soft law" approaches, and national adoption of international consensus standards—are evaluated in this article.
Crall, James J
The purpose of this paper was to highlight information and issues raised in a keynote address for the American Academy of Pediatric Dentistry's Symposium on Lifetime Oral Health Care for Patients with Special Needs held in November, 2006. Topics include: (1) relevant statistics and definitions; (2) the prevalence and impact of common oral diseases in individuals with special health care needs (ISHCN); (3) an overview of oral health care delivery for ISHCN; (4) key delivery system and policy issues; and (5) a synopsis of major contextual initiatives related to ISHCN. In light of the Academy's primary interest in infants, children, and adolescents--including children with special health care needs--the major focus is on children. Significant oral health and oral health care issues for adults with special needs, however, generally parallel those for children and are of interest to the Academy, particularly as they relate to the transition from pediatric care to adult care, a critical period for extending the level of oral health and health trajectory established during childhood.
Van Luit, Johannes E. H.; Schopman, Esther A.
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…
Ali, Moazzam; Ahmed, Khawaja Masuood; Kuroiwa, Chushi
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.
Maknun, J.; Barliana, M. S.; Cahyani, D.
The problem of vocational education for Children with Special Needs (CSN) is not only about the service profile, spectrum relevance and competency level, but also the carrying capacity of educational facilities. In this regard, two important things are highlighted. First, the different characteristics of the design of educational facilities between regular and exceptional schools. Second, the distinctive characteristics of the design of the school facilities are extraordinary for general education (academic) and vocational education. The purpose of this study is to describe the level of suitability of the architectural design of educational facilities with the needs of vocational learning behavior for children with special needs in West Java, Indonesia. The entire research used the Education Research and Development (R & D) method of Developing the Architectural Facility Design Guide to Support the Vocational Competence of Crew Competence in accordance with the stages developed by Thiagarajan (1974) known as Four-D Model. To achieve the above objectives, then the stages of the R & D method that is done is the define, design and develop stage. Evaluation results show the infrastructure of education of Special School (SLB) Cicendo, Indonesia has met the standards set by the government, especially on aspects of land and building areas have met the standards. Most aspects of accessibility such as the basic size of space, pedestrian pathways, and doors have been met. But other aspects such as guiding lines, ram, ladders, toilets, showers, sinks, furniture and signs do not meet accessibility requirements. The conclusion is the educational infrastructure of the school in general has met the standards set by the government.
Fernandes, Luiz Henrique; Alvarenga, Carlos Willie; Santos, Luciane Loures dos; Pazin Filho, Antonio
To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher's tests were used to compare categorical and continuous variables, respectively, between the groups. The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.
Kraft, G; Kraft, S D
The large interest in heavy-ion therapy is stimulated from its excellent clinical results. The bases of this success are the radiobiological and physical advantages of heavy-ion beams and the active beam delivery used for an intensity-modulated particle radiotherapy (IMPT). Although heavy-ion therapy has reached a high degree of perfection for clinical use there is still large progress possible to improve this novel technique: in order to extend IMPT to more tumor entities and to tailor the planning more individually for each patient in an adaptive way, radiobiological work is required both experimentally and theoretically. It is also not clear whether the neighboring ions to carbon could have a clinical application as well. For this extension basic biological studies as well as physics experiments have to be performed. On the technical side, many improvements of the equipment used seem to be possible. Two major topics are the extension of IMPT to moving organs and the transition to more compact and therefore cheaper particle accelerators. In the present paper, these topics are treated to some extent in order to give an outline of the great future potential of ion-beam therapy.
Sofinowski, E. J.; Boquist, C. L.
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.
Oedewald, P.; Väisäsvaara, J.
In Finland the Radiation and Nuclear Safety Authority STUK specifies detailed regulatory requirements for good safety culture. Both the requirements and the practical safety culture oversight activities reflect a systemic approach to safety: the interconnections between the technical, human and organizational factors receive special attention. The conference paper aims to show how the oversight of safety culture can be integrated into everyday oversight activities. The paper also emphasises that the scope of the safety culture oversight is not specific safety culture activities of the licencees, but rather the overall functioning of the licence holder or the new build project organization from safety point of view. The regulatory approach towards human and organizational factors and safety culture has evolved throughout the years of nuclear energy production in Finland. Especially the recent new build projects have highlighted the need to systematically pay attention to the non-technical aspects of safety as it has become obvious how the HOF issues can affect the design processes and quality of construction work. Current regulatory guides include a set of safety culture related requirements. The requirements are binding to the licence holders and they set both generic and specific demands on the licencee to understand, monitor and to develop safety culture of their own organization but also that of their supplier network. The requirements set for the licence holders has facilitated the need to develop the regulator’s safety culture oversight practices towards a proactive and systemic approach.
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.
... 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 regulatory...
... 32 National Defense 6 2010-07-01 2010-07-01 false Information Security Oversight Committee. 2700... MICRONESIAN STATUS NEGOTIATIONS SECURITY INFORMATION REGULATIONS Implementation and Review § 2700.51 Information Security Oversight Committee. The OMSN Information Security Oversight Committee shall be chaired...
... 32 National Defense 6 2010-07-01 2010-07-01 false Information Security Oversight Committee. 2103... BE DECLASSIFIED Implementation and Review § 2103.51 Information Security Oversight Committee. The NCS Information Security Oversight Committee shall be chaired by the Staff Counsel of the National Security...
... NATIONAL TRANSPORTATION 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... ``Public Aircraft Oversight Forum: Ensuring Safety for Critical Missions'', are to (1) raise awareness of...
... 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 to...
... 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 Lender...
Project No. D2016-D000RD-0057.000) │ i Results in Brief Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self ...Defense Logistics Agency Disposition Services Needs to Improve Demilitarization Program Self ‑Assessment Evaluations Management Comments and Our...Agency Disposition Services Needs to Improve Demilitarization Program Self -Assessment Evaluations (Report No. We are providing this report for your
Report #16-P-0100, March 10, 2016. The EPA’s audit follow-up oversight for offices reviewed did not ensure that agreed-to corrective actions were managed effectively in the agency’s Management Audit Tracking System (MATS).
Morain, Stephanie R; Joffe, Steven; Campbell, Eric G; Mello, Michelle M
The conflicts of interest that may arise in relationships between academic researchers and industry continue to prompt controversy. The bulk of attention has focused on financial aspects of these relationships, but conflicts may also arise in the legal obligations that faculty acquire through consulting contracts. However, oversight of faculty members' consulting agreements is far less vigorous than for financial conflicts, creating the potential for faculty to knowingly or unwittingly contract away important rights and freedoms. Increased regulation could prevent this, but it is unclear what forms of oversight universities view as feasible and effective. In this article, we report on a Delphi study to evaluate several approaches for oversight of consulting agreements by medical schools. The panel was comprised of 11 senior administrators with responsibility for oversight of faculty consulting relationships. We found broad agreement among panelists regarding the importance of institutional oversight to protect universities' interests. There was strong support for two specific approaches: providing educational resources to faculty and submitting consulting agreements for institutional review. Notwithstanding the complexities of asserting authority to regulate private consulting agreements between faculty members and companies, medical school administrators reached consensus that several approaches to improving institutional oversight are feasible and useful. © 2015 American Society of Law, Medicine & Ethics, Inc.
Report #16-P-0196, June 2, 2016. The EPA will continue to improve its national security information program by completing information classification guides that can be used uniformly and consistently throughout the agency.
Seid, Michael. Varni, James W.; Cummings, Leslie; Schonlau, Matthias
This research brief describes an examination of the effect of the State Children's Health Insurance Program (SCHIP) on children's access to needed health services and on their quality of life. The analysis focused on a sample of California families who had recently enrolled in that state's SCHIP. The study found that, after enrollment, children…
Report #2007-P-00030, August 20, 2007. EPA established a partnership with the Exchange Network’s governance bodies to assist them with accomplishing Network initiatives, more improvements are needed to ensure Network partners fully utilize the Network.
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 416.919t... Examination § 416.919t Consultative examination oversight. (a) We will ensure that referrals for consultative... monitoring may include reviews by independent medical specialists under direct contract with SSA. (b) Through...
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 404.1519t... Examination § 404.1519t Consultative examination oversight. (a) We will ensure that referrals for consultative... monitoring may include reviews by independent medical specialists under direct contract with SSA. (b) Through...
... 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 by...
... 49 Transportation 7 2010-10-01 2010-10-01 false Designation of oversight agency. 659.9 Section 659.9 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAIL FIXED GUIDEWAY SYSTEMS; STATE SAFETY OVERSIGHT Role of the...
... Program-General § 1703.107 Reporting and oversight requirements. (a) A project performance activity report... financial assistance is expended for approved purposes. (d) Recipients shall diligently monitor performance... 7 Agriculture 11 2010-01-01 2010-01-01 false Reporting and oversight requirements. 1703.107...
... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Land use and oversight. 80.19... RELOCATION FOR OPEN SPACE Post-Award Requirements § 80.19 Land use and oversight. This section applies to... and beneficial functions of the floodplain. (ii) In the rare circumstances where the Administrator has...
.... This report discusses the management oversight and procurement authority within the Navy. Two other reports discussed the management oversight and procurement authority within the Army and Air Force...
Taymour, Rekar K; Abir, Mahshid; Chamberlin, Margaret; Dunne, Robert B; Lowell, Mark; Wahl, Kathy; Scott, Jacqueline
Introduction In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care. This systematic literature review and environmental scan addresses NAM's recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight? To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved. A total of 58 peer-reviewed articles met inclusion
Hani Abdulsattar Shaker
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.
Jung, S.J.; Choi, Y.S.; Kim, J.T.
In Korea, a regulatory oversight program of safety culture was launched in 2012 to establish regulatory measures against several events caused by weak safety culture in the nuclear industry. This paper is intended to introduce the preliminary regulatory oversight framework, development and validation of safety culture components, pilot safety culture inspection results and lessons learned. The safety culture model should be based on a sound understanding of the national culture and industry characteristics where the model will be applied. The nuclear safety culture oversight model is being developed and built on the Korean regulatory system to independently assess the nuclear power operating organizations’ safety culture.
Paju, Birgit; Kajamaa, Anu; Pirttimaa, Raija; Kontu, Elina
The aim of this paper is to enhance understanding of the contradictions that arise in the drive to improve teaching practices among pupils with special educational needs (SENs). A questionnaire was administrated to 167 classroom teachers, subject teachers, special education teachers and teaching assistants in Finland. The analysis, based on…
shortfalls, including addressing the issue of homelessness . According to the National Law Center on Homelessness and Poverty, as of October 2013 the...MILITARY BASE REALIGNMENTS AND CLOSURES Process for Reusing Property for Homeless Assistance Needs Improvements...COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Military Base Realignments and Closures: Process for Reusing Property for Homeless Assistance
.... This report is the first in a series related to the DFAS Corporate Database. Specifically, this report discusses DoD oversight of DFAS development of the DFAS Corporate Information Infrastructure, DFAS Corporate Database, and associated applications...
Light, Janice; Mcnaughton, David
There is a rapidly growing body of research that demonstrates the positive effects of augmentative and alternative communication (AAC) intervention on the communication of children and adults with complex communication needs. Despite the positive impact of many AAC interventions, however, many individuals with complex communication needs continue to experience serious challenges participating in educational, vocational, healthcare, and community environments. In this paper, we apply the framework proposed by the International Classification of Functioning, Disability and Health (ICF) to illustrate the need to re-think AAC intervention to improve outcomes for individuals with complex communication needs, and to foster a new generation of intervention research that will provide a solid foundation for improved services. Specifically, the paper emphasizes the need to take a more holistic view of communication intervention and highlights the following key principles to guide AAC intervention and research: (a) build on the individual's strengths and focus on the integration of skills to maximize communication, (b) focus on the individual's participation in real-world contexts, (c) address psychosocial factors as well as skills, and (d) attend to extrinsic environmental factors as well as intrinsic factors related to the individual who requires AAC.
Radiša R. Stefanović
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.
Romeo Cătălin CREŢU
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.
Choi, Jae-Young; Ramachandran, Gurumurthy
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.
Scott, Michael J
Improving Access to Psychological Therapies is a UK government-funded initiative to widen access to the psychological treatment of depression and anxiety disorders. The author has had the opportunity to independently assess 90 Improving Access to Psychological Therapies clients, using a standardised semi-structured interview, the Structured Clinical Diagnostic Interview for DSM Disorders (SCID) and to listen to their account of interaction with the service. The results suggest that only the tip of the iceberg fully recovers from their disorder (9.2%) whether or not they were treated before or after a personal injury claim. There is a pressing need to re-examine the modus operandi of the service.
Pries, Charlene R; Vanin, Sharon; Cartagena, Rosario G
Independent health facilities ("IHFs") are an important part of Canada's health care system existing at the interface of public and private care. They offer benefits to individual patients and the public at large, such as improved access to care, reduced wait times, improved choice in the delivery of care, and more efficient use of health care resources. They can also provide physicians greater autonomy, control of resources, and opportunity for profit compared to other practice settings, particularly because IHFs can deliver services outside of publicly-funded health care plans. IHFs also present challenges, particularly around quality of care and patient safety, and the potential to breach the principles of "Medicare" under the Canada Health Act. Various measures are in place to address these challenges, while still enabling the benefits IHFs can offer. IHFs are primarily regulated and overseen at the provincial level through legislation, regulations and provincial medical regulatory College by-laws. Health Canada is responsible for administering the overarching framework for "Medicare". Oversight and regulatory provisions vary across Canada, and are notably absent in the Maritime provinces and the territories. This article provides an overview of specific provisions related to IHFs across the country and how they can co-exist with the Canada Health Act.
The mission of the nuclear safety oversight function at the Savannah River Plant is to enhance the process and nuclear safety of site facilities. One of the major goals surrounding this mission is the reduction of human error. It is for this reason that several human factors engineers are assigned to the Operations assessment Group of the Facility Safety Evaluation Section (FSES). The initial task of the human factors contingent was the design and implementation of a site wide root cause analysis program. The intent of this system is to determine the most prevalent sources of human error in facility operations and to assist in determining where the limited human factors resources should be focused. In this paper the strategy used to educate the organization about the field of human factors is described. Creating an awareness of the importance of human factors engineering in all facets of design, operation, and maintenance is considered to be an important step in reducing the rate of human error
Colvin, Jeffrey D; Bettenhausen, Jessica L; Anderson-Carpenter, Kaston D; Collie-Akers, Vicki; Plencner, Laura; Krager, Molly; Nelson, Brooke; Donnelly, Sara; Simmons, Julia; Higinio, Valeria; Chung, Paul J
It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting. During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use. A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months). A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Experience across the international nuclear industry and in other technical fields over the past few decades has demonstrated the importance of a healthy safety culture in maintaining the safety of workers, the public and the environment. Both regulators and the nuclear industry recognize the need for licensees to develop a strong safety culture in order to support successful and sustainable nuclear safety performance. Progress over recent years can be observed in the rapid development of approaches to overseeing licensees' safety culture. This publication follows on and complements earlier publications on safety culture, from the publication Safety Culture (Safety Series No. 75-INSAG-4 (1991)), published after the Chernobyl accident, to the more recently published Safety Requirements on The Management System for Facilities and Activities (IAEA Safety Standards Series No. GS-R-3 (2006)), which states that the management system is to be used to promote and support a strong safety culture. A number of attempts have been made at both the international and national levels to establish practical approaches to regulatory oversight of safety culture. During 2010 and 2011, two projects were conducted by the IAEA under the scope of the Safe Nuclear Energy - Regional Excellence Programme within the Norwegian Cooperation Programme with Bulgaria and Romania. These projects were implemented at the Bulgarian and Romanian regulatory bodies. They encompassed the development of a specific process to oversee licensees' safety culture, and involved 30 experts from 17 countries and 22 organizations. The IAEA continues to support Member States in the area of safety culture through its projects on safety management and capacity building. This publication addresses the basics of regulatory oversight of safety culture, describes the approaches currently implemented at several regulatory bodies around the world and, based on these examples, proposes a path to developing such a process
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).
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.
Holm, Anne Lise; Severinsson, Elisabeth
Older people with depression constitute a vulnerable group, and evidence from different parts of the world has demonstrated the need for healthcare improvements at the community level. In this study, we described team members' perceptions of improvements in the care of older people with depression living in the community after the implementation of the Chronic Care Model, with a focus on delivery-system design, self-management support, and teamwork. This follow-up study was based on focus-group interviews with healthcare team members. The data were analyzed by qualitative content analysis. Four themes emerged: (i) ensuring a pathway to the top level of the organization; (ii) the need for leadership from senior managers; (iii) the need to formalize collaboration; and (iv) increasing self-management. Senior managers should cooperate with specialist care givers and administrators in the community. They must also redesign the delivery system to facilitate teamwork and the self-management ability of older people with depression. © 2014 Wiley Publishing Asia Pty Ltd.
Scarbecz, Mark; Russell, Cynthia K; Shreve, Robert G; Robinson, Melissa M; Scheid, Cheryl R
There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007-08, as part of an effort to expand education-related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education-related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.
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.
Hamilton, L.D.; Holtzman, S.; Meinhold, A.F.; Morris, S.C.; Rowe, M.D.; Daniels, J.I.; Layton, D.W.; Anspaugh, L.R.
Realistic health risk assessments were performed in a pilot study of three U.S. Department of Energy (USDOE) sites. These assessments, covering a broad spectrum of data and methods, were used to identify needs for improving future health risk assessments at USDOE sites. Topics receiving specific recommendations for additional research include: choice of distributions for Monte Carlo simulation; estimation of risk reduction; analysis of the U.S. Department of Agriculture Database on food and nutrient intakes; investigations on effects of food processing on contaminant levels; background food and environmental concentrations of contaminants; method for handling exposures to groundwater plumes, methods for analyzing less than lifetime exposure to carcinogens; and improvement of bioaccumulation factors
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.
Full Text Available The purpose of the paper is to study the relationship of the formation and implementation of the range of social needs with the evolution and activity is focused on the improvement of the territorial organization of society. Methodology of research involves: the substantiation of the origin, factors for the development, approaches to classification, functions of public needs in the development of state and society; the study of the socio-humanitarian space of formation and realization of the needs of individuals, functional and territorial communities, as well as a mechanism of their satisfaction at the national and spatial scales (on the example of Ukraine – a country with a developing economy, wherein the decentralization of powers in the field social welfare and consolidation of local communities are implemented at present. Results. Summarized and proved the patterns and trends of development, evolution, transformation of needs of social groups, functional and territorial communities of the population, as well as the relationship of these processes with the economic and institutional capacities and mechanisms of satisfaction of the spectrum of social needs in consideration of peculiarities, achieved and desired parameters of development of productive forces, human and other components of the social and humanitarian potential, cultural features of the society. The development of the institutional, functional and territorial organization of society, in fact, is a process of formation and implementation in the range of human needs (individual and collective, which is estimated with the factors, conditions and mechanisms of their satisfaction, including through the dynamics of the positions of the spectrum of social groups and subjects concerning the required amount of vital goods consumption. Practical implications. Social and political transformation stimulates the establishment of the multidirectional formation in the Ukrainian economy of
Droppo, James G.
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
end travel system for business travel . DTS’s reported utilization rates for the period October 2005 through April 2006 averaged 53 percent for...endeavor, should help in making DTS the standard integrated, end-to-end travel system for business travel . Management oversight is essential for this to
Danz, Margie Sherwood; Hempel, Susanne; Lim, Yee-Wei; Shanman, Roberta; Motala, Aneesa; Stockdale, Susan; Shekelle, Paul; Rubenstein, Lisa
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.
McMillan, Catherine; D'Hondt, Veerle; Marshall, Alexandra H; Binhammer, Paul; Lipa, Joan; Snell, Laura
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.
Hardcastle, Lisa Raysby; Perry, Matthew; Browne, Ashley
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.
Military Training: Continued Actions Needed to Guide DOD's Efforts to Improve Language Skills and Regional Proficiency. Testimony Before the Subcommittee on Oversight and Investigations, Committee on Armed Services, House of Representatives. GAO-10-879T
Pickup, Sharon L.
Today, and in the foreseeable future, military operations require U.S. personnel to work alongside multinational partners and among local populations. The Department of Defense (DOD) has placed a greater emphasis on transforming language and regional proficiency capabilities, which includes cultural awareness. GAO's prior work has found that…
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
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.
Lázaro-Martín, N I; Catalán-González, M; García-Fuentes, C; Terceros-Almanza, L; Montejo-González, J C
To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions. Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation. ICU of a hospital of high complexity. Adult ICU forecast more than 48h of artificial nutrition. Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio. A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56). The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
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.
... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Information Security Oversight Office; National Industrial Security Program Policy Advisory Committee (NISPPAC) AGENCY: National Archives and Records... individuals planning to attend must be submitted to the Information Security Oversight Office (ISOO) no later...
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Veterans Affairs, Volume 1: Integrated Report (Washington, D.C.: Sept. 1, 2015). This assessment was conducted in response to a requirement in the Veterans...VETERANS AFFAIRS INFORMATION TECHNOLOGY Management Attention Needed to Improve Critical System Modernizations...Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems What GAO Found GAO
de Jong, J.P.
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
Amedee, Ronald G; Piazza, Janice C
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. 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. 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. 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 this SI to advancing our GME enterprise is
de Jong, J.P.
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 many years, with Research Ethics Committees as their cornerstone. Although these oversight systems aim to ensure that the ethical quality of research is in order, they have been criticized for imped...
Tarigan, U.; Ginting, R.; Siregar, I.
A Newborns need particular attention because it takes time to adapt to the outside world. In accordance with the standard post-neonatal procedures, newborns should be incorporated into the incubator within a specified period of time according to the infant’s health level. Infant incubator as a medical device used to care for newborns, often get complaints from doctors and child nurses. The complaint indicates consumer dissatisfaction with incubator products in the hospital. Broadly speaking, objection against infant incubators lie in inappropriate designs. To overcome these complaints the researchers apply the method of Quality Function Deployment to determine the characteristics of priority techniques in accordance with the wishes of consumers with it. The primary focus of QFD is to engage customers in the product development process as early as possible, which their needs and desires serve as the starting point of the QFD process. Therefore, QFD is called the voice of customer. The underlying philosophy is that customers are not always satisfied with a product even though the product has been perfectly produced. The results show that the category used as a priority improvement is the additional function of the oxygen cylinder and the size of the door hole. QFD phase one produces technical characteristics of Ergonomy, Features and Cost as critical part determinants.
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.
Full Text Available There is a common understanding among thermal-hydraulic experts that the system analysis codes have currently reached an acceptable degree of maturity. Reliable application, however, is still limited to the validated domain. There is a growing need for qualified codes in assessing the safety of the existing reactors and for developing advanced reactor systems. Under conditions involving multi-phase flow simulations, the use of classical methods, mainly based upon the one dimensional approach, is not appropriate at all. The use of new computational models, such as the direct numerical simulation, large-eddy simulation or other advanced computational fluid dynamics methods, seems to be more suitable for more complex events. For this purpose, the European Commission financed NURESIM Integrated Project (as a part of the FP6 programme, was adopted to provide the initial step towards a Common European Standard Software Platform for Modeling, recording and recovering computer data for nuclear reactor simulations. Some of the studies carried out at the University of Pisa within the framework of the NURESIM project are presented in this paper. They mainly concern the investigation of two critical phenomena connected with jet instabilities and direct contact condensation that occur during emergency core cooling. Through these examples, the state-of-the-art and the need for model improvements and validation against new experimental data for the sake of getting a better understanding and more accurate predictions are discussed.
Bousbia-Salah, A.; Moretti, F.; D'auria, F.; Bousbia-Salah, A.)
There is a common understanding among thermal-hydraulic experts that the system analysis codes have currently reached an acceptable degree of maturity. Reliable application, however, is still limited to the validated domain. There is a growing need for qualified codes in assessing the safety of the existing reactors and for developing advanced reactor systems. Under conditions involving multi-phase flow simulations, the use of classical methods, mainly based upon the one dimensional approach, is not appropriate at all. The use of new computational models, such as the direct numerical simulation, large-eddy simulation or other advanced computational fluid dynamics methods, seems to be more suitable for more complex events. For this purpose, the European Commission financed NURESIM Integrated Project (as a part of the FP6 programme), was adopted to provide the initial step towards a Common European Standard Software Platform for modelling, recording and recovering computer data for nuclear reactor simulations. Some of the studies carried out at the University of Pisa within the framework of the NURESIM project are presented in this paper. They mainly concern the investigation of two critical phenomena connected with jet instabilities and direct contact condensation that occur during emergency core cooling. Through these examples, the state-of-the-art and the need for model improvements and validation against new experimental data for the sake of getting a better understanding and more accurate predictions are discussed. (author)
Nauta, Russell J
Despite a quarter century of discourse since a sentinel event in New York City raised the question of appropriate oversight for graduate medical education, many questions remain unanswered. Even with the Accreditation Council for Graduate Medical Education rules in place, some opportunity remains to examine handoff methodology, the relationship of duty hours to education, and the impact of fatigue on resident performance. Neurophysiologic adjuncts applied concomitantly to evaluation of didactic performance offer promise for data-driven definition of the optimal shift. Concurrently, the merits of specialty-specific oversight of graduate medical education remain under active consideration. Copyright © 2012 Elsevier Inc. All rights reserved.
Humphrey, Neil; Lendrum, Ann; Barlow, Alexandra; Wigelsworth, Michael; Squires, Garry
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. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.
Agha, Riaz Ahmed; Lee, Seon-Young; Jeong, Kyung Jin Lee; Fowler, Alexander J; Orgill, Dennis P
Our objective was to determine the compliance of observational studies in plastic surgery with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist. All cohort, cross-sectional, and case-control studies published in five major plastic surgery journals in 2013 were assessed for their compliance with the STROBE statement. One hundred thirty-six studies were identified initially and 94 met the inclusion criteria. The average STROBE score was 12.4 (range, 2-20.1) with a standard deviation of 3.36. The most frequent reporting deficiencies were not reporting the study design in the title and abstract 30% compliance; describing the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection (24%); describing efforts to address sources of bias (20%); reporting numbers of individuals at each stage of the study (20%); and discussing limitations (40%). The reporting quality of observational studies in Plastic Surgery needs improvement. We suggest ways this could be improved including better education, awareness among all stakeholders, and hardwiring compliance through electronic journal submission systems.
Brynes, Nicole; Lee, Heeyoung; Ren, Dianxu; Beach, Michael
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.
Penney, Christine; Henry, Effie
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
... 49 Transportation 7 2010-10-01 2010-10-01 false Oversight agency safety and security reviews. 659... Role of the State Oversight Agency § 659.29 Oversight agency safety and security reviews. At least... safety program plan and system security plan. Alternatively, the on-site review may be conducted in an on...
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Office of Federal Housing Enterprise Oversight. 1700.1 Section 1700.1 Banks and Banking OFFICE OF FEDERAL HOUSING ENTERPRISE OVERSIGHT, DEPARTMENT OF... of Federal Housing Enterprise Oversight. (a) Scope and authority. The Office of Federal Housing...
... 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...
... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION QUALIFICATION AND CERTIFICATION OF LOCOMOTIVE ENGINEERS Administration of the Certification Programs § 240.309 Railroad oversight responsibilities. (a) No later than... and analysis concerning the administration of its program for responding to detected instances of poor...
... 46 Shipping 6 2010-10-01 2010-10-01 false Production oversight. 160.001-5 Section 160.001-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) EQUIPMENT, CONSTRUCTION, AND MATERIALS... with the independent laboratory's name or identifying mark. (j) Lot rejection. Each nonconforming unit...
Profession: Oversight, Auditor Independence, and Financial Reporting Issues Dear Mr. Chairman: This letter responds to your recent request that we provide...selected financial reporting matters. The sudden and largely unexpected bankruptcy of the Enron Corporation (Enron) and other large corporations... financial reporting restatements have raised questions about the soundness of the current self-regulatory and financial reporting systems and resulted in
Sep 6, 2004 ... government based on the principle of separation of powers between the legislature, the executive and the .... is, its representative role.25 The principle behind legislative oversight is that legislative function does not ..... (a) information on the Appropriation Bills, (b) reports on accounting, financial control and.
... 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...
Lindley, Lisa C; Rotella, Joseph D; Ast, Katherine; Matzo, Marianne; Kamal, Arif H
The American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA) convened the Measuring What Matters (MWM) initiative in 2013, which recommended 10 quality performance measures; yet, little is known about the quality improvement (QI) environment and implementation of the MWM among hospices and palliative care services. The objective of this study was to describe the findings of the 2016 AAHPM/HPNA Needs Assessment survey exploring the QI environment among hospice and palliative care services. An online survey was distributed to approximately 16,500 AAHPM and HPNA members, and other hospice and palliative care organizations were invited to respond. Summary data and individual write-in responses were collated and analyzed. Data analysis included generating descriptive statistics and analyzing individual write-in responses for additional information and themes. More than 1000 responses were received. Most organizations had a designated QI leader and used an electronic medical record. Less than 50% of systems had fields for palliative care information. The top three MWM measures collected through an electronic medical record were pain treatment (66%), screening for physical symptoms (55%), and comprehensive assessment (54%). The most common barrier to implementing QI was time constraint. Most respondents had received no training and education in how to implement QI. The 2016 AAHPM/HPNA Needs Assessment Survey provided important information about the QI systems and measurement environment within hospice and palliative care services. Survey insights can aid AAHPM/HPNA in developing resources to empower hospice and palliative care clinicians to make QIs that matter for their patients and families. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Kravet, Steven J; Bailey, Jennifer; Demski, Renee; Pronovost, Peter
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.
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.
Banach, Maciej; Stulc, Tomas; Dent, Ricardo; Toth, Peter P
Although statin therapy has proven to be the cornerstone for prevention and treatment of cardiovascular disease (CVD), there are many patients for whom long-term therapy remains suboptimal. The aims of this article are to review the current complex issues associated with statin use and to explore when novel treatment approaches should be considered. Statin discontinuation as well as adherence to statin therapy remain two of the greatest challenges for lipidologists. Evidence suggests that between 40 and 75% of patients discontinue their statin therapy within one year after initiation. Furthermore, whilst the reasons for persistence with statin therapy are complex, evidence shows that low-adherence to statins negatively impacts clinical outcomes and residual CV risk remains a major concern. Non-adherence or lack of persistence with long-term statin therapy in real-life may be the main cause of inadequate low density lipoprotein cholesterol lowering with statins. There is a large need for the improvement of the use of statins, which have good safety profiles and are inexpensive. On the other hand, in a non-cost-constrained environment, proprotein convertase subtilisin/kexin type 9 inhibitors should arguably be used more often in those patients in whom treatment with statins remains unsatisfactory. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
In the industrialized world, the negative image that many people (including politicians) have of pharmaceutical companies not only makes the life for those working in this field more difficult, in a sense it is a road block. Without an improvement in communication between the public world and the pharmaceutical industry, one can foresee this industry steadily becoming a more difficult environment to work in. There is a clear need for knowing more about all the work done inside these companies before a new drug is approved (it is not all about marketing…). That society has no understanding of the ever-increasing costs of new drugs is also related to this lack of understanding of how tricky and cumbersome the process is to take a new idea for treating a certain disease to production of a marketed drug. With a relatively small investment of money, but with an investment of much good will, brain power, and trust, it should be possible to bring all relevant parties together and make a change. PMID:20046667
González Otero, Rebeca
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…
the Freedom of Information Act. The Air Force Needs to Improve Cost -Effectiveness and Availability of the Joint Surveillance Target Attack Radar... Target Attack Radar System Objective We determined whether the Air Force made cost -effective purchases on the performance-based logistics contract to...0263.000) Results in Brief The Air Force Needs to Improve Cost -Effectiveness and Availability of the Joint Surveillance Target Attack Radar System
the commanding officer of an accused servicemember. 21Army Regulation 600-20 defines sexual harassment as a form of gender discrimination that...SEXUAL ASSAULT Better Resource Management Needed to Improve Prevention and Response in the Army National Guard and Army...Resource Management Needed to Improve Prevention and Response in the Army National Guard and Army Reserve What GAO Found The Army National Guard
Lake, James; Turner, Mason Spain
Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally.This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics.
Sau, Ashis; Sau, Mita; Ahmed, Hasib; Brown, Richard
The objective of this study was to assess the use and efficacy of delivery by vacuum extraction or ventouse in routine clinical practice and to assess some aspects of the procedure that may reflect the quality of training in this technique. Women's demographic profiles and delivery details were collected in both the prospective (B) and retrospective (A) arm of the study. In addition, in the prospective arm of the study two custom-designed forms were used: the obstetrician recorded their perception of where the vacuum cup had been placed on one form while on a second form the pediatrician indicated the actual site of the cup placement as observed from the position of the chignon. All the diagrams of cup placement were reviewed by one of the authors, who was blinded to the outcome of the procedure. The vacuum extractor was the first instrument to be used in 79% and 87% of the instrumental deliveries in groups A and B, respectively, with corresponding failure rates of 20% and 21%. Although an occipito-posterior position was diagnosed in 11% of cases of group A and 14% of cases of group B, the specifically designed occipito-posterior cup was not used at all. The vacuum cup was considered to have been applied suboptimally in 40% of the cases where attempted vacuum delivery failed. The high rate of inappropriate positioning of the cup may reflect difficulty in accurately applying the cup, perhaps due to caput or malposition, but may also represent poor assessment of the orientation and position of the fetal skull and therefore be indicative of a need for improvement in training methods.
Agha, Riaz A; Barai, Ishani; Rajmohan, Shivanchan; Lee, Seon; Anwar, Mohammed O; Fowler, Alexander J; Orgill, Dennis P; Altman, Douglas G
Evidence-based medicine works best if the evidence is reported well. Past studies have shown reporting quality to be lacking in the field of surgery. Reporting guidelines are an important tool for authors to optimize the reporting of their research. The objective of this study was to analyse the frequency and strength of recommendation for such reporting guidelines within surgical journals. A systematic review of the 198 journals within the Journal Citation Report 2014 (surgery category) published by Thomson Reuters was undertaken. The online guide for authors for each journal was screened by two independent groups and results compared. Data regarding the presence and strength of recommendation to use reporting guidelines was extracted. 193 journals were included (as five appeared twice having changed their name). These had a median impact factor of 1.526 (range 0.047-8.327), with a median of 145 articles published per journal (range 29-659), with 34,036 articles published in total over the two-year window 2012-2013. The majority (62%) of surgical journals made no mention of reporting guidelines within their guidelines for authors. Of the 73 (38%) that did mention them, only 14% (10/73) required the use of all relevant reporting guidelines. The most frequently mentioned reporting guideline was CONSORT (46 journals). The mention of reporting guidelines within the guide for authors of surgical journals needs improvement. Authors, reviewers and editors should work to ensure that research is reported in line with the relevant reporting guidelines. Journals should consider hard-wiring adherence to them. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Pidcoe, W.W. Jr. [Westinghouse Savannah River Company, Aiken, SC (United States)
Science Applications International Corporation was tasked under subcontract C002025P to provide technical oversight for the drilling of one pilot borehole, and the drilling and installation of five piezometers in the TNX Area Swamp. The work was performed in accordance with the Statement of Work in Task Order Proposal No. ER39-129 dated August 6, 1996. This report describes the activities associated with the performance of the task.
Pagnozzi, Alex M; Gal, Yaniv; Boyd, Roslyn N; Fiori, Simona; Fripp, Jurgen; Rose, Stephen; Dowson, Nicholas
Cerebral palsy (CP) describes a group of permanent disorders of posture and movement caused by disturbances in the developing brain. Accurate diagnosis and prognosis, in terms of motor type and severity, is difficult to obtain due to the heterogeneous appearance of brain injury and large anatomical distortions commonly observed in children with CP. There is a need to optimise treatment strategies for individual patients in order to lead to lifelong improvements in function and capabilities. Magnetic resonance imaging (MRI) is critical to non-invasively visualizing brain lesions, and is currently used to assist the diagnosis and qualitative classification in CP patients. Although such qualitative approaches under-utilise available data, the quantification of MRIs is not automated and therefore not widely performed in clinical assessment. Automated brain lesion segmentation techniques are necessary to provide valid and reproducible quantifications of injury. Such techniques have been used to study other neurological disorders, however the technical challenges unique to CP mean that existing algorithms require modification to be sufficiently reliable, and therefore have not been widely applied to MRIs of children with CP. In this paper, we present a review of a subset of available brain injury segmentation approaches that could be applied to CP, including the detection of cortical malformations, white and grey matter lesions and ventricular enlargement. Following a discussion of strengths and weaknesses, we suggest areas of future research in applying segmentation techniques to the MRI of children with CP. Specifically, we identify atlas-based priors to be ineffective in regions of substantial malformations, instead propose relying on adaptive, spatially consistent algorithms, with fast initialisation mechanisms to provide additional robustness to injury. We also identify several cortical shape parameters that could be used to identify cortical injury, and shape
Salemink, S.; Dekker, N.; Kets, C.M.; Looij, E. van der; Zelst-Stams, W.A.G. van; Hoogerbrugge-van der Linden, N.
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
Stoddard, Hugh A; Brownfield, Erica D; Churchward, Gordon; Eley, J William
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.
Kuzma, Jennifer; Kuzhabekova, Aliya
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.
Kuzma, Jennifer; Kuzhabekova, Aliya
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.
Hennig, Michael; Hundt, Ferdinand; Busta, Susanne; Mikus, Stefan; Sanden, Per-Holger; Sörgel, Andrea; Ruppert, Thorsten
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.
Gatsby’s Grill at the Golf Course Strike Zone Grill at the Bowling Center Delta Breeze Colocated Club Rickenbacker’s Coffee Shop Source: GAO... nutritional standards. 7. Improve efficiency Improve food service delivery approaches to improve efficiency. 8. Decrease costs Maintain or decrease the cost...resources and are trained to undertake the full mission for which they are trained without any compensation for deficiencies . To measure progress in
Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.
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),
.... The attachment is a Visual Basic Script (VBS) file.2 As long as recipients do not run the attached file, their systems will not be affected and they need only to delete the e-mail and its attachment...
Full Text Available No abstract available. Article truncated at 150 words. On September 8, 2014 the Washington Examiner reported that the Central Office of the VA was allowed to change language in the VA Office of Inspector General (VAOIG report on delays in patient care at the Phoenix VA Medical Center (1. Crucial language that the VAOIG could not “conclusively” prove that delays in care caused patient deaths at a Phoenix hospital was added to its final report after a draft version was sent to agency administrators for comment. Rep. Jeff Miller, chairman of the House veterans' committee, said "there are significant differences between the final IG report and the draft version ...". The following day Richard Griffin, the acting VAOIG, vigorously defended the independence of his office and bristled at the allegations that the VA was allowed to alter his office's report. However, his denials and indignance seem disingenuous. To understand why, we need to go back a few years. ...
... with requirements of the Federal Financial Management Improvement Act of 1996. A separate report on the implementation status of recommendations from our prior IRS financial audits and related financial management reports will be issued shortly...
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)
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.
Fraze, Taressa; Lewis, Valerie A; Rodriguez, Hector P; Fisher, Elliott S
Addressing nonmedical needs-such as the need for housing-is critical to advancing population health, improving the quality of care, and lowering the costs of care. Accountable care organizations (ACOs) are well positioned to address these needs. We used qualitative interviews with ACO leaders and site visits to examine how these organizations addressed the nonmedical needs of their patients, and the extent to which they did so. We developed a typology of medical and social services integration among ACOs that disentangles service and organizational integration. We found that the nonmedical needs most commonly addressed by ACOs were the need for transportation and housing and food insecurity. ACOs identified nonmedical needs through processes that were part of the primary care visit or care transformation programs. Approaches to meeting patients' nonmedical needs were either individualized solutions (developed patient by patient) or targeted approaches (programs developed to address specific needs). As policy makers continue to provide incentives for health care organizations to meet a broader spectrum of patients' needs, these findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations. Project HOPE—The People-to-People Health Foundation, Inc.
Full Text Available 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.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.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.Our method was successful in revealing specific details of the training needs countrywide. A national strategy is needed to ensure rational planning of training, personnel motivation and long-term sustainability. In
Kok, Maarten Olivier; Bal, Roland; Roelefs, Caspar David; Schuit, Albertine Jantine
In several countries, attempts are made to improve health promotion by centrally rating the effectiveness of health promotion interventions. The Dutch Effectiveness Rating System (ERS) for health promotion interventions is an improvement-oriented approach in which multi-disciplinary expert committees rate available health promotion interventions as 'theoretically sound', 'probably effective' or 'proven effective'. The aim of this study is to explore the functioning of the ERS and the perspective of researchers, policy-makers and practitioners regarding its contribution to improvement. We interviewed 53 selected key informants from research, policy and practice in the Netherlands and observed the assessment of 12 interventions. Between 2008 and 2012, a total of 94 interventions were submitted to the ERS, of which 23 were rejected, 58 were rated as 'theoretically sound', 10 were rated as 'probably effective' and 3 were rated as 'proven effective'. According to participants, the ERS was intended to facilitate both the improvement of available interventions and the improvement of health promotion in practice. While participants expected that describing and rating interventions promoted learning and enhanced the transferability of interventions, they were concerned that the ERS approach was not suitable for guiding intervention development and improving health promotion in practice. The expert committees that assessed the interventions struggled with a lack of norms for the relevance of effects and questions about how effects should be studied and rated. Health promotion practitioners were concerned that the ERS neglected the local adaptation of interventions and did not encourage the improvement of aspects like applicability and costs. Policy-makers and practitioners were worried that the lack of proven effectiveness legitimised cutbacks rather than learning and advancing health promotion. While measuring and centrally rating the effectiveness of interventions can be
Curran, Connie R; Totten, Mary K
Making sure the relative roles of the board and management are clear and agreed upon is becoming more important as market and regulatory forces compel boards to govern at levels of detail once considered micromanagement, but are now required and necessary in the current environment of heightened governance accountability. A clear understanding of each other's roles and responsibilities is step one in building a solid partnership between the board and chief executive. A second element of building a strong foundation for the board-CEO relationship is taking time early on to establish mutual expectations about working together. The board's responsibilities in CEO performance management and compensation include setting performance expectations and goals that are clear and measurable and coaching and motivating the CEO. When a CEO fails, one of the most important steps for the board to take is to look in the mirror and commit to the rigorous due diligence needed to avoid future mistakes. Boards should always have CEO succession on their agenda.
Norrbrink, Cecilia; Löfgren, Monika
The present purpose was to explore patients' and involved physicians' needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen patients with SCI and neuropathic pain, and nine physicians, were interviewed in focus-groups or individual interviews. An emergent design was used and the interviews and analyses were carried out in parallel, making it possible to use and deepen new emerging knowledge. The interviews were transcribed verbatim and processed according to content analysis. A final model with four themes described the results. Three themes covered the current situation: limitations in structure, lack of knowledge and competence, and frustrations. A fourth theme, needs and requests, described suggestions by patients and physicians for future improvements. Suggestions included increased participation, increased patient involvement in the pain rehabilitation process, support in the process of learning to live with pain, implementation of multi-modal pain rehabilitation, and the use of complementary treatments for neuropathic pain. Neuropathic pain following SCI needs to be assessed and treated using a structured, inter-disciplinary, multi-modal rehabilitation approach involving patients in planning and decision-making. For improving SCI neuropathic pain management, there is a great need for individually-tailored management, planned in a dialogue on equal terms between health care and the patient. Patients desire continuity and regularity and the possibility of receiving complementary treatments for SCI neuropathic pain. Access to structured pain rehabilitation is needed. Support and tools need to be provided in the learning-to-live with pain process.
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...
Simeonova, V.; Valk, van der A.J.J.
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
Bailey, Rita L.; Angell, Maureen E.; Stoner, Julia B.
A structured intervention package including direct, scaffolded, instructional lessons was implemented using an error correction learning system and a picture book-based phonological and phonemic awareness activity for four participants with complex communication needs, ranging from 12 to 15 years, in a junior high school setting. Although…
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.
Ten Veldhuis, J.A.E.; Ochoa-Rodriguez, S.; Gires, A.; van Assel, J.; Ichiba, A.; Kroll, S.; Wang, L.; Tchiguirinskaia, I.; Schertzer, D.; Willems, P.
Cities are particularly vulnerable to rainfall-generated floods that are typically characterised by their rapid onset and localised nature. This implies that precipitation and catchment information need to be available at high resolution to reliably predict hydrological response and potential
General Accounting Office, Washington, DC.
A General Accounting Office (GAO) study evaluated the Bureau of Indian Affairs' (BIA) new facilities management information system (FMIS). Specifically, the study examined whether the new FMIS addresses the old system's weaknesses and meets BIA's management needs, whether BIA has finished validating the accuracy of data transferred from the old…
Gordon R. Cessford
This paper summarizes the social impact research and information needs derived from a workshop of over 50 recreation management staff in the New Zealand Department of Conservation. The overall objective was to establish the basis for developing a research plan underpinning social impact management. After scoping the diversity of social impact issues, the workshop...
The energy balance of the former USSR is a decisive factor in the economies of the countries now remaining. This balance is facing a crunch due to excessive consumption of liquid hydrocarbons, combined with a downswing in production since 1988. There is a pressing need to open up the petroleum industries to Western technologies and partnerships. 1 fig., 4 tabs
Le Moullec, Aurelie
The improvement in air quality that began some years ago continued. Average concentrations of pollutants decreased and exceedance of thresholds for protection of health was observed in fewer areas. Progress was, notably, the result of efforts made to reduce emissions, something made more difficult by the number and variety of sources of pollution. These improvements were, however, fragile as they were partially dependent on weather conditions. 2014 was, thus, marked by an important episode of particulate pollution. In addition, the progress made was not sufficient to bring France into full compliance with European standards, as was also the case for other European countries. (author)
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
This thesis addresses the problem of providing policy and budget oversight of Ukrainian intelligence organizations in accordance with norms and practices developed in contemporary Western democracies...
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.
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
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...
Metzger, Jed; Mastrocinque, Jeanna M; Navratil, Peter; Cerulli, Catherine
Homicide is a pressing issue in America. This study used qualitative data obtained from focus groups of family and friends of homicide victims (FFHV) to assess and better meet the needs of victims post homicide. The study results posit myriad changes to the systematic response to homicide. The article concludes with recommendations for training and resources, with specific attention to legal, law enforcement, medical, and behavioral health providers.
Leon, Federico R.; Lundgren, Rebecka; Sinai, Irit; Jennings, Victoria
A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on…
Given the focus on phonological attainment in the National Phonics Screening Check, small-scale school-based action research was undertaken to improve phonological recognition and assess the impact on progress and attainment in a sample drawn from Key Stage 1 which included pupils on the Special Educational Needs (SEN) Register. The research…
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.
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…
America , and Paralyzed Veterans of America . 17GAO, Standards for Internal Control in the Federal Government GAO/AIMD-00-23.3.1 (Washington, D.C...progress in reducing veteran homelessness , improving the employee experience, staffing critical positions, transforming Office of Information...organizational health indicators that are necessary for a successful health care delivery system. 36The other priority goal is reducing the number of homeless
Abraira, Víctor; Muriel, Alfonso; Emparanza, José I; Pijoan, José I; Royuela, Ana; Plana, María Nieves; Cano, Alejandra; Urreta, Iratxe; Zamora, Javier
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.
Kaletsky, K.; Earle, J.R.; Schneider, T.A.
This paper presents findings on Ohio EPA Office of Federal Facilities Oversight's (OFFO) use of GIS and GPS for environmental remediation oversight at the U.S. Department of Energy's (DOE) Fernald Site. The Fernald site is a former uranium metal production facility within DOE's nuclear weapons complex. Significant uranium contamination of soil and groundwater is being remediated under state and federal regulations. OFFO uses GIS/GPS to enhance environmental monitoring and remediation oversight. These technologies are utilized within OFFO's environmental monitoring program for sample location and parameter selection, data interpretation and presentation. GPS is used to integrate sample data into OFFO's GIS and for permanently linking precise and accurate geographic data to samples and waste units. It is important to identify contamination geographically as all visual references (e.g., buildings, infrastructure) will be removed during remediation. Availability of the GIS allows OFFO to perform independent analysis and review of DOE contractor generated data, models, maps, and designs. This ability helps alleviate concerns associated with open-quotes black boxclose quotes models and data interpretation. OFFO's independent analysis has increased regulatory confidence and the efficiency of design reviews. GIS/GPS technology allows OFFO to record and present complex data in a visual format aiding in stakeholder education and awareness. Presented are OFFO's achievements within the aforementioned activities and some reasons learned in implementing the GIS/GPS program. OFFO's two years of GIS/GPS development have resulted in numerous lessons learned and ideas for increasing effectiveness through the use of GIS/GPS
The environmental, health, and safety regulatory process has slowly evolved into a vast number of complex and uncoordinated institutional processes. These processes add unnecessary project costs, in addition to stifling and deterring government and industry from meeting their full responsibilities. The regulatory process is weighted down with inflexibility, staff bureaucracies, duplication of effort, and confusing court cases. The process has become so complex and bureaucratic that it appears incapable of being patched up or reformed from within. Thus, a whole new regulatory process, more integrated, simplified, and expeditious is needed
Schwind, Karen S; Freeman, Sally Ann; Garcia, Molly; Roberts, Ruth
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.
Antonsson, Ann-Beth; Hasle, Peter
towards knowledge-based behaviour. Additionally the time required increases when moving from skill- to knowledge-based behaviour. On the other hand, skill-based behaviour lacks the ability to solve problems and adapt to new situations. In the working environment risk assessment as well as the development...... for risk assessment or risk management. However, there is a lot of criticism towards this kind of good practice, ranging from that it can easily be used for behavioural control to the problem with odd working environments and the need for tailoring the solutions to each workplace. The pros and cons...
Tackney, Charles T.
a comparative legal ecology model of the modern enterprise to gain theoretical and empirical insight into the economic and societal costs of combining Japanese manufacturing techniques with managerial prerogative pursued "the American way." I begin by introducing the comparative legal ecology of the workplace...... as a theoretical concept to compare and contrast national differences in the modern industrial enterprise. This provides a standard to evaluate the extent to which General Motors had appropriately adapted the Japanese modes of social relations within the firm. The events associated with the Flint strikes evidence...... the cost of this oversight. The paper concludes by discussing the need to appropriately emulate Japanese modes of social relation when firms seek to successfully adapt their modes of production....
Collins, Sarah A; Yoon, Sunmoo; Rockoff, Maxine L; Nocenti, David; Bakken, Suzanne
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. © The Author(s) 2014.
c. Perform Quality assurance rev iews of trave l vouchers to improve cOlllp1i ~mce with Joint Federal Trave l Regulati ons, volume 1, "Uniformed...annu al reviews of un liquidated orders are flUW roulinely conducted with more emph<ls is on trave l transactions. Actions t<lken should close OUI...detennined to be improper payments; and 6 vouchers were indctermiIMble due to aged records in the defense trave l system (DTS). CO llectjOil actions have
Cao, Yingjuan; Davidson, Patricia M; DiGiacomo, Michelle
This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Position paper. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease.
Bond, A.H.; Rogers, R.D.; Dietz, M.L.
Several recent national and international reports have predicted that the demand for radionuclides used in medicine will increase significantly over the next 20 years. Separation science is an integral part of the production and development of new radionuclides for diagnostic and therapeutic applications and will play a major role in process improvements to existing radiopharmaceuticals to meet increasing demands. The role of separation science in the production of radionuclides for medical applications is briefly discussed, followed by an overview of the manuscripts from the American Chemical Society symposium 'Nuclear Separations for Radiopharmacy'. A listing of the most widely used radionuclides in clinical application and medical research serves as a foundation for the discussion of future research opportunities in separation science
Full Text Available The paper analyses the railway accidents sources in the Czech Republic on the basis of knowledge on complex system behaviour. It derives seven categories of sources of railway accidents. The individual categories include the accident sources from the same field domain. These domains are: technical related to rail traffic vehicles; technical related to rail infrastructure and railway station; railway operation control – organizational causes; railway operation control – cyber causes; control of rail traffic vehicles; attack on the train; domain legislative and other. The results show that for railway traffic safety improvement, it is necessary to pay attention to all categories, and especially to these that lead to organizational accidents origination.
Mookherji, Sangeeta; Mehl, Garrett; Kaonga, Nadi; Mechael, Patricia
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.
Suyitno, A.; Sugiharti, E.; Pujiastuti, E.
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.
Warren, Ashley; Cordon, Roberto; Told, Michaela; de Savigny, Don; Kickbusch, Ilona; Tanner, Marcel
The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients' misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique. We conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing. Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund's structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement. To date, there are no institutional requirements for
Catherine M. McMahon
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.
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.
McMahon, Catherine M.; Gopinath, Bamini; Schneider, Julie; Reath, Jennifer; Hickson, Louise; Leeder, Stephen R.; Mitchell, Paul; Cowan, Robert
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. PMID:23710184
Ricci, Maria Teresa; Sciallero, Stefania; Mammoliti, Serafina; Gismondi, Viviana; Franiuk, Marzena; Bruzzi, Paolo; Varesco, Liliana
Nearly 15% of all ovarian cancer patients carry a germline BRCA mutation. A pilot project was started at IRCCS AOU San Martino--IST, Genoa, to assess the feasibility and consequences of offering genetic counselling to all ovarian cancer patients during routine oncology appointments. We present early results of this project. Patients who attended an oncology visit at the Medical Oncology Unit 1 between November 2012 and December 2013 were identified. Medical records were reviewed for clinical data, genetic counselling and testing outcomes. Out of 104 women diagnosed with ovarian cancer undergoing an oncology visit, 94 had not had genetic counselling in the past. Twenty-nine patients (29/94, 31%) were referred to the Unit of Hereditary Cancer; of these, 14/26 (54%) were referred at the first visit and 15/68 (22%) at the follow-up visit (p = 0.003). Most referred women attended genetic counselling (22/29, 76%) and had BRCA genetic testing (21/22, 95%). Four BRCA1 mutations were detected (4/21, 19%). Oncologists discuss genetic counselling with a minority of ovarian cancer patients. Mainstreaming such practice is important to optimize the management of these patients and their families. Efforts are needed to identify new models for introducing ovarian cancer genetic risk assessment in oncology practice. © 2015 S. Karger AG, Basel.
Daykin, Anne; Selman, Lucy E; Cramer, Helen; McCann, Sharon; Shorter, Gillian W; Sydes, Matthew R; Gamble, Carrol; Macefield, Rhiannon; Lane, J Athene; Shaw, Alison
developments in trial design and conduct have been accompanied by changes in roles and relationships between trial oversight groups. Recognising and respecting the value of differing priorities among those involved in running trials is key to successful relationships between committees, funders and sponsors. Clarity regarding appropriate lines of communication, roles and accountability is needed. We present 10 evidence-based recommendations to inform updates to international trial guidance, particularly the Medical Research Council guidelines.
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
The Federal Transit Administration (FTA) conducted an on-site audit of the safety program implemented by the Washington Metropolitan Area Transit Authority (WMATA) and overseen by the Tri-State Oversight Committee (TOC) between December 14 and 17, 20...
Eckenwiler, Lisa; Pringle, John; Boulanger, Renaud; Hunt, Matthew
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. © 2015 John Wiley & Sons Ltd.
Bernstad, A; Malmquist, L; Truedsson, C; la Cour Jansen, J
The aim of the present study was to investigate the efficiency in physical pretreatment processes of source-separated solid organic household waste. The investigation of seventeen Swedish full-scale pretreatment facilities, currently receiving separately collected food waste from household for subsequent anaerobic digestion, shows that problems with the quality of produced biomass and high maintenance costs are common. Four full-scale physical pretreatment plants, three using screwpress technology and one using dispergation technology, were compared in relation to resource efficiency, losses of nitrogen and potential methane production from biodegradable matter as well as the ratio of unwanted materials in produced biomass intended for wet anaerobic digestion. Refuse generated in the processes represent 13-39% of TS in incoming wet waste. The methane yield from these fractions corresponds to 14-36Nm(3)/ton separately collected solid organic household waste. Also, 13-32% of N-tot in incoming food waste is found in refuse. Losses of both biodegradable material and nutrients were larger in the three facilities using screwpress technology compared to the facility using dispersion technology.(1) Thus, there are large potentials for increase of both the methane yield and nutrient recovery from separately collected solid organic household waste through increased efficiency in facilities for physical pretreatment. Improved pretreatment processes could thereby increase the overall environmental benefits from anaerobic digestion as a treatment alternative for solid organic household waste. Copyright © 2012 Elsevier Ltd. All rights reserved.
Attaway, David Frost; Jacobsen, Kathryn H; Falconer, Allan; Manca, Germana; Waters, Nigel M
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.
James J. H. Liou
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.
... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for payment of care plan oversight... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight. (a) General...
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... Accounting Oversight Board; Order Approving Proposed Rules on Auditing Standards Related to the Auditor's Assessment of and Response to Risk and Related Amendments to PCAOB Standards December 23, 2010. I. Introduction On September 15, 2010, the Public Company Accounting Oversight Board (the ``Board'' or the ``PCAOB...
... SCIENCE AND TECHNOLOGY POLICY INFORMATION SECURITY PROGRAM Declassification and Downgrading § 2400.19 Declassification by the Director of the Information Security Oversight Office. If the Director of the Information... Information Security Oversight Office. 2400.19 Section 2400.19 National Defense Other Regulations Relating to...
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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.
Full Text Available Science process skills (SPS are an important aspect of learning science. SPS help students to develop creativity in learning. Process skills such as observing, formulating questions, interpreting, experimenting, hypothesizing, applying concepts, and communicating. This study aims to analyze the need for development resources needs of science filled with science process skills. Requirement analysis of the development of teaching materials with the skill of the process of science needs to be done because the textbook is the reference a teacher in the class. The subjects matter of chemistry the study was three senior high schools in Sambas, West Borneo. Needs analysis conducted using a qualitative approach, in terms of needs in classroom learning and content of process skills on teaching materials. Data were collected by interviews and questionnaires were analyzed descriptively. The results showed that as many as 27 percents of students perceive the book used in learning has not yet trained the science process skills. As many as 73 percents of students perceive that they need instructional materials in the form of inquiry-based chemistry modules to improve science process skills. Modules are developed based guided inquiry for having guided inquiry learning stages that can practice students' science process skills.
Noble, J.B.; Hemphill, J.B.
The Department of Energy's Nuclear Siting and Licensing Act of 1978 (S.2775; H.R.11704) proposes Federal/State coordination in need for facility decisionmaking for nuclear power stations. A prior study by the Nuclear Regulatory Commission's Office of State Programs, ''Improving Regulatory Effectiveness in Federal/State Siting Actions'', NUREG-0195, May 1977, considered the concept of need for power/facility. The present study expands the inquiry into need for power/facility by examining the decisionmaking criteria utilized by forty-four States in making a determination of need for power/facility. Specific criteria are identified along with the number of States which make those criteria a primary consideration or a secondary consideration in determining need for facility. Individual profiles of the studied States' decisionmaking criteria are provided. In addition, the study examines the different organizational and functional patterns found in the States' regulatory processes to certificate power stations. The coordination or lack of coordination of the issuance of associated environmental permits required for power stations is outlined for each State. Information concerning States' rate treatment of expenses associated with the construction and operation of a power station is provided. The relationship between the need for power decisionmaking process and the ratemaking process is explored
Documentation of Counter ‑Improvised Explosive Device Initiatives Visit us at www.dodig.mil Objective Our audit objective was to determine whether...E XC E L L E N C E Joint Improvised‑Threat Defeat Agency Needs to Improve Assessment and Documentation of Counter ‑Improvised Explosive Device...JIDA processes for identifying, validating, and prioritizing requirements for countering improvised explosive devices (IEDs) and for developing
DEPARTMENT OF THE ARMY SUBJECT: DoD Needs to Improve Screening and Access Controls for General Public Tenants Leasing Housing on Military...public tenants who leased DoD privatized housing before granting those tenants unescorted access to military installations. In addition, DoD officials...issued access badges to general public tenants with expiration dates that exceeded the tenants’ lease terms. As a result, DoD assumed a higher and
Hennig, Michael; Hundt, Ferdinand; Busta, Susanne; Mikus, Stefan; Sanden, Per-Holger; Sörgel, Andrea; Ruppert, Thorsten
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. PMID:28163667
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.
Kainulainen, E. (ed.)
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
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
Johnson, D.R.; McClung, R.W.; Janney, M.A.; Hanusiak, W.M.
A needs assessment was performed for nondestructive testing and materials characterization to achieve improved reliability in ceramic materials for heat engine applications. Raw materials, green state bodies, and sintered ceramics were considered. The overall approach taken to improve reliability of structural ceramics requires key inspections throughout the fabrication flowsheet, including raw materials, greed state, and dense parts. The applications of nondestructive inspection and characterization techniques to ceramic powders and other raw materials, green ceramics, and sintered ceramics are discussed. The current state of inspection technology is reviewed for all identified attributes and stages of a generalized flowsheet for advanced structural ceramics, and research and development requirements are identified and listed in priority order. 164 refs., 3 figs.
Penadés, Rafael; Catalán, Rosa; Puig, Olga; Masana, Guillem; Pujol, Núria; Navarro, Víctor; Guarch, Joana; Gastó, Cristóbal
While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established, the relationship between cognitive and functional change in the context of treatments is far from clear. The current paper tries to identify which cognitive changes lead to improvements in daily functioning among persons with chronic schizophrenia who had current negative symptoms and evidenced neuropsychological impairments. In a previous work, Cognitive Remediation Therapy (CRT) was compared with a control therapy, involving similar length of therapist contact but different targets. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and functioning [Schizophrenia Research, 87 (2006) 323-331]. Subsequently, analyses of covariance (ANCOVA) were conducted with baseline and cognitive change scores as covariates to test whether cognitive change predicted change in functioning. Additionally, statistical tests to establish the mediation path with significant variables were performed. Although verbal memory, but not executive functioning, was associated with functioning at baseline, it was the improvement in executive functioning that predicted improved daily functioning. Verbal memory played a mediator role in the change process. Consequently, in order to improve daily functioning with CRT, executive function still needs to be targeted in despite of multiple cognitive impairments being present. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Cederberg, C; Henriksson, M; Berglund, M
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.
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.
Singh, Mamta K; Einstadter, Douglas; Lawrence, Renee
Multiple resident-related factors contribute to 'missed opportunities' in providing comprehensive preventive care for female patients, including comfort level, knowledge and experience--all of which are compounded by resident turnover rates. Of particular concern among Internal Medicine (IM) residents is their knowledge and comfort level in performing pelvic exams. To evaluate the impact of a quality improvement project of implementing a Women's Preventive Health Clinic (WPHC) on addressing gaps identified by needs assessments: residents' comfort and knowledge with female preventive care and cervical cancer screening. The WPHC, a multidisciplinary weekly clinic, focused on preventive services for women with chronic conditions. The alternating didactic and clinic sessions emphasised women's preventive health topics for IM residents. Sixty-three IM residents participated in WPHC between 2002 and 2005. Pre- and post-test design was used to assess resident knowledge and comfort levels. Cervical cancer screening rates of residents' patients were assessed pre- and post-WPHC initiation. There was a significant improvement in general knowledge (64% correct at pretest vs 73% at post-test, p=0.0002), resident comfort level in discussing women's health topics and performing gynaecological exams (p<0.0002). Cervical cancer screening rates among IM residents' patients improved from 54% (pre-WPHC initiation) to 65% (post-WPHC initiation period). The results indicate that a focused resident preventive programme can meet gaps identified by education and needs assessments, and simultaneously have a positive impact on cervical cancer screening rates and thus may serve as a model for other residency programmes.
.... Wen Ho Lee, an Asian American accused of espionage, have called into question the equitable treatment of minorities and women in personnel actions at these laboratories in areas such as hiring, pay, and promotion...
Facilities Utilization Board is a joint board that evaluates and reconciles component requests for real estate , use of existing facilities, inter...department guidance provides that a single project or requirement may not be split into smaller projects solely in order to stay below the funding...39 See, e.g., B-234326.15, Dec. 24, 1991 (concluding that the Air Force improperly split a project
14Patriot’s 12 foreign military sale partners are the Netherlands, Germany, South Korea, Japan , Qatar, Saudi Arabia...through 2021 are based on detailed Army planning budget data supporting the President’s budget for fiscal year 2017. We deflated these budget
... monopolies to competitive markets. These fluctuations-the most notable in California during the summer of 2000-have caused some consumers and state officials to question the wisdom of moving to competitive energy markets...
2013 to 2014, the NSC interdicted nearly 60 percent more pounds of drugs (cocaine and marijuana ) per day compared to the HECs operating during the...and Evaluation 8 Figure 4: National Security Cutter Combat Weapon Systems 15 Figure 5: Wave Height of Different Sea States Compared to the National...is intended to be capable of extended deployments, increased endurance, and enhanced communication and surveillance systems compared to the High
electronically , you must send them over the SECRET Internet Protocol Router Network (SIPRNET). We appreciate the courtesies extended to the staff...using ABACUS billing functions with electronic claims filing and electronic payment functions will further reduce timelines. This should address...accounts, valued at $4,564,704, that were delinquent for more than 120 days. According to Department of Army Form 3154, “Hospital Invoice and Receipt
National Aeronautics and Space Administration — Current Unmanned Aircraft Systems (UAS) operations in the National Airspace System (NAS) rely heavily on human oversight, with the majority of commercial operations...
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.
.... Official government documents, news reports and other literature on the intelligence system in Ukraine, as well as studies of intelligence oversight within democracies are the primary sources of data...
STUDENT LOANS Oversight of Servicemembers’ Interest Rate Cap Could Be Strengthened Report to Ranking Member...Governmental Affairs, U.S. Senate November 2016 STUDENT LOANS Oversight of Servicemembers’ Interest Rate Cap Could Be Strengthened Why GAO Did...This Study SCRA helps servicemembers financially by capping interest rates on student loans during active duty. As of May 2016, about 1.3 million
Comptroller General of the U.S., Washington, DC.
This report from the Comptroller General to the United States Congress finds Head Start to be an effective program whose fund distribution formula needs revision and whose management controls need improvement. Head Start's funding for enrollment and operating costs increased significantly between 1977-81. However, these funding increases were not…
Hetherington, Sharon; Henwood, Tim; Swinton, Paul; Keogh, Justin; Gardiner, Paul; Tuckett, Anthony
To investigate the associations of balance confidence with physical and cognitive markers of wellbeing among older adults receiving government-funded aged care services, and whether progressive resistance plus balance training could positively influence change. Intervention study. Community-based older-adult-specific exercise clinic. Older adults (N=245) with complex care needs who were receiving government aged care support. 24 weeks of twice-weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. The primary measure was the Activity-specific Balance Confidence score. Secondary measures included the Short Physical Performance Battery, fall history, hierarchical timed balance tests, Geriatric Anxiety Index, Geriatric Depression Score, FRAIL scale and EuroQol 5D 3L. At baseline, higher physical performance (r = 0.54, p confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r = -0.55, p confidence following the exercise intervention was accompanied by improved physical performance (+12%) and decreased frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. This study shows that reduced physical performance and quality of life, and increasing frailty, are predictive of poor balance confidence among older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented, that reduces frailty and increases physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of wellbeing determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls among older adults. Copyright © 2018. Published by Elsevier Inc.
Petersen, Polly A; Way, Sandra M
Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution. ©2017 American Association of Nurse Practitioners.
Hutchison, Brian; Glazier, Richard
Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation.
Jerg-Bretzke, L; Krüsmann, P; Traue, H C; Limbrecht-Ecklundt, K
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. N=120 doctors of the medical faculty and N=679 medical students in their premedical and clinical training participated online. 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. 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. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Abstract Background Quality of supervision is a major predictor for successful PhD projects. A survey showed that almost all PhD students in the Health Sciences in Denmark indicated that good supervision was important for the completion of their PhD study. Interestingly, approximately half of the students who withdrew from their program had experienced insufficient supervision. This led the Research Education Committee at the University of Copenhagen to recommend that supervisors further develop their supervision competence. The aim of this study was to explore PhD supervisors’ self-reported needs and wishes regarding the content of a new program in supervision, with a special focus on the supervision of PhD students in medical fields. Methods A semi-structured interview guide was developed, and 20 PhD supervisors from the Graduate School of Health and Medical Sciences at the Faculty of Health and Medical Sciences at the University of Copenhagen were interviewed. Empirical data were analysed using qualitative methods of analysis. Results Overall, the results indicated a general interest in improved competence and development of a new supervision programme. Those who were not interested argued that, due to their extensive experience with supervision, they had no need to participate in such a programme. The analysis revealed seven overall themes to be included in the course. The clinical context offers PhD supervisors additional challenges that include the following sub-themes: patient recruitment, writing the first article, agreements and scheduled appointments and two main groups of students, in addition to the main themes. Conclusions The PhD supervisors reported the clear need and desire for a competence enhancement programme targeting the supervision of PhD students at the Faculty of Health and Medical Sciences. Supervision in the clinical context appeared to require additional competence. Trial registration The Scientific Ethical Committee
Challenges and opportunities for appropriate oversight of nanotechnology applied to or derived from biological systems (nano-bio interface) were discussed in a public workshop and dialog hosted by the Center for Science, Technology, and Public Policy of the University of Minnesota on September 15, 2005. This paper discusses the themes that emerged from the workshop, including the importance of analyzing potential gaps in current regulatory systems; deciding upon the general approach taken toward regulation; employing non-regulatory mechanisms for governance; making risk and other studies transparent and available to the public; bolstering mechanisms for public participation in risk analysis; creating more opportunities for meaningful discussion of the social and ethical dimensions of the nano-bio interface; increasing funds for implications and problem-solving research in this area; and having independent and reliable sources for communication. The workshop was successful in identifying ways of moving forward responsibly so that ultimately nanotechnology and its products can succeed in developers', researchers', regulators', and the public's eyes
Yun, I.; Kim, S. Y.; Jeong, G. Y.; Kim, S. P.
This process provides a risk-informed approach such as construction significance determination process (SDP) and construction program performance index analogous to those used in the Reactor Oversight Process (ROP). The cROP has been applied to Vogtle units 3, 4 and V.C. Summer units 2, 3 under construction for the regulatory inspection. In this paper, the cROP is dissected to present its major contents and characteristics. The main features of the cROP can be summarized as followings: 1) The cROP which adopts the concept of the ROP used for operating NPPs assesses NPP under construction periodically to determine the appropriate level of regulatory response. 2) The cROP consists of three parts: the CIP, the CAP and the CEP. 3) The inspections for NPPs under construction can be categorized into three parts: vendor inspection, baseline inspection and supplemental and plant specific inspections. USNRC's regulatory resources can be used effectively based on baseline inspection, which is using ITAAC inspections. The construction SDP is used to assign the color scheme to categorize the significance of inspection findings. Regulatory actions are taken from CAM to which the significance of inspection findings input. In this paper, major contents and characteristics of USNRC's cROP have been presented
This report summarizes a January 17--28, 1994, oversight assessment of restart activities for the 242-A Evaporator at the US Department of Energy's (DOE's) Hanford Site about 25 miles northeast of Hanford, Washington. The assessment was conducted by qualified staff and consultants from the DOE Office of Environment, Safety and Health (EH). Its focus was the readiness of the facility for the resumption of safe operations, in particular those operations involved in the treatment and disposal of condensate from the evaporation of liquid radioactive waste, a key element of the tank waste remediation project administered by the DOE Richland Operations Office (DOE-RL). Overall, the assessment yielded eight programmatic concerns, supported by 38 individual findings. Of the concerns, four have already been closed, and the other four have been resolved. Results pointed up strengths in management and engineering design, as well as effective support of facility training programs by the management and operating contractor, Westinghouse Hanford Company (WHC). Weaknesses were evident, however, in conduct of operations, maintenance, and radiological practices. Furthermore, problems in the submittal and approval of Compliance Schedule Approvals--that is, WHC documentation of the status of compliance with DOE orders--were indicative of a programmatic breakdown in the DOE Order compliance process. According to the results of this assessment, there are no safety and health issues that would preclude or delay restart of the evaporator
Challenges and opportunities for appropriate oversight of nanotechnology applied to or derived from biological systems (nano-bio interface) were discussed in a public workshop and dialog hosted by the Center for Science, Technology, and Public Policy of the University of Minnesota on September 15, 2005. This paper discusses the themes that emerged from the workshop, including the importance of analyzing potential gaps in current regulatory systems; deciding upon the general approach taken toward regulation; employing non-regulatory mechanisms for governance; making risk and other studies transparent and available to the public; bolstering mechanisms for public participation in risk analysis; creating more opportunities for meaningful discussion of the social and ethical dimensions of the nano-bio interface; increasing funds for implications and problem-solving research in this area; and having independent and reliable sources for communication. The workshop was successful in identifying ways of moving forward responsibly so that ultimately nanotechnology and its products can succeed in developers', researchers', regulators', and the public's eyes.
Watt, D G; Wilson, M S J; Shapter, O C; Patil, Pradeep
Emergency surgery is associated with poorer outcomes and higher mortality with recent studies suggesting the 30-day mortality to be 14-15%. The aim of this study was to analyse the 30-day mortality, age-related 30-day mortality and 1-year mortality following emergency laparotomy. We hope this will encourage prospective data collection, improvement of care and initiate strategies to establish best practice in this area. This was a retrospective study of patients who underwent emergency laparotomy from June 2010 to May 2012. The primary end point of the study was 30-day mortality, age-related 30-day mortality and 1-year all-cause mortality. 477 laparotomies were performed in 446 patients. 57% were aged 70 years. 30-day mortality was 12, 4% in those aged 70 years (p 70 years (p laparotomy carries a high rate of mortality, especially in those over the age of 70 years, and more needs to be done to improve outcomes, particularly in this group. This could involve increasing acute surgical care manpower, early recognition of patients requiring emergency surgery, development of clear management protocols for such patients or perhaps even considering centralisation of emergency surgical services to specialist centres with multidisciplinary teams involving emergency surgeons and care of the elderly physicians in hospital and related community outreach services for post-discharge care.
Ng, Kwan-Hoong; Lean, Mei-Li
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.
Templin, Ludivine; Grosse, Camille; Andres, Virginie; Robert, Clotilde Des; Fayol, Laurence; Simeoni, Umberto; Boubred, Farid
Objective Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). Study Design This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24 +0 and 26 +6 weeks' gestation before (period 1, n = 40) and after (period 2, n = 52) implementing the new protocol. Results Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, p = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, p = 0.002) and during the hospital stay (75 vs. 92.5%, p < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity. Conclusion A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Beaudrie, Christian E H; Kandlikar, Milind; Satterfield, Terre
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.
Richardson, Joshua E; Vest, Joshua R; Green, Cori M; Kern, Lisa M; Kaushal, Rainu
We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Oversight and Influencing of Licensee Leadership and Management for Safety, Including Safety Culture - Regulatory Approaches and Methods. Proceedings of an NEA/IAEA Workshop, Chester, United Kingdom, 26-28 September 2011
major events, and from the inquiry into the Nimrod air crash. There were also presentations by regulatory bodies on developments in their approaches to oversight of leadership and management for safety/safety culture (LMfS/SC) since the previous workshop, and by industry representatives on perceptions of regulatory approaches. The workshop programme also included structured discussion sessions, in which a set of issues were explored by small groups and then discussed in a plenary session. A pre-workshop survey of participating regulatory bodies was also conducted to obtain information on current approaches and areas for discussion. The discussions during the workshop and results of the pre-workshop survey confirmed that most regulators have further developed their approaches to LMfS/SC oversight since Chester. Key developments include: - Use of a structured framework for LMfS/SC interventions is now common. - Training for regulatory staff in LMfS/SC and intervention strategies/approaches is more prevalent. - There is increasing dialogue on LMfS/SC between regulators and licensees. - There is widespread recognition of the need to use multiple data sources and processes to build a meaningful picture of strengths and areas for improvement. - Increasing engagement is taking place at corporate levels of the licensee organisation, recognising the importance of focusing on key decision makers
Brownlee, Katherine; Minnier, Tamra E; Martin, Susan Christie; Greenhouse, Pamela K
Widespread changes in the health care landscape require a paradigm shift from an educational model where quality improvement (QI) expertise is centralized to a model where foundational and functional QI knowledge is widespread through all levels of a health care organization. To support a new educational structure prioritizing QI education as a stand-alone priority, a 6-month educational course was introduced for operational leaders (requiring completion of a real-life improvement project) and a second, introductory QI education set of 5 stand-alone classes was introduced for managers and frontline staff; the latter is provided at centralized sites, on-site, and via webinars. Additional QI courses have been introduced for board members. Sixty operational leaders attended the first 2 offerings of the 6-month course and completed 50 associated QI projects, as of July 2012; nearly 1500 participants have attended the "Just-in-Time" classes, representing 13 University of Pittsburgh Medical Center hospitals and affiliated facilities. Eighty-three percent of recent participants rated the 6-month course a 4 or 5 in terms of efficacy. Two-thirds of participants from both 6-month series reported that they continued to work on their project once the class was over. The number of course attendees and their feedback regarding efficacy of this educational approach, as well as the volume of associated completed projects, indicate success in providing greater numbers of staff at all levels of the organization with QI education and tools. This educational format shows promise for further refinement and replicability.
Weiskopf, S. R.; Myers, B.; Beard, T. D.; Jackson, S. T.; Tittensor, D.; Harfoot, M.; Senay, G. B.
At the global scale, well-accepted global circulation models and agreed-upon scenarios for future climate from the Intergovernmental Panel on Climate Change (IPCC) are available. In contrast, biodiversity modeling at the global scale lacks analogous tools. While there is great interest in development of similar bodies and efforts for international monitoring and modelling of biodiversity at the global scale, equivalent modelling tools are in their infancy. This lack of global biodiversity models compared to the extensive array of general circulation models provides a unique opportunity to bring together climate, ecosystem, and biodiversity modeling experts to promote development of integrated approaches in modeling global biodiversity. Improved models are needed to understand how we are progressing towards the Aichi Biodiversity Targets, many of which are not on track to meet the 2020 goal, threatening global biodiversity conservation, monitoring, and sustainable use. We brought together biodiversity, climate, and remote sensing experts to try to 1) identify lessons learned from the climate community that can be used to improve global biodiversity models; 2) explore how NASA and other remote sensing products could be better integrated into global biodiversity models and 3) advance global biodiversity modeling, prediction, and forecasting to inform the Aichi Biodiversity Targets, the 2030 Sustainable Development Goals, and the Intergovernmental Platform on Biodiversity and Ecosystem Services Global Assessment of Biodiversity and Ecosystem Services. The 1st In-Person meeting focused on determining a roadmap for effective assessment of biodiversity model projections and forecasts by 2030 while integrating and assimilating remote sensing data and applying lessons learned, when appropriate, from climate modeling. Here, we present the outcomes and lessons learned from our first E-discussion and in-person meeting and discuss the next steps for future meetings.
Mertens, C. J.; Kress, B. T.; Wiltberger, M. J.; Tobiska, W.; Xu, X.
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.
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
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 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. PMID:23289677
The historical factors that led to the waste at Hanford are outlined. Westinghouse Hanford Company mission and organization are described. The role of the Quality Oversight organization in nuclear hazardous waste management and environmental restoration at Westinghouse Hanford Company is delineated. Tank Waste Remediation Systems activities and the role of the Quality Oversight organization are described as they apply to typical projects. Quality Oversight's role as the foundation for implementation of systems engineering and operation research principles is pointed out
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)
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
Melber, Barbara; Durbin, Nancy E.; Tael, Irene
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; Tension
Glezeva, Nadezhda; Chisale, Master; McDonald, Kenneth; Ledwidge, Mark; Gallagher, Joe; Watson, Chris J
Type 2 diabetes mellitus is no longer a disease of high income countries but a global health pandemic. With the continued and rapid increase in its prevalence worldwide it is forecasted that diabetes will be a leading cause of morbidity and mortality. A major concern stems from its role in development and progression of cardiovascular disease, including cardiac dysfunction and heart failure. Within low- and middle-income areas such as Sub-Saharan Africa the burden of diabetes is already significant driven by many factors, including, socioeconomic (urbanisation), nutritional (high-calorie "western-diet", obesity) and lifestyle (physical inactivity) changes. Insufficient economic and community resources, poor health care system development and chronic disease management, poor education, and a lack of preventative and diagnostic measures further aggravate the severity of the diabetes problem. This review outlines the burden of type 2 diabetes mellitus in Sub-Saharan Africa and highlights the need for improved community health care and regulations to reduce its epidemiological spread and devastating impact on health. Copyright © 2018 Elsevier B.V. All rights reserved.
Adedimeji, Adebola A; Lounsbury, David; Popoola, Oluwafemi; Asuzu, Chioma; Lawal, Akinmayowa; Oladoyin, V; Crifase, Cassandra; Agalliu, Ilir; Shankar, Viswanathan; Adebiyi, Akindele
Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system. We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis. Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts. Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
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.
Aprilyn B. Dimalaluan
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.
Chakaya, Jeremiah M; Carter, E Jane; Hopewell, Philip C
It is estimated that 85% of the world's population lives in low- and middle-income countries (LMICs). Although economic conditions are improving in these countries, health expenditures have not kept pace with the overall economic growth, and health systems remain weak. These already inadequate systems are being further stressed by the epidemiologic transition that is taking place, characterized by a slow decrease in communicable diseases and an increase in noninfectious chronic diseases, resulting in a "double burden" of infectious and noninfectious diseases. Respiratory diseases comprise the largest category of illness within this combined burden of disease. Although there are chronic respiratory disease programs of proven effectiveness appropriate for LMICs, implementation has been greatly hampered by the lack of physicians who have special knowledge and skills in addressing the full spectrum of lung diseases. Thus, there is an urgent need to create training programs for specialists in respiratory diseases. Such programs should be developed and conducted by institutions in LMICs and tailored to fit the prevailing circumstances of the country. Existing curriculum blueprints may be used to guide training program development with appropriate modifications. Academic institutions and professional societies in high-income countries may be called upon to provide technical assistance in developing and implementing training programs. In order to better define the burden of respiratory diseases and identify effective interventions, research, moved forward by persons committed and specialized in this area of health, will be essential.
Wyrsch, Ethan R.; Roy Chowdhury, Piklu; Chapman, Toni A.; Charles, Ian G.; Hammond, Jeffrey M.; Djordjevic, Steven P.
Contamination of waste effluent from hospitals and intensive food animal production with antimicrobial residues is an immense global problem. Antimicrobial residues exert selection pressures that influence the acquisition of antimicrobial resistance and virulence genes in diverse microbial populations. Despite these concerns there is only a limited understanding of how antimicrobial residues contribute to the global problem of antimicrobial resistance. Furthermore, rapid detection of emerging bacterial pathogens and strains with resistance to more than one antibiotic class remains a challenge. A comprehensive, sequence-based genomic epidemiological surveillance model that captures essential microbial metadata is needed, both to improve surveillance for antimicrobial resistance and to monitor pathogen evolution. Escherichia coli is an important pathogen causing both intestinal [intestinal pathogenic E. coli (IPEC)] and extraintestinal [extraintestinal pathogenic E. coli (ExPEC)] disease in humans and food animals. ExPEC are the most frequently isolated Gram negative pathogen affecting human health, linked to food production practices and are often resistant to multiple antibiotics. Cattle are a known reservoir of IPEC but they are not recognized as a source of ExPEC that impact human or animal health. In contrast, poultry are a recognized source of multiple antibiotic resistant ExPEC, while swine have received comparatively less attention in this regard. Here, we review what is known about ExPEC in swine and how pig production contributes to the problem of antibiotic resistance. PMID:27379026
Singh, Rekha; Tandon, Ashwani; Gupta, Sushil Kumar; Saroja, K
Many patients with hypothyroidism complain of persistent residual symptoms, despite optimal treatment, although the similar prevalence is seen in patients with documented absence of thyroid disorder in primary health-care setup. We aimed to investigate symptomatic relief in new cases of primary hypothyroidism and compare with controls with other chronic conditions. This prospective case-control follow-up study enrolled patients from July 2014 to May 2015 in an endocrine outpatient clinic of a tertiary hospital. Controls were age- and gender-matched ambulatory individuals with well-controlled other chronic diseases and no major comorbidity. Thyroid symptom questionnaire (TSQ) was administered at pretreatment to all the cases and then they were started on levothyroxine (LT). At euthyroidism, TSQ was readministered. For controls, TSQ was administered only once. TSQ was measured on Likert scale 1-4 for lack of energy, dry skin, constipation, aches and pains, cold intolerance, poor memory, depression, weight gain, tiredness after walking, and difficulty in getting up (DGU). P < 0.05 was considered statistically significant. A total of 194 cases (147 females and 47 males) and 259 controls (187 females and 72 males) were analyzed. A significant difference in the symptoms prevalence was seen between controls and pretreatment cases, except for DGU, and between subclinical and overt hypothyroidism. Pretreatment serum thyroid-stimulating hormone in cases correlated significantly with all their pretreatment symptoms score. All symptoms prevalence decreased significantly posttreatment. At euthyroidism, the mean symptoms score in posttreatment cases was similar or lower than the controls. LT effectively improves the symptoms of hypothyroidism in newly diagnosed cases of primary hypothyroidism. The residual symptoms need an alternation explanation other than hypothyroidism.
Lowery, Bobby; Scott, Elaine; Swanson, Mel
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.
Report #15-P-0046, January 7, 2015. Improved communication to state agencies regarding NPIC's role and services will improve NPIC's value and ability to provide reliable information to the public and states.
Hao Xiaofeng; Chen Rui; Zhou Limin; Wang Xiuqing
The NRC New Reactor Oversight Process focuses the nuclear safety supervision on the 3 areas: Reactor Safety, Radiation safety and Plant Security. Within the 3 areas, 7 cornerstones are detailed for the purpose. They are Initiating Events, Mitigating Systems, Barrier Integrity, Emergency Preparedness, Occupational Radiation Protection, Public Radiation Safety and Physical Protection. On cooperating with the inspections, the new process ensures a more effective, objective and timely evaluation of the safety level of the operating nuclear power plants. On considering the practices and the status in China nuclear safety supervision, the authors have to learn something from the NRC New Reactor Oversight Process. The authors must make an optimization on Chinese limited resources and put the emphasis on the issues with high risk in order to prevent the occurrence of the accidents. Properly inducing some ideas and methodology from the NRC New Reactor Oversight Process will benefit the development and perfection of the supervision mode of the NNSA
Burnett, LouAnn Crawford; Brodsky, Benjamin H.
Sandia National Laboratories' International Biological and Chemical Threat Reduction (SNL/IBCTR) conducted, on behalf of the Federal Select Agent Program (FSAP), a review of risk assessment in modern select agent laboratories. This review and analysis consisted of literature review, interviews of FSAP staff, entities regulated by FSAP, and deliberations of an expert panel. Additionally, SNL/IBCTR reviewed oversight mechanisms used by industries, US agencies, and other countries for high-consequence risks (e.g, nuclear, chemical, or biological materials, aviation, off-shore drilling, etc.) to determine if alternate oversight mechanisms existed that might be applicable to FSAP oversight of biological select agents and toxins. This report contains five findings, based on these reviews and analyses, with recommendations and suggested actions for FSAP to consider.
Gabrielian, Sonya; Yuan, Anita; Rubenstein, Lisa; Andersen, Ronald M; Gelberg, Lillian
This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population.
Dyson, Melissa C; Carpenter, Calvin B; Colby, Lesley A
Research with hazardous biologic materials (biohazards) is essential to the progress of medicine and science. The field of microbiology has rapidly advanced over the years, partially due to the development of new scientific methods such as recombinant DNA technology, synthetic biology, viral vectors, and the use of genetically modified animals. This research poses a potential risk to personnel as well as the public and the environment. Institutions must have appropriate oversight and take appropriate steps to mitigate the risks of working with these biologic hazards. This article will review responsibilities for institutional oversight of occupational health and safety for research involving biologic hazards.
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.
Paradise, Jordan; Tisdale, Alison W; Hall, Ralph F; Kokkoli, Efrosini
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.
Report #18-P-0031, October 30, 2017. Although the EPA has an effective information security program, management emphasis is needed to achieve a higher level of maturity for the agency’s information security program.
Tan, Nget Hong; Wong, Kin Ying; Tan, Choo Hock
The venom proteome of Naja sputatrix (Javan spitting cobra) was elucidated through reverse-phase HPLC, nano-ESI-LCMS/MS and data mining. A total of 97 distinct protein forms belonging to 14 families were identified. The most abundant proteins are the three-finger toxins (3FTXs, 64.22%) and phospholipase A 2 (PLA 2 , 31.24%), followed by nerve growth factors (1.82%), snake venom metalloproteinase (1.33%) and several proteins of lower abundance (neurotoxins (7.89%) predominate over the long neurotoxins (0.48%) among other neurotoxins of lesser toxicity (muscarinic toxin-like proteins, 5.51% and weak neurotoxins, 2.26%). The major SNTX, CTX and PLA 2 toxins were isolated with intravenous median lethal doses determined as 0.13, 1.06 and 0.50μg/g in mice, respectively. SABU, the Indonesia manufactured homologous tri-specific antivenom could neutralize the CTX and PLA 2 fraction with moderate potency (potency=0.14-0.16mg toxin per ml antivenom). The SNTX, however, was very poorly neutralized with a potency level of 0.034mg/ml, indicating SNTX as the main limiting factor in antivenom neutralization. The finding helps elucidate the inferior efficacy of SABU reported in neutralizing N. sputatrix venom, and supports the call for antivenom improvement. The Javan spitting cobra, Naja sputatrix is by itself a unique species and should not be confused as the equatorial and the Indochinese spitting cobras. The distinction among the spitting cobras was however unclear prior to the revision of cobra systematics in the mid-90's, and results of some earlier studies are now questionable as to which species was implicated back then. The current study successfully profiled the venom proteome of authenticated N. sputatrix, and showed that the venom is made up of approximately 64% three-finger toxins (including neurotoxins and cytotoxins) and 31% phospholipases A 2 by total venom proteins. The findings verified that the paralyzing components in the venom i.e. neurotoxins are
Liu, Yaoze; Engel, Bernard A; Flanagan, Dennis C; Gitau, Margaret W; McMillan, Sara K; Chaubey, Indrajeet
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
Ordnance Information System RFID Radio Frequency Identification SEP Supporting Execution Plan STRATEGY Strategy for Improving DOD Asset...efforts to improve asset tracking and in-transit visibility. Although DOD has made progress in these efforts, we also found that more work remains to...The SEPs for DOD IUID Implementation Plans, the Army’s Mortuary Affairs Reporting and Tracking System, and the Joint Staff Development of In
Nyman, Samuel R; Szymczynska, Paulina
Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson's theory of psychosocial development to dementia care. We argue for the importance of activity provision for people with dementia to help promote wellbeing
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0080] Guidance on Food and Drug Administration Oversight of Positron Emission Tomography Drug Products--Questions and Answers; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0080] Draft Guidance on Food and Drug Administration Oversight of Positron Emission Tomography Drug Products--Questions and Answers; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...
... 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 48...
... 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 officer...
... 42 Public Health 1 2010-10-01 2010-10-01 false Assurances and State oversight of the Charitable Choice requirements. 54.9 Section 54.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... PREVENTION AND TREATMENT BLOCK GRANTS AND/OR PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS GRANTS...
... the target threshold for U.S. market capitalization for 2009. The PCAOB was unable to conduct the... the U.S. market capitalization of the aforementioned 49 firms' issuer audit clients. The proposed rule... jurisdictions have or soon will have a local auditor oversight authority with which the Board would seek to work...
This thesis examines the law and practice of official secrets in order to appraise whether and how they restrict democratic oversight and fundamental rights in the European Union. It provides a systematic and in-depth analysis of what the rules of official secrets are, who establishes them and how
... 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... through registration of public accounting firms and standard setting, inspection, and disciplinary...
... 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... through registration of public accounting firms and standard setting, inspection, and disciplinary...
... 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... through registration of public accounting firms and standard setting, inspection, and disciplinary...
... 29 Labor 1 2010-07-01 2010-07-01 true What are a Governor's oversight responsibilities regarding... NONDISCRIMINATION AND EQUAL OPPORTUNITY PROVISIONS OF THE WORKFORCE INVESTMENT ACT OF 1998 (WIA) Governor's Responsibilities To Implement the Nondiscrimination and Equal Opportunity Requirements of WIA § 37.53 What are a...
... 29 Labor 1 2010-07-01 2010-07-01 true What are a Governor's oversight responsibilities? 37.51... OPPORTUNITY PROVISIONS OF THE WORKFORCE INVESTMENT ACT OF 1998 (WIA) Governor's Responsibilities To Implement the Nondiscrimination and Equal Opportunity Requirements of WIA § 37.51 What are a Governor's...
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)
... financial statements or an audit of financial statements only. 2. Other Public Company Accounting Oversight..., including significant discussions regarding the application of accounting principles and auditing standards... policies and practices.\\15\\ \\15\\ See, e.g., Financial Accounting Standards Board Accounting Standards...
On July 1, 1993, a Regulatory Oversight (RO) organization was established within the United States Department of Energy (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 RO program was to ensure continued plant safety, safeguards and security while the Paducah and Portsmouth gaseous diffusion plants (GDPs) transitioned to regulatory oversight by the Nuclear Regulatory Commission (NRC). These activities were performed under the authority of the lease agreement between DOE and USEC until NRC issued a Certificate of Compliance or approved a Compliance Plan pursuant to Section 1701 of the Atomic Energy Act of 1954, as amended, and assumed regulatory responsibility. This report chronicles the formal development, operation and key activities of the RO organization from its beginning in July 1993, until the turnover of the regulatory oversight responsibility to the NRC on March 3, 1997. Through its evolution to closure, the RO program was a formal, proceduralized effort designed to provide consistent regulation and to facilitate transition to NRC. The RO Program was also a first-of-a-kind program for DOE. The process, experience, and lessons learned summarized herein should be useful as a model for transition of other DOE facilities to privatization or external regulation
On July 1, 1993, a Regulatory Oversight (RO) organization was established within the United States Department of Energy (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 RO program was to ensure continued plant safety, safeguards and security while the Paducah and Portsmouth gaseous diffusion plants (GDPs) transitioned to regulatory oversight by the Nuclear Regulatory Commission (NRC). These activities were performed under the authority of the lease agreement between DOE and USEC until NRC issued a Certificate of Compliance or approved a Compliance Plan pursuant to Section 1701 of the Atomic Energy Act of 1954, as amended, and assumed regulatory responsibility. This report chronicles the formal development, operation and key activities of the RO organization from its beginning in July 1993, until the turnover of the regulatory oversight responsibility to the NRC on March 3, 1997. Through its evolution to closure, the RO program was a formal, proceduralized effort designed to provide consistent regulation and to facilitate transition to NRC. The RO Program was also a first-of-a-kind program for DOE. The process, experience, and lessons learned summarized herein should be useful as a model for transition of other DOE facilities to privatization or external regulation.
Mustapha, Ramlee B.; Ali, Manisah Mohd; Bari, Safani; Amat, Salleh
In the era of globalization, Malaysia's ability to remain economically competitive depends on the skills of its workforce. The policies and practices of Malaysia's vocational education system must be revised to do more to give the country's disabled citizens the training they need to find employment and become taxpayers. More concerted efforts are…
This article describes a study in which seven students with diverse disabilities participated in a one-credit online library research course which had been adapted to be accessible using the best practices literature on distance education for students with special needs. Students provided feedback on the design of the course and participated in…
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.
Lubberding, Sanne; van Uden-Kraan, Cornelia F; Te Velde, Elisabeth A; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M
To gain insight into cancer survivors' needs towards an eHealth application monitoring quality of life and targeting personalised access to supportive care. Supportive care in cancer addresses survivors' concerns and needs. However, many survivors are not taking advantage of supportive care provided. To enable cancer survivors to benefit, survivors' needs must be identified timely and effectively. An eHealth application could be a solution to meet patients' individual supportive care needs. A qualitative approach. Thirty cancer survivors (15 head and neck and 15 breast cancer survivors) participated. The majority were female (n = 20·67%). The mean age was 60 (SD 8·8) years. Mean time interval since treatment was 13·5 months (SD 10·5). All interviews were audio-recorded and transcribed verbatim. During the interviews, participants were asked about their unmet needs during follow-up care and a potential eHealth application. Data were analyzed independently by two coders and coded into key issues and themes. Cancer survivors commented that they felt unprepared for the post-treatment period and that their symptoms often remained unknown to care providers. Survivors also mentioned a suboptimal referral pattern to supportive care services. Mentioned advantages of an eHealth application were as follows: insight into the course of symptoms by monitoring, availability of information among follow-up appointments, receiving personalised advice and tailored supportive care. Cancer survivors identified several unmet needs during follow-up care. Most survivors were positive towards the proposed eHealth application and expressed that it could be a valuable addition to follow-up cancer care. Study results provide care providers with insight into barriers that impede survivors from obtaining optimal supportive care. This study also provides insight into the characteristics needed to design, build and implement an eHealth application targeting personalised access to supportive
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.
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
Chockie, Alan [Chockie Group International, Inc., Seattle, WA (United States)
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
Snoek, G.J.; IJzerman, Maarten Joost; Hermens, Hermanus J.; Maxwell, D.; Biering-Sorensen, F.
Objective: To investigate the impact of upper extremity deficit in subjects with tetraplegia. Setting: The United Kingdom and The Netherlands. Study design: Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations. Main outcome parameter: Indication of expected improvement
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…
Raffing, Rie; Jensen, Thor Bern; Tønnesen, Hanne
who withdrew from their program had experienced insufficient supervision. This led the Research Education Committee at the University of Copenhagen to recommend that supervisors further develop their supervision competence. The aim of this study was to explore PhD supervisors' self-reported needs...... and wishes regarding the content of a new program in supervision, with a special focus on the supervision of PhD students in medical fields. Methods: A semi-structured interview guide was developed, and 20 PhD supervisors from the Graduate School of Health and Medical Sciences at the Faculty of Health......, due to their extensive experience with supervision, they had no need to participate in such a programme. The analysis revealed seven overall themes to be included in the course. The clinical context offers PhD supervisors additional challenges that include the following sub-themes: patient recruitment...
not request waivers when the program did not meet the certification criteria needed to enter initial operational test and evaluation ( IOT &E...readiness review (OTRR) briefings that did not fully document that they had met the certification criteria for entering IOT &E. These conditions...October 8, 2015 As a result, the NMT program completed IOT &E with deficiencies that diminished the system’s ability to perform its primary communication
Wang, Li; Sprung, Brandon S; DeCross, Arthur J; Marino, Danielle
Split-dose bowel preparation is associated with improved mucosal visualization and patient tolerance, becoming a standard of care. However, quality measures data associated with this preparation are limited. At our academic tertiary-care facility, we aim to study the effect of changing from single- to split-dose preparation on colonoscopy quality measures. A retrospective cohort study with quality indicators was conducted using electronic medical record data. Cases were identified via ICD9 code V76.51, "Special screening for malignant neoplasms of colon." Single-dose preparation data was collected from 9/1/13 to 8/31/14. Split-dose preparation was implemented 11/2014, and data were collected from 1/1/15 to 8/31/15. A total of 1602 colonoscopies in the single-dose group and 1061 colonoscopies in the split-dose group were analyzed. The Boston Bowel Preparation Scale was significantly improved in the split-dose group 8.64 ± SD 1.25 versus 8.25 ± SD 1.61, p 2.9%), p = 0.92; however, the rate for recommending an early repeat examination due to an inadequate bowel preparation was significantly decreased to 3.9% (95% CI 2.7-5.0%) versus 8.9% (95% CI 1.52-2.97%), p preparation significantly improves overall bowel cleanliness, there is no significant adenoma detection rate improvement with high baseline rate, suggesting a threshold which may not improve with enhanced preparations. Split-dose preparation significantly reduces the frequency with which inadequate preparation prompts an early repeat examination, which has important clinical implications on performance, costs, and patient experience, providing further evidence supporting split-dose preparation use.
Arlt, R.; Kovar, A.; Swoboda, M.; Beck, P.; Duftschmid, K.E.; Lewis, W.
Nuclear radiation measurement instruments and devices for the detection and characterisation of nuclear material and radioactive isotopes at borders play a decisive role in the set of technical measures needed to deal with the problem of illicit trafficking. Therefore the availability of a range of devices with adequate performance at affordable prices is essential. The needed equipment can be classified into the following categories: Detection equipment (border monitors and radiation pagers); Hand held devices for neutron/gamma source search and in-field characterisation of radiation sources by customs inspectors; NDA (non-destructive assay) instruments for in-depth investigation of a seized item by experts either in the field or under laboratory conditions. Instruments and techniques, which use destructive assay methods, are not considered in this paper. The most recent overview on the performance of such instruments is given in the Final Report of ITRAP (Illicit Trafficking Radiation Detection Assessment Program). According to the findings of ITRAP, although in all above mentioned categories equipment is commercially available, deficiencies and shortcomings were identified. In this paper we describe our effort in addressing some of the most essential equipment problems, identified in ITRAP - the sensitivity of border monitors with respect to the detection of nuclear material and the performance and usability of hand held and portable devices needed for in-field characterisation of seized items by customs inspectors
To address the potential threat that suspect/counterfeit parts could pose to DOE workers and the public, the Office of the Deputy Assistant Secretary for Oversight initiated a number of activities beginning in mid-1995. Oversight placed increased emphasis on the field's quality assurance-suspect/counterfeit parts programs during safety management evaluations, in keeping with the Office of Environment, Safety and Health (EH) oversight responsibilities, which include oversight of the Department's quality assurance (QA) programs. In addition, Oversight reviewed relevant policy documents and occurrence reports to determine the nature and magnitude of the problem within the Department. The results of that review, contained in an Office of Oversight report, Independent Oversight Analysis of Suspect/Counterfeit Parts Within the Department of Energy (November 1995), indicate a lack of consistency and comprehensiveness in the Department's QA-suspect/counterfeit parts program. A detailed analysis of the causes and impacts of the problem was recommended. In response, this review was initiated to determine the effectiveness of the Department's QA program for suspect/counterfeit parts. This study goes beyond merely assessing and reporting the status of the program, however. It is the authors intention to highlight the complex issues associated with suspect/counterfeit parts in the Department today and to present approaches that DOE managers might consider to address these issues
Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford
The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.
Comptroller General of the U.S., Washington, DC.
This report discusses specific findings of a review of language training and requirements in the Department of Defense. It contains: (1) a letter to the Secretary of Defense from the Office of the Comptroller General of the U.S.; (2) an Appendix giving a description of the Defense Language Institute and an outline of areas that need improvement;…
Collender, Guy; Gabrysch, Sabine; Campbell, Oona M R
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. © 2012 Blackwell Publishing Ltd.
The individual views are presented of the panel members relating to the basic issues and framework for improvements of the Federal/state process for licensing of nuclear power plants, associated facilities, transmission lines, reprocessing of fuel and uranium enrichment. The synopsis supplements the initial synopsis of the views presented to the National Governors Conference Workshop ''State Perspectives on Energy Facility Siting'' in Atlanta, Georgia on December 15--16, 1976. Both synopses constitute the report of this panel
Loh, Debbie Ann; Choo, Wan Yuen; Hairi, Noran Naqiah; Othman, Sajaratulnisah; Mohd Hairi, Farizah; Mohd Mydin, Fadzilah Hanum; Jaafar, Siti Nur Illiani; Tan, Maw Pin; Mohd Ali, Zainudin; Abdul Aziz, Suriyati; Ramli, Rohaya; Mohamad, Rosmala; Lal Mohammad, Zaiton; Hassan, Norlela; Brownell, Patricia; Bulgiba, Awang
The aim of this study was to describe a trial protocol of an educational intervention for nurses to improve their awareness and practice in detecting and managing elder abuse and neglect. Knowledgeable and skilful nurses are crucial amidst the growing numbers of maltreated older patients. This trial is a multi-site, three-armed, community-based cluster randomized controlled trial with 6-months follow-up. This study will involve 390 community and registered nurses from government health clinics in Negeri Sembilan, Malaysia (protocol approved in October 2013). This three-phased study, premised on the Precede-Proceed Model, comprises baseline focus group discussion and survey (Phase 1), development of training module (Phase 2) and implementation and evaluation of the training (Phase 3). Eligible participants will be randomized to the control group (continuous nursing education), intervention group A (face-to-face intensive training programme) or group B (face-to-face intensive training programme and an educational video). Outcome measures include improvement in knowledge and awareness on elder abuse and neglect and the number of cases identified and managed during follow-up. Data will be collected at baseline, immediate postintervention, 3- and 6-month follow-up. Findings from this study will provide empirical support for the development of a training module for nurses on the detection and management of elder abuse and neglect, towards improving healthcare delivery and the well-being of vulnerable older adults. This study is funded by the University of Malaya Research Grant (RP001C-13HTM), (FL002-13SBS) and University of Malaya Grand Challenge (PEACE) Grant (GC001C-14HTM) awarded in May 2013, July 2013 and September 2014. © 2015 John Wiley & Sons Ltd.
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.
Howard, Anita R
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
Deaño, Manuel Deaño; Alfonso, Sonia; Das, Jagannath Prasad
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. Copyright © 2014 Elsevier Ltd. All rights reserved.
Anton, Stephen D.; Duncan, Glen E.; Limacher, Marian C.; Martin, A. Daniel; Perri, Michael G.
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 = 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
Brownson, Ross C; Diez Roux, Ana V; Swartz, Katherine
This commentary describes the concept of evidence-based public health, including the limitations of evidence. Increased attention to evidence may have numerous benefits for public health practice, including access to higher-quality information on what works, a higher likelihood of successful programs and policies being implemented, greater workforce productivity, and more efficient use of resources. To broaden thinking on the sources and scope of evidence, the three reviews in this symposium seek to (a) compare and contrast several evaluation designs that are alternatives to the randomized controlled trial; (b) describe two research approaches that are useful in addressing complex, multilevel public health issues (i.e., mixed methods research and mixed studies reviews); and (c) provide an overview of the value and approaches for generating practice-based evidence. These reviews highlight the complexity and interrelatedness of public health challenges, limitations of researcher-driven, quantitative approaches, and the need to broaden our current concepts of evidence.
Cadogan, Cathal A; Ryan, Cristín; Hughes, Carmel
There is a growing emphasis on behavior change in intervention development programmes aimed at improving public health and healthcare professionals' practice. A number of frameworks and methodological tools have been established to assist researchers in developing interventions seeking to change healthcare professionals' behaviors. The key features of behavior change intervention design involve specifying the target group (i.e. healthcare professional or patient cohort), the target behavior and identifying mediators (i.e. barriers and facilitators) of behavior change. Once the target behavior is clearly specified and understood, specific behavior change techniques can then be used as the basis of the intervention to target identified mediators of behavior change. This commentary outlines the challenges for pharmacy practice-based researchers in targeting dispensing as a behavior when developing behavior change interventions aimed at pharmacists and proposes a definition of dispensing to consider in future research. Copyright © 2016 Elsevier Inc. All rights reserved.
Mendell, Mark J.; Fisk, William J.; Kreiss, Kathleen; Levin, Hal; Alexander, Darryl; Cain, William S.; Girman, John R.; Hines, Cynthia J.; Jensen, Paul A.; Milton, Donald K.; Rexroat, Larry P.; Wallingford, Kenneth M.
Indoor nonindustrial work environments were designated a priority research area through the nationwide stakeholder process that created the National Occupational Research Agenda. A multidisciplinary research team used member consensus and quantitative estimates, with extensive external review, to develop a specific research agenda. The team outlined the following priority research topics: building-influenced communicable respiratory infections, building-related asthma/allergic diseases, and nonspecific building-related symptoms; indoor environmental science; and methods for increasing implementation of healthful building practices. Available data suggest that improving building environments may result in health benefits for more than 15 million of the 89 million US indoor workers, with estimated economic benefits of $5 to $75 billion annually. Research on these topics, requiring new collaborations and resources, offers enormous potential health and economic returns. PMID:12197969
Swed, Ori; Crosbie, Thomas Alexander
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...
Braga, Anthony A; Hureau, David M
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.
Hitchcock, Laurel Iverson; Mulvihill, Beverly A
This historical study examines the early years of the federal program of services for children with physical disabilities in the United States (US) during the 1930s, known today as services for Children with Special Health Care Needs (CSHCN). Established as part of the Social Security Act (SSA) of 1935, the Crippled Children Services (CCS) program was one of the first medical programs for children supported by the federal government. Under the SSA, states and territories quickly developed state-level CCS programs during the late 1930s. The US Children's Bureau administered the program for the federal government and helped states to incorporate preventive services and interdisciplinary approaches to service provision into state-level CCS programs. Factors that influenced the implementation of these programs included the availability of matching state funds, the establishment of state programs for crippled children prior to the SSA, and the accessibility of qualified health care professionals and facilities. The early efforts of this federal program on behalf of children with disabilities can be seen in services for CSHCN today.
Scheuerman, Oded; Zilber, Eyal; Davidovits, Miriam; Chodick, Gabriel; Levy, Itzhak
This study investigated the under-researched area of annual influenza vaccination rates in children with chronic kidney disease and identified reasons for nonimmunisation. A prospective cross-sectional study was conducted in the nephrology clinic and dialysis unit of a tertiary paediatric medical centre from August to October 2011 and September to October 2012. Parents were asked to complete a questionnaire on their child's immunisation against influenza. Of the 217 children studied, 45.6% were vaccinated against influenza. The major reason for nonimmunisation was because the parents had not received the necessary information from the primary physician or treating nephrologist. The nonvaccinated children were significantly more likely to be less than two years old and female and to have parents who did not believe in the benefits of vaccination (p vaccinate their child, 38% claimed they would have done so if the vaccine had been offered in the nephrology clinic. Children with kidney disease had a higher annual influenza vaccination rate than the general population, but it was still suboptimal. Nephrologists should be alerted to the need to provide parents with information on influenza vaccinations and they should be available in nephrology clinics. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Nuno Henrique Franco
Full Text Available There is growing concern over the welfare of animals used in research, in particular when these animals develop pathology. The present study aims to identify the main sources of animal distress and to assess the possible implementation of refinement measures in experimental infection research, using mouse models of tuberculosis (TB as a case study. This choice is based on the historical relevance of mouse studies in understanding the disease and the present and long-standing impact of TB on a global scale. Literature published between 1997 and 2009 was analysed, focusing on the welfare impact on the animals used and the implementation of refinement measures to reduce this impact. In this 12-year period, we observed a rise in reports of ethical approval of experiments. The proportion of studies classified into the most severe category did however not change significantly over the studied period. Information on important research parameters, such as method for euthanasia or sex of the animals, were absent in a substantial number of papers. Overall, this study shows that progress has been made in the application of humane endpoints in TB research, but that a considerable potential for improvement remains.
Medical Oversight, Educational Core Content, and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators, Medical Directors, and Regulators Using a Delphi Approach.
Millin, Michael G; Johnson, David E; Schimelpfenig, Tod; Conover, Keith; Sholl, Matthew; Busko, Jonnathan; Alter, Rachael; Smith, Will; Symonds, Jennifer; Taillac, Peter; Hawkins, Seth C
A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers: Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with
Her, X.; Turner, S. P.; LaDue, N.; Bentley, A. P.; Petcovic, H. L.; Mogk, D. W.; Cartwright, T.
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.
Project #OA-FY17-0382, August 28, 2017. The EPA OIG plans to begin preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel to Oklahoma.
Malone, Roy W., Jr.
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.
Parker, Gretchen E
The treatment therapies and technologies currently emerging from the rapidly evolving health care industry must undergo full examination in a clinical setting if they are to be marketed to the public. All elements of clinical studies involving human subjects must undergo thorough IRB review before study activities can commence. Regulations regarding IRB oversight apply to all clinical studies-including retrospective examinations of private medical data and identifiable biological samples. It is not uncommon for researchers to be unsure whether, or on what level, IRB review and oversight are required for a particular project. Yet, if human subjects or their private medical data are utilized in a study, peer-reviewed journals will require relevant IRB approval information be provided as a requirement for publication. This article examines IRB processes and review types, offers insight into the IRB decision-making process, and emphasizes the importance of engaging an IRB consultant early in the clinical study design process.
Contracted services are an integral part of the design, construction and operation of a nuclear facility. Changes in the nuclear industry sector, including varied availability of nuclear expertise, the expansion of the international supply market and the introduction of new technologies, have tended to increase licensees' use of contracted services. These changes have created challenges for licensees and regulators related to the retention of nuclear expertise, the effective management of the interfaces between the licensees and contractors, and the oversight of contractor manufacturing quality in the context of greater multinational diversity. The regulatory body must address these challenges to provide assurance that the licensees maintain their responsibility for the safety of the facilities, regardless of who provides goods and services or where the activities involved in the supply chain take place. This report is intended to assist regulatory bodies in assessing their current practices for the regulatory oversight of licensees' use of contractors, and adapting them where necessary to meet the evolving situation
Moyé, Lemuel A; Sayre, Shelly L; Westbrook, Lynette; Jorgenson, Beth C; Handberg, Eileen; Anwaruddin, Saif; Wagner, Kristi A; Skarlatos, Sonia I
The Cardiovascular Cell Therapy Research Network (CCTRN), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), was established to develop, coordinate, and conduct multiple collaborative protocols testing the effects of cell therapy on cardiovascular diseases. The Network was born into a difficult political and ethical climate created by the recent removal of a dozen drugs from the US formulary and the temporary halting of 27 gene therapy trials due to safety concerns. This article describes the Network's challenges as it initiated three protocols in a polarized cultural atmosphere at a time when oversight bodies were positioning themselves for the tightest vigilance of promising new therapies. Effective strategies involving ongoing education, open communication, and relationship building with the oversight community are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.
Brawley Lawrence R
known to be determinants of self-efficacy. Overall, strong evidence to support definitive recommendations for optimal message content and structure was lacking. Conclusions Additional research testing the optimal content of messages used to supplement physical activity guidelines is needed. Tailored messages, gain-framed messages, and self-efficacy change messages hold promise as strategies for constructing physical activity messages and should be a focus of future research.
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...
Bock, Peter; Beyers, Nulda; Fidler, Sarah
Antiretroviral treatment (ART) is highly effective reducing mortality and AIDS-related morbidity in HIV-infected people and at preventing transmission of HIV between individuals. The article reviewed for this commentary reported on data from an Indian ART cohort that showed low median baseline CD4 counts and high rates of mortality and loss to follow-up. Programme implementers in developing regions need to balance the need for rapid scale-up and simultaneous improvement in clinical outcomes. Challenges outlined support HIV treatment strategies that combine improved HIV diagnosis, linkage to care and provision of ART with a strong community-based component. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: email@example.com.
Parker, Gretchen E
The treatment therapies and technologies currently emerging from the rapidly evolving health care industry must undergo full examination in a clinical setting if they are to be marketed to the public. All elements of clinical studies involving human subjects must undergo thorough IRB review before study activities can commence. Regulations regarding IRB oversight apply to all clinical studies?including retrospective examinations of private medical data and identifiable biological samples. It ...
Bannerman, Carl J.; Cannon, Doris E.; Jones, Gary L.; Ulrich, Timothy W.
Several major events that preceded the Secretary's decision to restructure DOE's management of its nuclear facilities were identified. The proposed restructuring plan, in concept, is designed to set in place an oversight framework, which will provide confidence in DOE's ability to operate its nuclear facilities in a safe manner. Further, on the basis of the previous work in this area as well as other independent studies, several issues were identified that may affect the success of the proposed restructuring plan
Dyson, Melissa C; Carpenter, Calvin B; Colby, Lesley A
Research with hazardous biologic materials (biohazards) is essential to the progress of medicine and science. The field of microbiology has rapidly advanced over the years, partially due to the development of new scientific methods such as recombinant DNA technology, synthetic biology, viral vectors, and the use of genetically modified animals. This research poses a potential risk to personnel as well as the public and the environment. Institutions must have appropriate oversight and take app...
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
to police misconduct towards ethnic minorities. Criminology professors Brad Smith and Malcolm Holmes discuss concerns about misconduct and...Brutality: An Examination of Civil Rights Criminal Complaints,” Criminology 41, no. 4 (2003): 1037– 1038. 13 Hryniewicz, “Civilian Oversight as a Public...minorities into the complaint process. As mentioned in the literature review, criminology professors Brad Smith and Malcolm Holmes voice concern that a
In preparation for this workshop, a survey was sent to members of the WGHOF in Autumn 2006. Purpose of the Survey was to explore and share the methods and approaches used to maintain oversight of licensee safety culture. 13 countries responded to the survey. The responses were used in the development of discussion topics and themes for this workshop. This presentation (slides) summarizes the results of the survey
USAID used the feedback loop to facilitate the U.S. response to two recent food quali complaints of corn- soya blend delivered to Haiti and Guatemala... soya blend to improve the standards and testing of domestically procured products. Based on information provided by USAID and USDA, and our own
Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos
To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and
Darjoto, S.W.; Martono, A.; Michel, J.
The World Federation of Engineering Organizations - WFEO - through the work of its Committee on Engineering Information, aims at improving the efficiency of engineers and particularly at developing new attitudes and practices concerning the specialized information mastering. One important part of the WFEO/CEI programme of activities during the last years and for the next years was and is devoted to a better understanding of the information needs of engineers. But also, it seems now essential to WFEO/CEI to better evaluate information services in order to correctly adapt them to the identified needs of engineers. The following communication will emphasize these two main and related perspectives: identifying the information needs of engineers; developing Value Analysis approaches for engineering information services. (author). 3 refs
Foerster, Christopher R; Tavares, Walter; Virkkunen, Ilkka; Kämäräinen, Antti
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.
Sea Systems issue guidance to contracting officers to obtain a quality assurance surveillance plan for all service contracts, and ensure that the...prepare a quality assurance surveillance plan (QASP) for service contracts in order to facilitate assessment of contractor performance.12 Furthermore...that the contracting activities received and paid for goods or services that did not meet contract performance standards. At the time of the audit
.... The current level of airline safety has been achieved, in part, because the airline industry and government regulatory agencies have implemented rigorous pilot training and evaluation programs...
GAO-12-471SU (Washington, D.C.: Apr. 20, 2012). Examples of biometric information include fingerprints , iris scans, and facial photographs. Letter...armor to respond to active shooters. Officials at Joint Base San Antonio also told us that they had procured upgrades on locks and doors for...should be closed as implemented or remain open as an effort in continued progress. However, we found that DOD was not monitoring implementation of the
defense power sources industry in DOD investments in power source S&T, we met with representatives of Saft America Inc. ( Saft ), Advanced Thermal Batteries...and EaglePicher Technologies, LLC (EaglePicher). According to the companies, Saft and Page 33 GAO-11-113 Defense Acquisitions Appendix I...Air-to-Surface Standoff Missile, Navstar Global Positioning System (GPS) GPS III, and Advanced Extremely High Frequency satellites program offices
Of the 169 accidents that involved the major airlines and that were : investigated and reported on in detail by the National Transportation : Safety Board from 1983 through 1995, about 30 percent were caused in : part by the pilots performance, ac...
Marchant, Gary E.; White, Andrew
As governments around the world begin to implement regulations aimed at controlling nanotechnology, those regulations should be based upon the best available science, applied as consistently as possible within jurisdictions and, to the extent feasible, across jurisdictions. These goals would be easier to achieve with the creation of an international nanoscience advisory board. Such a body could be modeled on similar international scientific advisory bodies for other issues, such as the Intergovernmental Panel on Climate Change (IPCC) and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Such a body should also take into account lessons learned from these similar organizations. An international nanoscience advisory board could assist regulatory bodies by providing a central source of accurate scientific information about the risks and benefits of nanotechnology, including relevant uncertainties, rather than having each regulatory body make these determinations independently. An international nanoscience advisory board could facilitate harmonization within and between jurisdictions by involving the top experts in the field to produce a centralized knowledge base for regulatory decisions. While an international nanoscience advisory board presents many potential benefits, it also faces significant difficulties, which are best illustrated by examining the history and challenges of existing international science advisory bodies.
Uckert, G.; Hafner, J.; Graef, F.; Hoffmann, H.; Kimaro, A.; Sererya, O.; Sieber, S.
Enhancing food security is one of the main goals of subsistence farmers in Sub-Saharan Africa. This study investigates the implementation of improved loam-made cooking stoves and its contribution to coping and livelihood strategies. Controlled combustion, air as well as smoke flue, and heat insulation facilitate the more efficient fuel consumption of improved cooking stoves compared to traditional stoves—namely three stone fires. Although the majority of small-scale farmers in Sub-Saharan Africa rely on the free public good of firewood, the increasing time needed for collecting firewood implies high opportunity costs for productive members of the family. The primary outcomes for users of improved stoves are reduced fuel consumption, greater safety, saved time, and reduced smoke in the kitchen. The paper illustrates part of the output, outcome, and impact of a participatory action research approach for implementing improved cooking stoves. Special emphasis was put on enabling the villagers to construct their stoves without external support, hence having locally manufactured stoves made of mud, bricks, and dried grass. The impact pathway of improved cooking stoves followed the training-of-trainers concept, where members of the initially established farmer groups were trained to construct stoves on their own. Special focus was given to knowledge exchange and knowledge transfer in order to increase firewood efficiency and overall satisfaction of users of improved cook stoves. Encouraging the members to further adapt the stoves enabled them to scale-up the construction of improved cooked stoves into a business model and increase dissemination while creating income. Although many important benefits, like time and knowledge gain, were identified by the farmers after adoption of the new technology, we found adoption rates differed significantly between regions.
Many small dams around the world are poorly maintained and represent a safety hazard, according to Pisaniello et al. Better oversight of small dams is needed, the authors argue. The researchers reviewed literature, conducted case studies in four states in Australia, and developed policy benchmarks and best practices for small-dam management. Small dams, often just several meters high and typically privately owned by individual farmers, have historically caused major damage when they fail. For instance, in China in 1975, 230,000 people died when two large dams failed because of the cumulative failure of 60 smaller upstream dams. In the United States, in 1977 the 8-meter-high Kelly Barnes Lake dam failed, killing 39 people. Many other small-dam failures around the world have resulted in casualties and severe ecological and economic damage.
Luzzi, Valeria; Ierardo, Gaetano; Corridore, Denise; Di Carlo, Gabriele; Di Giorgio, Gianni; Leonardi, Emanuele; Campus, Guglielmo-Giuseppe; Vozza, Iole; Polimeni, Antonella; Bossù, Maurizio
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. 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. 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. 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.
Blanchette, M.; Kenney, J.; Zelmer, B.
'Full text:' The management of radioactive waste is one of the most serious environmental problems facing Canadians. From the early industrial uses of radioactive material in the 1930s to the development of nuclear power reactors and the medical and experimental use of radio-isotopes today, there has been a steady accumulation of waste products. Historic waste is low-level radioactive waste for which the federal government has accepted responsibility for long-term management. This paper will outline the policy framework used to govern institutional and financial arrangements for the disposal of radioactive waste by waste producers and owners and the major radioactive projects in which the Government of Canada is currently involved. It will provide an overview of the organizations established for the management of historic radioactive waste and NRCan's oversight role. Finally, an overview of the historic waste program activities managed on behalf of the federal government through these organizations in the Port Hope area, the Greater Toronto Area, in Fort McMurray, Alberta and along the Northern Transportation Route is provided. Canada's Policy Framework for Radioactive Waste, sets out principles that govern the institutional and financial arrangements for disposal of radioactive waste by waste producers and owners. According to the Policy Framework: The federal government will ensure that radioactive waste disposal is carried out in a safe, environmentally sound, comprehensive, cost-effective and integrated manner; The federal government has the responsibility to develop policy, to regulate, and to oversee producers and owners; and, The waste producers and owners are responsible, in accordance with the principle of 'polluter pays', for the funding, organization, management and operation of disposal and other facilities required for their wastes. Arrangements may be different for nuclear fuel waste, low-level radioactive waste and
KOJURI, JAVAD; AMINI, MITRA; KARIMIAN, ZAHRA; DEHGHANI, MOHAMMAD REZA; SABER, MAHBOOBEH; BAZRAFCAN, LEILA; EBRAHIMI, SEDIGHEH; REZAEE, RITA
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
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
Kojuri, Javad; Amini, Mitra; Karimian, Zahra; Dehghani, Mohammad Reza; Saber, Mahboobeh; Bazrafcan, Leila; Ebrahimi, Sedigheh; Rezaee, Rita
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. 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). 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. Our faculty development program have a significant positive effect on medical university teaching staff members
Lee, Li-Chin; Tsai, Alan C; Wang, Jiun-Yi; Hurng, Baai-Shyun; Hsu, Hui-Chuan; Tsai, Hsin-Jen
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 pintervention did not significantly improve hematocrit, hemoglobin or lymphocyte count status. Results suggest
Carlton, Erik L; Singh, Simone Rauscher
To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health. We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health. The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives. Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.
SECURITY ADMINISTRATION’S FOUR MAJOR SECURITY PROGRAMS FOR MASS TRANSIT—HOW THEY CAN BE IMPROVED TO ADDRESS THE NEEDS OF TIER II MASS TRANSIT...Transportation Security Administration’s Four Major Security Programs for Mass Transit—How They Can Be Improved To Address the Needs of Tier II Mass Transit...TRANSIT—HOW THEY CAN BE IMPROVED TO ADDRESS THE NEEDS OF TIER II MASS TRANSIT AGENCIES John P. Joyce Chief, Transit Police Chief of Greater
Report #17-P-0326, July 18, 2017. The EPA is taking action to improve oversight tools used to determine whether public water systems are monitoring and reporting drinking water quality in accordance with the Safe Drinking Water Act.
Lazarchik, David A; Haywood, Van B
Plaque accumulation and resulting caries or periodontal disease is a frequent problem in patients with special-care needs. Tray-applied 10 percent carbamide peroxide (CP) is a tooth-bleaching agent that has positive effects on plaque, gingival health and caries. The authors review the antibacterial properties of CP and the effects of CP on saliva, plaque, caries and gingival health. They also review tray fabrication options and techniques, application methods, safety and side effects. Finally, they address the challenges involved in and research needed regarding use of tray-applied CP materials in special-care patients. In their literature review and clinical experience, the authors found 10 percent CP delivered in a custom-fitted tray to be an effective treatment for caries in patients with compromised oral hygiene. Plaque suppression and caries control result from a CP-induced increase in salivary and plaque pH caused by CP's urea component, and from possible antimicrobial action via physical debridement and the direct chemical effect of hydrogen peroxide. Tray-applied 10 percent CP may hold great promise for improving the oral health of many special-care patients, including elderly patients, patients with cancer and patients with dry mouth. Further research is needed to verify the potential benefits, specifics of treatment times and protocols and most cost-effective products for use in various patient groups. Application of 10 percent CP in a custom-fitted tray may reduce caries by elevating the pH above the level at which the caries process can occur, in addition to debriding the teeth and improving gingival health.
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.
This paper has as its objective the generation of a debate over different alternatives of models of oversight and monitoring of fundamental rights of people suffering mental disorder. The Consent and Capacity Board of the province of Ontario, Canada will be considered. The Board is one of the oldest and leading administrative tribunals in the area of mental health. The paper will analyse the place of the Board in the Canadian legal system and the fundamental distinctions with similar Canadian mental health tribunals. The Board's administrative structure and jurisdiction will be examined, as well as its procedures and mechanisms of review of its decisions.
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.
key milestone dates. These status reports should describe the risks and potential consequences of: (1) failing to satisfy outstanding ERP ...planning, mitigation, and remediation, the department manages risk as part of acquisition oversight for each of the ERP systems. GAO Status: We...consider this recommendation partially met because DOD still needs to include risks and potential consequences of failing to satisfy outstanding ERP
recent DOD and military service investigations have revealed misconduct related to, among other things, sexual behavior, bribery , and cheating...scrutiny. These investigations have revealed misconduct related to, among other things, sexual behavior, bribery , travel, use of government funds, and
The Cheyenne Mountain Operations Center houses numerous complex computer systems for tracking air, missile, and space events that could threaten homeland security or undermine military operations in theater...
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...an onset in adolescence or early adulthood, and leads to distress or impairment. 4 The National Defense Authorization Act (NDAA) for Fiscal Year 2014
logic, and reprocessing claims of all prior years. Currently, the focus is on FY 13 claims. Staffing shortages and furlough will significantly impact...deleted for straight K61 beneficiaries (straight K61 beneficiaries are VA beneficiaries) and reprocess valid claims. VAPIHCS indicated that it will...Benefit* Amount of Benefit Account 3 Economy and Efficiency. VAPIHCS reimbursement for healthcare services rendered by TAMC to VAPIHCS patients
Solis, William M; Coffey, Carole; Baker, Sarah; Brown, Renee; Cantin, Janine; La Due Lake, Ronald; Lenane, Katherine; Sawyer, Jr, Connie W
.... Contractors at Camp Arifjan refurbish and repair a variety of military vehicles such as the Bradley Fighting Vehicle, armored personnel carriers and the High-Mobility, Multi-Purpose Wheeled Vehicle (HMMWV...
of passage can instill esprit de corps and loyalty and are included in many traditions throughout DOD and the Coast Guard. However, at times these...policies also contain guidance, such as responsibilities for policy implementation and direction on avoiding hazing in service customs and traditions...of passage can be effective tools to instill esprit de corps and loyalty among servicemembers and are included in many traditions throughout the
Forster, Alan J; Turnbull, Jeff; McGuire, Shaun; Ho, Michael L; Worthington, JR
Abstract The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; ...
Lee, Li-Chin; Tsai, Alan C; Wang, Jiun-Yi
Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance. This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. A 24-week randomized, double-blind, controlled trial. A privately managed geriatric nursing home in Taiwan. Ninety-two persons who were ≥65 years old, ≤25 kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2). The supplement contained 9.5 g protein, 250 kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all pintervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an
Kuzma, Jennifer; Roberts, John Patrick
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.
Kuzma, Jennifer; Roberts, John Patrick
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.
Welner, Michael; Davey, Emily E; Bernstein, Adam
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. © 2014 American Academy of Forensic Sciences.
The Belgian Regulatory Body has implemented a Safety Culture oversight process since 2010. In a nutshell, this process is based on field observations provided by inspectors or safety analysts during any contact with a licencee (inspections, meetings, phone calls, etc). These observations are recorded within an observation (excel) sheet—aiming at describing factual and contextual issues — and are linked to IAEA Safety Culture attributes. It should be stressed that the purpose of the process is not to give a comprehensive view of a licencee safety culture but to address findings that require attention or action on the part of a licencee. In other words, gathering safety culture observations aims at identifying cultural, organizational or behavioural issues in order to feed a regulatory response to potential problems. Safety Culture Observations (SCO) are then fully integrated in routine inspection activities and must be seen as an input of the overall oversight process. As a result, the assessment of the SCO is inserted within the yearly safety evaluation report performed by Bel V and transmitted to the licencee. However, observing safety culture is not a natural approach for engineers. Guidance, training and coaching must be provided in order to open up safety dimensions to be captured. In other words, a SCO process requires a continuous support in order to promote a holistic and systemic view of safety.
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.
This document presents the most complete analysis of the use of the words control, oversight, etc. as used in NEA, IAEA and ICRP literature connected to radioactive waste disposal. It reveals the many different ways the same word, 'control', has been used in international guidance and ambiguities than can arise, especially so for the post-closure phase of the repository. The newly introduced ICRP terminology, namely the use of the words 'oversight' and 'built-in controls', represents a step forward in terminology and resolves the ambiguity
The author first discusses the various concepts and definitions associated with energy needs, and then the difference between actual needs and energy needs by distinguishing personal needs, needs of the productive sector, energetic needs and services. In the next part, he discusses how energy needs are assessed. He discusses the relationship between energy needs and energy consumption, how energy consumptions can be analysed and interpreted. He comments how energy needs can be assessed and analysed in time and in space. He notices and explains why economy and climate are the main causes of spatial differences for energy needs per habitant, and comments the evolution of energy consumption over long periods
The medium term was introduced as the period of indirect oversight after repository closure, with timescales in the order of a few hundred years. While the importance of intrinsic control or 'passive' safety features in the post-closure phase of a geological repository has been recognised and stressed before, the role of oversight, by providing the capability to reduce or avoid some exposures, has come to the fore only recently. Oversight for the time being generally refers to 'watchful care' and society 'keeping an eye' on the technical system and the actual implementation of plans and decisions. In some regulatory frameworks oversight is indirectly required, for instance when mandating the creation of a land exclusion zone. In other frameworks, oversight is directly required, as illustrated, for instance, by the long-term stewardship concept of the US Environmental Protection Agency. Although sheer memory of the presence of the facility cannot be enough to constitute oversight, oversight and RK and M preservation do go hand in hand. For example, monitoring after repository closure fosters RK and M preservation, and vice versa. The presenter focused on terminology, potential oversight measures, and on roles and responsibilities of different stakeholders
Velonis, Alisa J; Molnar, Agnes; Lee-Foon, Nakia; Rahim, Ashnoor; Boushel, Mary; O'Campo, Patricia
This paper presents the findings of a rapid needs assessment conducted at the request of the local health authority responsible for health care services, the Toronto Central Local Health Integration Network (Ontario, Canada), to inform health and social service planning. We utilized concept mapping methodology to facilitate engagement with diverse stakeholders-more than 300 community members and service providers-with a focus on hard to reach populations. Key informant interviews with service providers were used to augment findings. Participants identified 48 unique services or service approaches they believed would improve the health of residents in the area, including those addressing health care, mental health and addictions, youth, families, people experiencing homelessness, seniors, general social services, and services targeting specific populations. While service providers consistently identified a critical need for mental health and addiction services, community members placed greater importance on the social determinants of health including access to housing, job placement supports and training and service accessibility. Both groups agreed that services and programs for seniors and people experiencing homelessness would be highly important. Our study provides a unique example of using concept mapping as a tool to aid a rapid service gap analysis and community engagement in a metropolitan area. The findings also reinforce the importance of working cross-sectorally, using a Health in All Policies approach when planning services for underserved populations.
Ci, Zhijia; Zhang, Xiaoshan; Wang, Zhangwei
The current understanding of the global mercury (Hg) cycle remains uncertain because Hg behavior in the environment is very complicated. The special property of Hg causes the atmosphere to be the most important medium for worldwide dispersion and transformation. The source and fate of atmospheric Hg and its interaction with the surface environment are the essential topics in the global Hg cycle. Recent declining measurement trends of Hg in the atmosphere are in apparent conflict with the increasing trends in global anthropogenic Hg emissions. As the single largest country contributor of anthropogenic Hg emission, China's role in the global Hg cycle will become more and more important in the context of the decreasing man-made Hg emission from developed regions. However, much less Hg information in China is available. As a global pollutant which undergoes long-range transport and is persistence in the environment, increasing Hg knowledge in China could not only promote the Hg regulation in this country but also improve the understanding of the fundamental of the global Hg cycle and further push the abatement of this toxin on a global scale. Then the atmospheric Hg research in China may be a breakthrough for improving the current understanding of the global Hg cycle. However, due to the complex behavior of Hg in the atmosphere, a deeper understanding of the atmospheric Hg cycle in China needs greater cooperation across fields.
Birch, Laura; Perry, Rachel; Penfold, Chris; Beynon, Rhona; Hamilton-Shield, Julian
Childhood obesity is one of the most serious, global, public health challenges and has adverse health consequences in both the short-and long-term. The purpose of this study is to establish the change in body mass index (BMI) needed to achieve improvements in metabolic health status in obese children and adolescents attending lifestyle treatment interventions. The following electronic databases will be searched from their inception: AMED, Embase, MEDLINE via OVID, Web of Science and CENTRAL via Cochrane library. Randomised controlled trials (RCTs) or cohort studies of lifestyle interventions (i.e. dietary, physical activity and/or behavioural therapy) for treating obesity in children and adolescents (4-18 years) will be included. Interventions that last less than 2 weeks and trials that include overweight participants or those with a secondary or syndromic cause of obesity will not be included. No language restrictions will be applied. Titles and abstracts will be assessed for eligibility by two reviewers, and data from full-text articles will be extracted using a standardised data extraction template. Reference lists of all included articles will be hand-searched for additional publications. A narrative synthesis of the findings will be presented, and meta-analysis will be conducted if considered appropriate. This will be the first systematic review of studies to establish the change in BMI required to improve metabolic health status in obese children and adolescents. PROSPERO CRD42016025317.
The article explores in how far financial accessibility of healthcare (FAH) is restricted for low-income groups and identifies social protection policies that can supplement health policies in guaranteeing universal access to healthcare. The article is aimed to advance the literature on comparative European social epidemiology by focussing on income-related barriers of healthcare take-up. The research is carried out on the basis of multi-level cross-sectional analyses using 2012 EU-SILC data for 30 European countries. The social policy data stems from EU-SILC beneficiary information. It is argued that unmet medical needs are a reality for many individuals within Europe - not only due to direct user fees but also due to indirect costs such as waiting time, travel costs, time not spent working. Moreover, low FAH affects not only the lowest income quintile but also the lower middle income class. The study observes that social allowance increases the purchasing power of both household types, thereby helping them to overcome financial barriers to healthcare uptake. Alongside healthcare system reform aimed at improving the pro-poor availability of healthcare facilities and financing, policies directed at improving FAH should aim at providing a minimum income base to the low-income quintile. Moreover, categorical policies should address households exposed to debt which form the key vulnerable group within the low-income classes.
German, J Bruce
Lactation biology, microbial selection, and human diversity are central themes that could guide investment in scientific research, industrial innovation, and regulatory policy oversight to propel yogurt into the central role for health-promoting food products. The ability of yogurt to provide the nourishing properties of milk together with the live microorganisms from fermentation provides a unique combination of food assets. Academic research must now define the various targets on which these biological assets act to improve health and develop the metrics that can quantitatively document their benefits. The food industry must reconcile that yogurt and its microorganisms cannot be expected to provide measurable benefits for all consumers, at all doses, and at all times. A supportive regulatory oversight must demand safety and yet encourage innovations that support a value proposition for yogurt in health. Health valuation in the marketplace will be driven by parallel innovations, including accurate assessment technologies, validated microbial ingredients, and health-aware consumers. PMID:24695899
Yee, Kwang Chien
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.
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
Worland, S. C.
through improved data collection, more efficient databases, and the development of deterministic and probabilistic models. Water-use data and research needs significantly more attention at the national level if we are to meet the water availability needs of society in the coming decades.
Report #15-P-0204, July 16, 2015. Enhanced EPA oversight of the permitting process for diesel fuel use during hydraulic fracturing can further EPA efforts to protect water resources, and establishment of a plan for determining whether to propose a chemical
... 200N, Rockville, MD 20852-1448; or the Office of Communication, Education and Radiation Programs... describes a modern, risk-based approach to monitoring that focuses on critical study parameters and relies... appropriate, and other forms of information technology. Title: Draft Guidance for Industry: Oversight of...
Nielsen, Kent; Hansen, Claus D.; Bloksgaard, Lotte
Background Although men have a higher risk of occupational injuries than women the role of masculinity for organizational safety outcomes has only rarely been the object of research. Aim The current study investigated the association between masculinity and safety oversights, safety priority and ...
A. Naudé Fourie (Andria)
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
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
Carli Buttenschoen, Daniela; Stephan, Jarad; Watanabe, Sharon; Nekolaichuk, Cheryl
The ESAS is a clinical symptom assessment tool developed for patients receiving palliative care for pain and symptom control. Recent studies have indicated that patients have difficulty understanding terminology and correct use of the ESAS, and that they appreciate the presence of a health care provider (HCP) to assist with ESAS completion. As appropriate assessment translates into effective treatment, it is important that HCPs have a good understanding of the tool. The purpose of this study was to assess HCPs' use, knowledge, and training needs of the ESAS. One hundred ninety-three HCPs in palliative care and chronic pain, who used the ESAS, were invited to participate in a survey. The response rate was 43 % (n = 83), with 62 % nurses, 26 % physicians, and 12 % other specialties. Most participants were palliative care specialists (79 %). The majority (77 %) had a good understanding of the ESAS terms. Knowledge problems included distinguishing tiredness and drowsiness (25 %), interpreting shortness of breath as a combination of subjective and objective symptoms (19 %), not indicating current symptom level (14 %), and reverse scoring of well-being (13 %) and appetite (9 %). Reported challenges were misinterpretation of some ESAS terms, assessing patients with impaired communication, and lack of time and reliability of caregiver assessments. Participants offered suggestions regarding how their knowledge and use of the ESAS could be improved. Suggestions for improving ESAS administration and training were to include term definitions and examples of how to ask about terms that might be challenging for patients. Furthermore, initial and ongoing training sessions might help to clarify issues with the tool.
The Hungarian Atomic Energy Authority (HAEA) has full regulatory competence; its mission is to oversee the safety and security of all the peaceful applications of atomic energy. All the radioactive sources having activity above the exemption level is registered and licensed both from safety and security points of view. The Hungarian central register of radioactive sources contains about 7,000 radioactive sources and 450 license holders. In order to use its limited resources the HAEA has decided to introduce an integrated regulatory oversight programme. Accordingly, during the licensing process and inspection activities the HAEA intends to assess both safety and security aspects at the same time. The article describes the Hungarian the various applications of radioactive materials, and summarizes the preparation activities of the HAEA. (author)
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.
Dawodu, Adekunle; Zalla, Lauren; Woo, Jessica G; Herbers, Patricia M; Davidson, Barbara S; Heubi, James E; Morrow, Ardythe L
Although exclusively breastfed infants are at increased risk of vitamin D (vit D) deficiency if vit D supplementation is lacking and sun exposure is limited, assessment of both risk factors in the first year of life is lacking. We evaluated the contribution of vit D intake and sunlight exposure to vit D status in 120 healthy, breastfeeding mother-infant dyads, who were followed up for 1 year. Vitamin D intake and skin sunlight exposure were evaluated using questionnaires. Serum 25-hydroxyvitamin D, parathyroid hormone (PTH) and alkaline phosphatase levels were determined post-natally in mothers at 4 weeks and in infants at 4, 26 and 52 weeks. Vitamin D supplementation was low (L(-1)) and 49% were insufficient (50-L(-1)), while 18% of infants were severely vit D deficient (L(-1)) and 77% were deficient (L(-1)). At 26 weeks, winter/spring birth season and shorter duration of months of exclusive breastfeeding were protective of vit D deficiency in infants. Vitamin D deficiency in infants decreased to 12% at 52 weeks with sunlight exposure. Serum PTH levels were significantly higher in severely vit D deficient than sufficient infants. Vitamin D deficiency was widespread in early post-partum breastfeeding mothers and infants, and declined to one in eight infants at 52 weeks due mostly to sunshine exposure. When sunlight exposure is limited or restricted, intensified vit D supplementation of breastfeeding mothers and infants is needed to improve vit D status. © 2012 John Wiley & Sons Ltd.
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
Singh, Hardeep; Classen, David C; Sittig, Dean F
Electronic health records (EHRs) have potential quality and safety benefits. However, reports of EHR-related safety hazards are now emerging. The Office of the National Coordinator for Health Information Technology recently sponsored an Institute of Medicine committee to evaluate how health information technology use affects patient safety. In this article, we propose the creation of a national EHR oversight program to provide dedicated surveillance of EHR-related safety hazards and to promote learning from identified errors, close calls, and adverse events. The program calls for data gathering, investigation/analysis, and regulatory components. The first 2 functions will depend on institution-level EHR safety committees that will investigate all known EHR-related adverse events and near-misses and report them nationally using standardized methods. These committees should also perform routine safety self-assessments to proactively identify new risks. Nationally, we propose the long-term creation of a centralized, nonpartisan board with an appropriate legal and regulatory infrastructure to ensure the safety of EHRs. We discuss the rationale of the proposed oversight program and its potential organizational components and functions. These include mechanisms for robust data collection and analyses of all safety concerns using multiple methods that extend beyond reporting, multidisciplinary investigation of selected high-risk safety events, and enhanced coordination with other national agencies to facilitate broad dissemination of hazards information. Implementation of this proposed infrastructure can facilitate identification of EHR-related adverse events and errors and potentially create a safer and more effective EHR-based health care delivery system.
Mark L. Zeidel
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
Zeidel, Mark L
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 systematic quality
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.
checklist item. Conclusion The reporting quality of abstracts of RCTs published in these four TCM journals needs to be improved. Since none of the four journals adopted CONSORT for Abstracts, we hope that the introduction and adoption of CONSORT for Abstracts by TCM journals will lead to an improvement in reporting quality. PMID:20615225
Alain K. Koffi
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.
Wang, Ling; Li, Yulin; Li, Jing; Zhang, Mingming; Xu, Lin; Yuan, Wenming; Wang, Gang; Hopewell, Sally
quality of abstracts of RCTs published in these four TCM journals needs to be improved. Since none of the four journals adopted CONSORT for Abstracts, we hope that the introduction and adoption of CONSORT for Abstracts by TCM journals will lead to an improvement in reporting quality.
individual checklist item. Conclusion The reporting quality of abstracts of RCTs published in these four TCM journals needs to be improved. Since none of the four journals adopted CONSORT for Abstracts, we hope that the introduction and adoption of CONSORT for Abstracts by TCM journals will lead to an improvement in reporting quality.
Tozer, Mark; Collins, Dave; Hathaway, Tanya
Allison and Von Wald (2010) highlight the substantial opportunities presented by expeditions to address the crucial topic of personal and social development. The present paper wishes to address the apparent oversight of transfer within such learning experiences. Issues that need to be addressed if the impact of transfer is to be optimised are…
Full Text Available The study aims at exploring the needs of a broad group of stakeholders of Malaysian public universities with respect to information items that should be disclosed in the university annual report, and their views on the disclosure importance of the items. This is a preliminary study towards the effort to develop an accountability reporting framework for Malaysian public universities. A questionnaire survey on the universities‟ stakeholders representing each stakeholder group which include policy makers, students, parents, employers, the public, university management and employees, suppliers and oversight entities was carried out in order to identify and confirm the stakeholders‟ disclosure needs. It is expected that the needs of the stakeholders in terms of information to be reported are comprehensive which include financial and non-financial information; and there are differences in the views on the disclosure importance of information among the stakeholder groups. The findings of this study provide a clear understanding of the information that should be disclosed in the annual reports of Malaysian public universities for accountability purpose. The findings may potentially assist the public universities to improve the way they discharge their public accountability through annual reporting.
Zhu, Ming; Moorer, Richard
This paper discusses the needs for risk informing decision making by the U.S. Department of Energy (DOE) Office of Environmental Management (EM). The mission of the DOE EM is to complete the safe cleanup of the environmental legacy brought about from the nation's five decades of nuclear weapons development and production and nuclear energy research. This work represents some of the most technically challenging and complex cleanup efforts in the world and is projected to require the investment of billions of dollars and several decades to complete. Quantitative assessments of health and environmental risks play an important role in work prioritization and cleanup decisions of these challenging environmental cleanup and closure projects. The risk assessments often involve evaluation of performance of integrated engineered barriers and natural systems over a period of hundreds to thousands of years, when subject to complex geo-environmental transformation processes resulting from remediation and disposal actions. The requirement of resource investments for the cleanup efforts and the associated technical challenges have subjected the EM program to continuous scrutiny by oversight entities. Recent DOE reviews recommended application of a risk-informed approach throughout the EM complex for improved targeting of resources. The idea behind this recommendation is that by using risk-informed approaches to prioritize work scope, the available resources can be best utilized to reduce environmental and health risks across the EM complex, while maintaining the momentum of the overall EM cleanup program at a sustainable level. In response to these recommendations, EM is re-examining its work portfolio and key decision making with risk insights for the major sites. This paper summarizes the review findings and recommendations from the DOE internal reviews, discusses the needs for risk informing the EM portfolio and makes an attempt to identify topics for R and D in integrated
Gautam, Chetanath; Alford, Betty J.; Khanal, Manju
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…
Haakma, Ineke; Janssen, Marleen; Minnaert, Alexander
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 deafblindness by enhancing teachers' need-supportive…
Project #OA-FY17-0382, October 6, 2017 - The EPA OIG plans to expand the scope of preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel.
In October of 1990, the New Mexico Environment Department entered into an agreement with the US Department of Energy (DOE) to create the Department of Energy Oversight and Monitoring Program. This program is designed to create an avenue for the State to ensure DOE facilities are in compliance with applicable environmental regulations, to allow the State oversight and monitoring independent of the DOE, to allow the State valuable input into remediation decision making, and to protect the environment and the public health and safety of New Mexicans concerning DOE facility activities. This agreement, called the Agreement in Principle (AIP), includes all four of New Mexico's DOE facilities: Los Alamos National Laboratory in Los Alamos; Sandia National Laboratories and the Inhalation Toxicology Research Institute on Kirtland Air Force Base in Albuquerque; and the Waste Isolation Pilot Plant near Carlsbad
On October 22, 1990 an agreement was entered into between the US DOE and the State of New Mexico. The agreement was designed to assure the citizens of New Mexico that the environment is protected and that public health, as related to the environment is also protected. The Agreement reflects the understanding and commitments between the parties regarding environmental oversight, monitoring, remediation and emergency response at the following DOE facilities: the Inhalation Toxicology Research Institute (ITRI); Los Alamos National Laboratory (LANL); Sandia National Laboratory (SNL); and the Waste Isolation Pilot Plant (WIPP). These provision are ongoing through a vigorous program of independent monitoring and oversight; prioritization of clean-up and compliance activities; and new commitments by DOE. While the initial assessment of the quality and effectiveness of the facilities' environmental monitoring and surveillance programs is not yet complete, preliminary findings are presented regarding air quality monitoring, environmental monitoring, and groundwater monitoring
Farrell, Brenda S; Moser, David; Beale, Rebecca; Cantin, Janine; Harms, Nicole; Richardson, Terry; Weissman, Cheryl; Young, Matthew
Military physicians and other health care professionals are needed to support operational forces during war or other military conflicts and to maintain the wellbeing of the forces during nonoperational periods...
The purpose of this document is to identify and describe the duties and responsibilities of Facility Security and Safeguards (FSS) Safeguards and Security (SS) organizations (groups/offices) with oversight functions over the Protection Force (PF) subcontractor. Responsible organizations will continue their present PF oversight functions under the Cost Plus Award Fee (CPAF) assessment, but now will be required to also coordinate, integrate, and interface with other FSS S and S organizations and with the PF subcontractor to measure performance, assess Department of Energy (DOE) compliance, reduce costs, and minimize duplication of effort. The role of the PF subcontractor is to provide the Laboratory with effective and efficient protective force services. PF services include providing protection for the special nuclear material, government property and classified or sensitive information developed and/or consigned to the Laboratory, as well as protection for personnel who work or participate in laboratory activities. FSS S and S oversight of both performance and compliance standards/metrics is essential for these PF objectives to be met
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
Tataris, Katie; Mercer, Mary; Brown, John
Since 2009, the seminal text in emergency medical services (EMS) medicine has been used to guide the academic development of the new subspecialty but direct application of the material into EMS oversight has not been previously described. The EMS/Disaster Medicine fellowship program at our institution scheduled a monthly meeting to systematically review the text and develop a study guide to assist the fellow and affiliated faculty in preparation for the board examination. In addition to the summary of chapter content, the review included an assessment of areas from each chapter subject where our EMS system did not exhibit recommended characteristics. A matrix was developed in the form of a gap analysis to include specific recommendations based on each perceived gap. Initial review and completion dates for each identified gap enable tracking and a responsible party. This matrix assisted the fellow with development of projects for EMS system improvement in addition to focusing and prioritizing the work of other interested physicians working in the system. By discussing expert recommendations in the setting of an actual EMS system, the faculty can teach the fellow how to approach system improvements based on prior experiences and current stakeholders. This collaborative environment facilitates system-based practice and practice-based learning, aligning with ACGME core competencies. Our educational model has demonstrated the success of translating the text into action items for EMS systems. This model may be useful in other systems and could contribute to the development of EMS system standards nationwide.
Research needs were identified during working sessions for several potential separation options. These options include sequestering agents, solvent extraction, membranes, solid sorbents, novel approaches, organic separation and destruction methods, and radiation and chemical stability of separation materials
Muething, Stephen E; Goudie, Anthony; Schoettker, Pamela J; Donnelly, Lane F; Goodfriend, Martha A; Bracke, Tracey M; Brady, Patrick W; Wheeler, Derek S; Anderson, James M; Kotagal, Uma R
Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture. SSEs per 10000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions.
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.
Elliott, Kevin C., E-mail: firstname.lastname@example.org [University of South Carolina, Department of Philosophy, USC NanoCenter (United States); Volz, David C. [University of South Carolina, Department of Environmental Health Sciences, Arnold School of Public Health (United States)
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.
Elliott, Kevin C.; Volz, David C.
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.
Elliott, Kevin C.; Volz, David C.
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.
Taylor, Holly A; Pronovost, Peter J; Faden, Ruth R; Kass, Nancy E; Sugarman, Jeremy
Questions have been raised about whether and how health care quality improvement (QI) initiatives ought to be reviewed to address possible ethical issues associated with them. These questions have focused primarily on whether some QI initiatives meet the regulatory criteria for human subject research and should therefore be regulated and reviewed as such. Based on surveys of health care system professionals conducting QI initiatives and hospital CEOs, this issue brief finds that QI initiatives are routinely reviewed by a variety of internal mechanisms prior to implementation, although rarely through an institutional review board or another independent body charged specifically with ethical oversight of QI initiatives. Further research, the authors say, is needed to achieve a better understanding of how review mechanisms for QI initiatives are structured, including information on who reviews these activities, how they are reviewed, and whether such processes include an ethical assessment of the proposed QI initiative.
There seems to be a trend towards expecting energy conservation to be a panacea for the world's ills. In fact, a global perspective on energy needs shows that more, not less, energy is needed and technological innovation in energy sources is essential in order to meet the needs of more than just the developed countries. Energy-intensive technology is the amplification of our natural resources rather than their depletion. A fundamental bioethical principle must be established if we are to analyze and organize scientific evidence about hazards from currently feasible energy resources, and separate genuine from counterfeit claims to credibility. In particular, public fears about radiation hazards and radioactive waste disposal are influenced too much by rhetorical cleverness and forensic skills of a vociferous minority. Potential hazard management is ethically equitable only if it is proportioned to actual basic harm that can be identified and reduced by expenditures of human effort, time and money
Morrongiello, Barbara A; Sandomierski, Megan; Spence, Jeffrey R
The aim of this longitudinal study was to determine how children's participation in swim lessons impacts parents' appraisals of children's drowning risk and need for supervision. Parents with 2-5-year old children enrolled in community swim lessons completed the same survey measures up to 4 times over an 8-month period. Multilevel regression analyses examining temporal relationships between parents' perceptions of their child's swim ability, supervision needs around water, and children's ability to keep themselves safe in drowning risk situations revealed that as children progressed through swim lessons, parents' perceptions of their child's swim ability and their belief that children are capable of keeping themselves safe around water increased. Further, the relation between parents' perceptions of swim ability and judgments of children's supervision needs was mediated through parents' judgment about their child's ability to secure their own safety near water. As parents perceive their child to be accumulating swim skills, they increasingly believe that children are capable of keeping themselves from drowning, and as a result, that less active parent supervision of their child is necessary. Implications of these findings for intervention efforts to counter this unwelcome way of thinking that may arise through continued participation in swim lessons are discussed. Incorporating a parent-focused component into children's learn-to-swim programs to promote more realistic appraisals of children's supervision needs and drowning risks may further enhance the positive benefits that swim lessons have for children's safety.
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…
Haakma, Ineke; Janssen, Marleen; Minnaert, Alexander
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
Hexem, Kari R; Bosk, Abigail M; Feudtner, Chris
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. 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. 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. 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.
Ruhl, H.A.; Andre, M.; Beranzoli, L.; Çagatay, M.N.; Colaço, A.; Cannat, M.; Dañobeitia, J.J.; Favali, P.; Géli, L.; Gillooly, M.; Greinert, J.; Hall, P.O.J.; Huber, R.; Karstensen, J.; Lampitt, R.S.; Larkin, K.E.; Lykousis, V.; Mienert, J.; Miranda, J.M.; Person, R.; Priede, I.G.; Puillat, I.; Thomsen, L.; Waldmann, C.
Society's needs for a network of in situ ocean observing systems cross many areas of earth and marine science. Here we review the science themes that benefit from data supplied from ocean observatories. Understanding from existing studies is fragmented to the extent that it lacks the coherent
database. These included demographic data, physical examination results, Glasgow Coma Scale (GCS) scores, and interventions performed on the patients...in cardiology . Fourth, this study did not consider analyses for examining the discriminating power of the models for the outcome of LSI needs...operating characteristic curves were obtained to examine the discriminating power of multivariate logistic re- gression models (excluding GCS scores
Hexem Kari R
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.
Nelson, Melissa C.; Lytle, Leslie A.; Pasch, Keryn E.
Despite the need for effective obesity prevention strategies, little research is currently available to assess adolescents’ knowledge around basic concepts of energy intake, expenditure and balance. Using data from 349 adolescent-caregiver pairs (recruited from Minneapolis/St. Paul metro region, MN, 2006-2007), cross-sectional linear regression was used to assess adolescent and parental knowledge related to energy intake and expenditure as a predictor of adolescent weight-related behaviors an...
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.
Daykin, Anne; Selman, Lucy E.; Cramer, Helen; McCann, Sharon; Shorter, Gillian W.; Sydes, Matthew R.; Gamble, Carrol; Macefield, Rhiannon; Lane, J. Athene; Shaw, Alison
BackgroundThe oversight and conduct of a randomised controlled trial involves several stakeholders, including a Trial Steering Committee (TSC), Trial Management Group (TMG), Data Monitoring Committee (DMC), funder, and sponsor. We aimed to examine how the relationships between these stakeholders affect the trial oversight process and its rigour, to inform future revision of Good Clinical Practice guidelines.MethodsUsing an ethnographic study design, we observed the oversight processes of eigh...
Regulation on safety, environment and health in Japan has before today been intended to correspond with an accident at forms of reinforcement of national standards and monitoring, if any. However, as it was thought that such regulation reinforcement was afraid to bring some social rigidity, and to weaken independent responsibility, as a result, because of anxiety of losing peoples' merits inversely, some fundamental directivity such as respect of self-responsibility principle' and 'necessary and least limit of regulation' were selected as a part of political innovation. On the other hand, at a background of wide improvements on various indexing values showing operation results of nuclear power stations in U.S.A., private independent effort on upgrading of safety is told to largely affect at beginning of INPO (Institute of Nuclear Power Operations), without regulation reinforcement of NRC side. This is a proof of concrete effect of transfer to oversight-based safety regulation. Here were introduced on nuclear safety in U.S.A. at a base of some references obtained on entering the 'MIT summer specialist program. Nuclear system safety', on focussing at new safety regulation of NRC and its effect and so on, and adding some considerations based on some knowledge thereafter. (G.K.)
Long, Timothy R; Poe, John D; Zimmerman, Richard S; Rose, Steven H
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.
Antoy, Sergio; Johannsen, Jacob; Libby, Steven
We define a compilation scheme for a constructor-based strongly-sequential graph rewriting system which shortcuts some needed steps. The result of this compilation is another constructor-based graph rewriting system that is normalizing for the original system when using an innermost strategy. We...... then modify the resulting rewrite sytem in a way that avoids totally or partially the construction of the contracta of some needed steps of a computation. The resulting rewrite system can be easily implemented by eager functions in a variety of programming languages. When computing normal forms in this way...
Larijani, Houman Hadad; Guggisberg, Marika
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 the...
Lee, D. S.; Yoon, S. N.; Kim, K. B.; Jeong, Z. K.; Lee, M. C.; Ko, C. S.
Controversy still exists about how to use the uptake at rest and 24 hour delay in rest redistribution Tl-201 SPECT to predict improvement of wall motion abnormality after bypass surgery. To find the best way to combine diagnostic efficacy of Tl-201 SPECT to predict myocardial viability, we studied the predictive values (positive: PPV, negative: NPV) of rest and 24 hour-delay Tl-201 SPECT in 21 patients. Wall motion was assessed comparing preoperative post-stress gated Tc-99m-MIBI SPECT with that of 3 months after surgery. Four point scoring system was used for 17 myocardial segments to asses uptakes ( 0 to 3 for normal to defect) at rest and 24 hour-delay and wall motion ( 0 to 3 for normal to dyskinesia). Ejection fraction improved after surgery (5011% vs 4313%). Intra-observer and inter-observer reproducibility of EF was 7 and 9% respectively when we used 3D Perfusion-Motion Map. Sixty seven segments showed wall motion abnormality before surgery. Predictive values of rest Tl-201 uptake decrease were as follows: 0: 15/15(100%), 1: 30/34(88%), 2: 6/11 (55%), 3: 3/7(43%). So PPV of mild decrease was 88%, and NPV of severe decrease was 50%. Delayed reversibility was evaluated in 37 segments (15 patients). Twenty seven segment had persistence or aggravation, but the other 10 segments improved at 24 hour delay. PPV of reversible 10 segments was 80%, and NPV of reversibility was only 46%. PPV of combination of rest Tl-201 uptake of mild degree and 24 hour reversibility was 86% (38/44) and NPV of neither one was 88%. We concluded that both semi-quantitative degree of Tl-201 uptake at rest and reversibility at 24 hour delay was the best to warrant or abandon postoperative improvement of abnormal wall motion found at preoperative post-stress gated myocardial SPECT
Møller, Marie Østergaard
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...... 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...
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: email@example.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
Sandhu, Jag S; Anderson, Keith; Keen, Dave; Yassi, Annalee
A web-based questionnaire-survey was administered primarily to determine what information is useful to managers in Fraser Health, of British Columbia to support decision-making for workplace health and safety. The results indicated that managers prefer electronic quarterly reports, with targets, goals, and historical trends rated as "very important." Over 85.7% "agree" that if information was readily available in the "most beneficial" format, they would be able to improve workplace health. Recommendations include that managers be presented with clear and concise workplace health reports that facilitate analysis for decision-making.
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...
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
Erwin, J; Edwards, K; Woolf, A; Whitcombe, S; Kilty, S
The aim of the present study was to identify the competencies that patients think non-specialist community-based nurses and allied health professionals (AHPs) need to enable them to assess, care for and manage arthritis appropriately. Four face-to-face focus groups were held with a total of 16 women and nine men with arthritis, to discuss the care they received from community-based health professionals, the skills and knowledge they expected from community-based health professionals and what they prioritized. People with arthritis wanted health providers to have an understanding of the difference between inflammatory arthritis (IA) and osteoarthritis (OA), of how serious OA can be, and of the unpredictability of IA and flares. They emphasized the need for nurses and AHPs to understand the psychosocial impact of arthritis on individuals, family and friends, and the psychological adjustment needed when diagnosed with IA. They wanted community-based health professionals to have some knowledge of the types of drug treatments that people with IA receive and the implications of taking immunosuppressive drugs. They also wanted them to understand the pain associated with arthritis, particularly OA, which participants felt was not taken seriously enough. They wanted nurses and AHPs in the community to be able to give basic advice on pacing and pain management, to make multidisciplinary referrals, to communicate effectively between referral points and to be able to signpost people to sources of help and good, reliable sources of education and information (especially for OA). They also wanted them to understand that patients who have had a diagnosis for a long time are the experts in their own disease. Other areas which were emphasized as being important were good communication skills and taking a holistic approach to caring for people with arthritis. OA and IA differ significantly, both in their nature and their management. However, patients with arthritis want health
Full Text Available Purpose: To evaluate the effects of phosphodiesterase type 5 inhibitor (PDE5i on urinary continence recovery after bilateral nerve-sparing radical prostatectomy (BNSRP. Materials and Methods: Between 2002 and 2012, 137 of 154 consecutive patients who underwent BNSRP in our institution retrospectively divided into 3 groups that included patients taking PDE5i immediately after surgery (immediate PDE5i group, n=41, patients starting PDE5i at an outpatient clinic after discharge (PDE5i group, n=56, and patients taking no medication (non-PDE5i group, n=40. Using self-administered questionnaires, the proportion of patients who did not require incontinence pads (pad-free patients was calculated preoperatively and at 1, 3, 6, 12, 18, and 24 months after BNSRP. Severity of incontinence was determined based on the pad numbers and then compared among the 3 groups. Results: Proportions of pad-free patients and severity of incontinence initially deteriorated in all of the groups to the lowest values soon after undergoing BNSRP, with gradual improvement noted thereafter. The deterioration was most prominent in the immediate PDE5i group. As compared to the non-PDE5i group, both the PDE5i and immediate PDE5i groups exhibited a better final continence status. Conclusions: PDE5i improves final continence status. However, administration of PDE5i immediately after surgery causes a distinct temporary deterioration in urinary incontinence.
The notion of privacy has long had a central role in human rights law, not least in connection to health and medicine. International, regional and national bodies have enacted a number of binding and non-binding document for physicians and researchers to adhere to, in order to protect the autonomy, dignity and privacy of patients and research subjects. With the development of new technologies, the right to privacy has gained a new perspective; the right to protection of personal data within information and communication technologies. The right to data protection has been attributed an increasing importance within EU law. Accordingly, the use of health data in medical research in general and in biobank-related medical research in particular, has made data protection law highly relevant. In medical research involving biobanks, transferring human biological samples and/or individual health data is taking place on a daily basis. These transfers involve several oversight bodies, institutional review boards (IRBs), research ethics committees, or even data protection authorities. This article investigates the role of these national oversight bodies in the transfer of health data in cross-border research, from an EU law point of view. A special focus is laid on transfer of health data for research purposes from the EU to the US, in the light of the recently enacted EU-US Privacy Shield. The main question posed is how American oversight bodies for medical research can be expected to handle the increasingly strict EU requirements for the processing of health data in medical research review.
West Cheri E
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.
Redman, Barbara K; Caplan, Arthur L
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.
Cristallo, S.; Straniero, O.; Gallino, R.
Thermally pulsing Asymptotic Giant Branch stars are responsible for the nucleosynthesis of the main component of the cosmic s-elements. The most important neutron source is the 13 C(α, n) 16 O reaction. Owing to the presence of a subthreshold resonance, the low energy extrapolation is a rather complex task. The rate quoted in the literature differ up to a factor of 4 at typical stellar energies. The latest improvements in computer power allows us to calculate the evolution of TP-AGB stars coupled with a full nuclear network, extending from hydrogen to lead. Here we discuss the effects of the variation of the 13 C(α, n) 16 O rate on the predicted neutron capture nucleosynthesis
Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; Dinant, Geert-Jan; Ronda, Gaby; van der Weijden, Trudy
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
de Vries Nanne K
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
The Department of Education (Education) relies on collection agencies to assist borrowers in rehabilitating defaulted student loans, which allows borrowers who make nine on-time monthly payments within 10 months to have the default removed from their credit reports. Education works with 22 collection agencies to locate borrowers and explain…
Whiting, Georgina; Magin, Parker; Morgan, Simon; Tapley, Amanda; Henderson, Kim; Oldmeadow, Chris; Ball, Jean; van Driel, Mieke; Spike, Neil; McArthur, Lawrie; Scott, John; Stocks, Nigel
Skin conditions are commonly encountered in general practice but dermatology is underrepresented in undergraduate medical courses. Australian and international studies have shown that the dermatological diagnostic ability of general practitioners (GPs) is suboptimal, contributing to increased dermatology outpatient referrals. Dermatological experience in GP vocational training is thus of particular importance. We aimed to document the prevalence of skin disease presentations and the range of skin diseases encountered by GP trainees. We also sought to establish associations of GP trainee's skin disease experience, including their personal characteristics, consultation factors, and the actions arising from the consultation. This study took place in the Registrars Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, prospective, multi-site cohort study of Australian GP trainees' consultations. A descriptive cross-sectional analysis was performed on trainees' consultation data. In total, 645 individual trainees contributed data from 84 615 consultations. Altogether, 11% of all problems managed were skin problems. Infections, dermatitis, injury and wounds were the most common presentations. Associations of consultations for skin problems (compared with all other problems) included seeking in-consultation advice, planning patient follow up and generating learning goals. These findings suggest GP trainees find skin problems challenging and may indicate a need for more and better targeted undergraduate and GP trainee education. © 2016 The Australasian College of Dermatologists.
Nelson, Melissa C; Lytle, Leslie A; Pasch, Keryn E
Despite the need for effective obesity prevention strategies, little research has assessed adolescents' knowledge about basic concepts of energy intake, expenditure, and balance. Using data from 349 adolescent-caregiver pairs (recruited from Minneapolis/St Paul, MN metro region, 2006-2007), cross-sectional linear regression was used to assess adolescent and parental knowledge related to energy intake and expenditure as a predictor of adolescent weight-related behaviors and outcomes. Findings indicated that knowledge related to energy intake and expenditure was highly variable, with a substantial proportion of participants (particularly adolescents) lacking knowledge on a range of concepts. Adolescent knowledge was positively associated with moderate physical activity and negatively associated with television viewing (Pfast food intake, weight status, and/or body composition. Although overall parental knowledge was a significant predictor of adolescent knowledge (Pknowledge was not a significant predictor of various weight-related outcomes, these and other findings suggest that purely education-based health promotion strategies are insufficient to initiate long-term healthful behavior change. Educational strategies may be effective when combined with those also targeting familial, social, and environmental influences. The examination of interactive effects between individual-level and environmental influences on health behavior is an important area for future obesity-related research.
Sten H Vermund
Full Text Available Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15-49 years was 12.6%, higher among women (15.3% than men (8.9%. We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART in a highly resource-limited setting.We studied rates of 2-year mortality and loss to follow-up (LTFU for children 60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk.Of 753 children, 29.0% (95% CI: 24.5, 33.2 were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9 were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4 after 90 days on cART and 19.2% (95% CI: 16.0, 22.3 after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3-8.4 g/dL, p<0.01. Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001.We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.
Vermund, Sten H; Blevins, Meridith; Moon, Troy D; José, Eurico; Moiane, Linda; Tique, José A; Sidat, Mohsin; Ciampa, Philip J; Shepherd, Bryan E; Vaz, Lara M E
Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15-49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting. We studied rates of 2-year mortality and loss to follow-up (LTFU) for children 60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk. Of 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3-8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001). We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.
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: firstname.lastname@example.org) Telephone 04 50 40 82 66 for further details of posts. Ple...
Larijani, Houman Hadad
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
Houman Hadad Larijani
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.
The megatrend of population ageing is leading to a growing demand for "anti-ageing" treatments, especially to prevent or treat skin ageing. Facing an increasing offer, consumers are choosing more and more skin care products supported by a scientific rationale, active ingredients and clinical proof of efficacy. Considering consumer expectations, this research led to the discovery of acetyl aspartic acid (A-A-A), a novel active ingredient to improve sagging skin and loss of skin firmness. This supplement is featuring seven manuscripts aiming at presenting the research and investigations from consumer insights, discovery of A-A-A, its in vitro activity confirmation, safety assessment, formulation and its dermal absorption to the clinical proof of efficacy, investigated through two pilots' double bind randomized and placebo controlled studies on photo-aged skin. This extensive research enabled us to discover A-A-A, as an active ingredient with potential to repair sign of skin ageing and supported by clinical proof of efficacy. This active ingredient will be soon launched in a commercial innovative skin care range, delivering desirable anti-wrinkle and skin lifting benefits. © 2015 Society of Cosmetic Scientists and the Société Française de Cosmétologie.
Cipriani, Andrea; Geddes, John R
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.