WorldWideScience

Sample records for programming providing emergency

  1. 47 CFR 79.2 - Accessibility of programming providing emergency information.

    Science.gov (United States)

    2010-10-01

    ..., widespread fires, discharge of toxic gases, widespread power failures, industrial explosions, civil disorders... of programming providing emergency information. (a) Definitions. (1) For purposes of this section, the definitions in §§ 79.1 and 79.3 apply. (2) Emergency information. Information, about a current...

  2. A novel internet-based geriatric education program for emergency medical services providers.

    Science.gov (United States)

    Shah, Manish N; Swanson, Peter A; Nobay, Flavia; Peterson, Lars-Kristofer N; Caprio, Thomas V; Karuza, Jurgis

    2012-09-01

    Despite caring for large numbers of older adults, prehospital emergency medical services (EMS) providers receive minimal geriatrics-specific training while obtaining their certification. Studies have shown that they desire further training to improve their comfort level and knowledge in caring for older adults, but continuing education programs to address these needs must account for each EMS provider's specific needs, consider each provider's learning styles, and provide an engaging, interactive experience. A novel, Internet-based, video podcast-based geriatric continuing education program was developed and implemented for EMS providers, and their perceived value of the program was evaluated. They found this resource to be highly valuable and were strongly supportive of the modality and the specific training provided. Some reported technical challenges and the inability to engage in a discussion to clarify topics as barriers. It was felt that both of these barriers could be addressed through programmatic and technological revisions. This study demonstrates the proof of concept of video podcast training to address deficiencies in EMS education regarding the care of older adults, although further work is needed to demonstrate the educational effect of video podcasts on the knowledge and skills of trainees. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  3. Emergency contraceptive pills: what you need to know. Brochure for programs providing combined ECPs.

    Science.gov (United States)

    1998-01-01

    This informational brochure was prepared for potential users of emergency contraceptive pills. In question-and-answer format, it presents facts on the mechanism of action, effectiveness, safety, and side effects of emergency contraception. It then outlines the regimen for method use. The brochure notes that emergency contraceptive pills cannot offer protection against HIV and other sexually transmitted diseases. Finally, two other emergency contraceptive regimens--the copper T IUD and progestin-only pills--are discussed. The brochure may be reproduced by family planning and other health programs.

  4. Educational program emergency planning.

    Science.gov (United States)

    Curtis, Tammy

    2009-01-01

    Tragic university shootings have prompted administrators of higher education institutions to re-evaluate their emergency preparedness plans and take appropriate measures for preventing and responding to emergencies. To review the literature and identify key components needed to prevent shootings at higher education institutions in the United States, and in particular, institutions housing radiologic science programs. Twenty-eight emergency preparedness plans were retrieved electronically and reviewed from a convenience sample of accredited radiologic science programs provided by the Joint Review Committee on Education in Radiologic Technology Web site. The review of the 28 emergency preparedness plans confirmed that most colleges are prepared for basic emergencies, but lack the key components needed to successfully address mass-casualty events. Only 5 (18%) of the 28 institutions addressed policies concerning school shootings.

  5. Development of a National Consensus for Tactical Emergency Medical Support (TEMS) Training Programs--Operators and Medical Providers.

    Science.gov (United States)

    Schwartz, Richard; Lerner, Brooke; Llwewllyn, Craig; Pennardt, Andre; Wedmore, Ian; Callaway, David; Wightman, John; Casillas, Raymond; Eastman, Alex; Gerold, Kevin; Giebner, Stephen; Davidson, Robert; Kamin, Richard; Piazza, Gina; Bollard, Glenn; Carmona, Phillip; Sonstrom, Ben; Seifarth, William; Nicely, Barbara; Croushorn, John; Carmona, Richard

    2014-01-01

    Tactical teams are at high risk of sustaining injuries. Caring for these casualties in the field involves unique requirements beyond what is provided by traditional civilian emergency medical services (EMS) systems. Despite this need, the training objectives and competencies are not uniformly agreed to or taught. An expert panel was convened that included members from the Departments of Defense, Homeland Security, Justice, and Health and Human Services, as well as federal, state, and local law-enforcement officers who were recruited through requests to stakeholder agencies and open invitations to individuals involved in Tactical Emergency Medical Services (TEMS) or its oversight. Two face-to-face meetings took place. Using a modified Delphi technique, previously published TEMS competencies were reviewed and updated. The original 17 competency domains were modified and the most significant changes were the addition of Tactical Emergency Casualty Care (TECC), Tactical Familiarization, Legal Aspects of TEMS, and Mass Casualty Triage to the competency domains. Additionally, enabling and terminal learning objectives were developed for each competency domain. This project has developed a minimum set of medical competencies and learning objectives for both tactical medical providers and operators. This work should serve as a platform for ensuring minimum knowledge among providers, which will serve enhance team interoperability and improve the health and safety of tactical teams and the public. 2014.

  6. Transportation Emergency Preparedness Program (TEPP)

    International Nuclear Information System (INIS)

    1991-04-01

    The Transportation Emergency Preparedness Program (TEPP) will develop and enhance integrated emergency preparedness capabilities in two major areas. First, the program is responsible for planning and ensuring proper DOE response to transportation incidents involving DOE shipments. Second, the program is responsible for ensuring DOE can carry out its responsibilities under regulations, the National Contingency Plan (NCP) and the Federal Radiological Emergency Response Plan (FRERP) to provide technical advice and assistance as needed for any transportation incident involving radioactive or mixed hazard materials. This plan proposes a strategy for developing a comprehensive Transportation Emergency Preparedness Program, including a well organized central management and coordination structure, that serves as a process to identify, verify, and establish a consolidated effort across the Department in this very important area. This plan assumes Emergency Management to be the full range of emergency activities necessary for mitigation, preparedness, response and recovery while Emergency Preparedness activities are primarily those necessary in preparation for Incident Response Emergency Preparedness, which is the focus of this strategy plan, requires a well organized central coordination structure to be effective. 7 refs

  7. The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.

    Science.gov (United States)

    Suffoletto, Brian; Lynch, Michael; Pacella, Charissa B; Yealy, Donald M; Callaway, Clifton W

    2018-04-01

    Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis. This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  8. Zika Virus: Critical Information for Emergency Providers.

    Science.gov (United States)

    Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

    2016-08-01

    Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Radiological emergency preparedness (REP) program

    International Nuclear Information System (INIS)

    Kwiatkowski, D.H.

    1995-01-01

    This talk focuses on the accomplishments of Radiological Emergency Preparedness Program. Major topics include the following: strengthening the partnership between FEMA, the States, and the Industry; the Standard Exercise Report Format (SERF); Multi-year performance partnership agreement (MYPPA); new REP Program guidance; comprehensive exercise program; federal radiological emergency response plan (FRERP); international interest; REP user fee; implementation EPA PAGs and Dose Limits; Contamination monitoring standard for portal monitors; guidance documents and training

  10. Search for an Emergency Contraception Provider in the United States

    Science.gov (United States)

    ... emergency contraception provider. Concerned about cost? Click here . ---------- Emergency contraceptive pills are stocked by all major pharmacy chains, ... daily birth control pills you can use as emergency contraceptive pills. You can search for a provider in ...

  11. Emerging industrial countries provide the sale opportunities

    International Nuclear Information System (INIS)

    Dzhefs, Eh.; Grinkhal, G.

    1982-01-01

    Main trends in the development of nuclear power engineering in capitalist countries are considred. A particular attention is paid to a sharp contrast in the attitude to nuclear engineering in the developed and developing countries. In the first ones a considerable influence on the realization of nuclear engineering programs is exerted by the political situation, in the second ones the tendency to a transition from the NPP import to an increase in domestic industry contribution designing and fabricating separate plant units, equipment and fuel is clearly manifested

  12. A mobile phone text message program to measure oral antibiotic use and provide feedback on adherence to patients discharged from the emergency department.

    Science.gov (United States)

    Suffoletto, Brian; Calabria, Jaclyn; Ross, Anthony; Callaway, Clifton; Yealy, Donald M

    2012-08-01

    Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions. This was a randomized controlled trial in an urban emergency department (ED) with an annual census of 65,000. A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled. Participants received either a daily SMS query about prescription pickup, and then dosage taken, with educational feedback based on their responses (intervention), or the usual printed discharge instructions (control). A standardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence: 1) the participant filled prescription within 24 hours of discharge and 2) no antibiotic pills were left on the day after intended completion of prescription. Of the 200 patients who agreed to participate, follow-up was completed in 144 (72%). From the 144, 26% (95% confidence interval [CI] = 19% to 34%) failed to fill their discharge prescriptions during the first 24 hours, and 37% (95% CI = 29% to 45%) had pills left over, resulting in 49% (95% CI = 40% to 57%) nonadherent patients. There were no differences in adherence between intervention participants and controls (57% vs. 45%; p = 0.1). African American race, greater than twice-daily dosing, and self-identifying as expecting to have difficulty filling or taking antibiotics at baseline were associated with nonadherence. Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge. © 2012 by the Society for Academic Emergency Medicine.

  13. Emergency diesel generator reliability program

    International Nuclear Information System (INIS)

    Serkiz, A.W.

    1989-01-01

    The need for an emergency diesel generator (EDG) reliability program has been established by 10 CFR Part 50, Section 50.63, Loss of All Alternating Current Power, which requires that utilities assess their station blackout duration and recovery capability. EDGs are the principal emergency ac power sources for coping with a station blackout. Regulatory Guide 1.155, Station Blackout, identifies a need for (1) an EDG reliability equal to or greater than 0.95, and (2) an EDG reliability program to monitor and maintain the required levels. The resolution of Generic Safety Issue (GSI) B-56 embodies the identification of a suitable EDG reliability program structure, revision of pertinent regulatory guides and Tech Specs, and development of an Inspection Module. Resolution of B-56 is coupled to the resolution of Unresolved Safety Issue (USI) A-44, Station Blackout, which resulted in the station blackout rule, 10 CFR 50.63 and Regulatory Guide 1.155, Station Blackout. This paper discusses the principal elements of an EDG reliability program developed for resolving GSI B-56 and related matters

  14. Provider Customer Service Program - Performance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS is continuously analyzing performance and quality of the Provider Customer Service Programs (PCSPs) of the contractors and will be identifying trends and making...

  15. Service providers' perception of the quality of emergency obsteric ...

    African Journals Online (AJOL)

    Facility/staff themes which emerged as contributing to the poor care were; inadequate resources, inadequate staffing, poor teamwork, and inadequate knowledge/supervision. Conclusion The findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were ...

  16. 75 FR 70083 - Emergency Forest Restoration Program and Emergency Conservation Program

    Science.gov (United States)

    2010-11-17

    ... Restoration Program and Emergency Conservation Program AGENCY: Farm Service Agency, USDA. ACTION: Interim rule. SUMMARY: The Farm Service Agency (FSA) is amending regulations as required by the Food, Conservation, and... as follows: PART 701--EMERGENCY CONSERVATION PROGRAM, EMERGENCY FOREST RESTORATION PROGRAM, AND...

  17. Financial Management: Emergency Steel Loan Guarantee Program

    National Research Council Canada - National Science Library

    2001-01-01

    In a February 1, 2001 letter, you expressed concerns about repayments of federally guaranteed loans by borrowers under the Emergency Steel Loan Guarantee Program and the effect of the program on the U.S. steel industry...

  18. Medical Emergency Education in Dental Hygiene Programs.

    Science.gov (United States)

    Stach, Donna J.; And Others

    1995-01-01

    A survey of 169 dental hygiene training programs investigated the curriculum content and instruction concerning medical emergency treatment, related clinical practice, and program policy. Several trends are noted: increased curriculum hours devoted to emergency care; shift in course content to more than life-support care; and increased emergency…

  19. Emergency Food Programs: Untapped Opportunities for Extension?

    Science.gov (United States)

    Mobley, Amy R.

    2012-01-01

    This article reports results from a questionnaire that assessed the frequency and type of nutrition questions asked at emergency food programs to determine if Extension professionals need to increase direct outreach efforts. Emergency food program workers (n = 460) were recruited via mail to complete a self-administered survey. More than one-third…

  20. Do prehospital providers and emergency nurses agree on triage assignment?

    DEFF Research Database (Denmark)

    Skjøt-Arkil, Helene; Pontoppidan, Louise L; Laursen, Jens O

    2018-01-01

    OBJECTIVES: The aim of this study was to investigate the agreement on triage level between prehospital providers and emergency department (ED) nurses in clinical practice when using the same triage system. The objectives were as follows: (a) What is the agreement of triage between prehospital...... providers and ED nurses, when using Danish Emergency Process Triage (DEPT) correctly? (b) Which part of the triage process yields the highest agreement regarding the final triage? METHODS: The study was a prospective and observational efficacy study. Patients transported to the ED by ambulances were...... included. They were triaged by prehospital providers while being transported by ambulance to the ED, and by ED nurses upon arrival. Triage was done using the DEPT - a five-level triage system based on vital signs and a presenting complaint algorithm. An agreement analysis was performed. RESULTS: DEPT...

  1. Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.

    Science.gov (United States)

    Saleh, Fareed; Breslin, Kristen; Mullan, Paul C; Tillett, Zachary; Chamberlain, James M

    2017-10-31

    The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity. There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site. Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.

  2. Health care providers' knowledge of, attitudes toward and provision of emergency contraceptives in Lagos, Nigeria.

    Science.gov (United States)

    Ebuehi, Olufunke Margaret; Ebuehi, Osaretin A T; Inem, Victor

    2006-06-01

    Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients. In 2003-2004, a sample of 256 health care providers within Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences. Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so. Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

  3. Clearing the airway by an emergency care provider in the prehospital emergency care

    OpenAIRE

    NOVOTNÁ, Magdalena

    2008-01-01

    Clearing an obstructed airway to facilitate breathing is a critical element of airway management. It is the emergency care provider who administers first aid and he/she has to master the technique of opening the airway as well as the aspiration prevention. The right airway management may avert the life-threatening condition of an injured person. The thesis is focused on the possibilities of clearing the airway by the emergency care provider in the Central Bohemian region. Techniques of openin...

  4. Hand Washing Practices Among Emergency Medical Services Providers

    Directory of Open Access Journals (Sweden)

    Joshua Bucher

    2015-10-01

    Full Text Available Introduction: Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS workers, respectively. Methods: We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results: There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003. Providers who brought their own sanitizer were more likely to clean their hands. Conclusion: Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  5. Hand Washing Practices Among Emergency Medical Services Providers.

    Science.gov (United States)

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-09-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  6. National emergency medical assistance program for commercial nuclear power plants

    International Nuclear Information System (INIS)

    Linnemann, R.E.; Berger, M.E.

    1987-01-01

    Radiation Management Consultant's Emergency Medical Assistance Program (EMAP) for nuclear facilities provides a twenty-four hour emergency medical and health physics response capability, training of site and off-site personnel, and three levels of care for radiation accident victims: first air and rescue at an accident site, hospital emergency assessment and treatment, and definitive evaluation and treatment at a specialized medical center. These aspects of emergency preparedness and fifteen years of experience in dealing with medical personnel and patients with real or suspected radiation injury will be reviewed

  7. Emergency medical service providers' experiences with traffic congestion.

    Science.gov (United States)

    Griffin, Russell; McGwin, Gerald

    2013-02-01

    The population's migration from urban to suburban areas has resulted in a more dispersed population and has increased traffic flow, possibly resulting in longer emergency response times. Although studies have examined the effect of response times on time to definitive care and survival, no study has addressed the possible causes of slowed response time from the point of view of emergency medical services (EMS) first responders. To assess the variables most commonly associated with increased emergency response time as described by the opinions and views of EMS first responders. A total of 500 surveys were sent to randomly selected individuals registered as first responders with the Alabama Department of Public Health, and 112 surveys were returned completed. The survey included questions regarding roadway design, response to emergency calls, in-vehicle technology aimed at decreasing travel time, and public education regarding emergency response. Respondents reported traveling on city streets most often during emergency calls, and encountering traffic more often on interstates and national highways. Traffic congestion, on average, resulted in nearly 10min extra response time. Most agreed that the most effective in-vehicle technology for reducing response time was a pre-emptive green light device; however, very few reported availability of this device in their emergency vehicles. Public education regarding how to react to approaching emergency vehicles was stated as having the greatest potential impact on reducing emergency response time. The results of the survey suggest that the best methods for reducing emergency response times are those that are easy to implement (e.g., public education). Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Development of software to provide practical guidance in the managing of a radiological emergency

    International Nuclear Information System (INIS)

    Ferreira Filho, Alfredo L.; Lima, Fernando R.A.; Loureiro, Eduardo C.M.

    2008-01-01

    One of the most important aspects of managing a radiological emergency is the ability to promptly and adequately determine and take actions to protect members of public and emergency workers. This work brings up to date a computer software program in Delphi, with the tools, generic procedures and the data necessary to support the Incident Commander, the Radiological Assessor and other members of a generic response organization in case of radiological accident. The aim is also to provide practical guidance for the first responders who will respond during the first few hours to a radiological emergency and for the national officials who would support this early response. Software is now based on the Manual for First Responders to a Radiological Emergency (EPR-First Responders), published in 2006 as part of the IAEA Emergency Preparedness and Response Series, as well as in the IAEA technical document, Generic Procedures for Assessment and Response during a Radiological Emergency, the IAEA-TECDOC-1162, taking account of the lessons learned from using this last document in the area of early response and first responders' actions. The proposed procedures provide action criteria that are clear, concise and predetermined, based on the present knowledge and the accumulated experiences, allowing the immediate decision-making. The objective is to provide, through a portable computer, practical guidance, in the form of action guides, instructions, and supporting data for emergency response that, if implemented, will provide a basic assessment and the response capability needed to protect public and workers in case of different types of radiological emergencies. In addition to appropriate protective action recommendations, it will also provide, when it is necessary, general guidance on the recovery of radioactive sources and initial cleanup operations. The philosophy is to keep the process simple and fast, yet effective. Software is available in Spanish, English and Portuguese

  9. Short radiological emergency response training program

    International Nuclear Information System (INIS)

    Williams, R.D.; Greenhouse, N.A.

    1977-01-01

    This paper presents an outline of a radiological emergency response training program conducted at Brookhaven National Laboratory by the health physics and safety training staff. This course is given to groups from local, county, state, and federal agencies and industrial organizations. It is normally three days in length, although the structure is flexible to accommodate individual needs and prior training. An important feature of the course is an emergency exercise utilizing a short lived radionuclide to better simulate real accident conditions. Groups are encouraged to use their own instruments to gain better familiarity with their operating characteristics under field conditions. Immediately following the exercise, a critical review of the students' performance is conducted

  10. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    Science.gov (United States)

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  11. Building capacity in VA to provide emergency gynecology services for women.

    Science.gov (United States)

    Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

    2015-04-01

    Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

  12. Risk communications and the Chemical Stockpile Emergency-Planning Program

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, B.M.; Sorensen, J.H.

    1994-09-01

    The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted during preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.

  13. Reliability assurance program for operational emergency ac power system

    International Nuclear Information System (INIS)

    Heineman, J.B.; Ragland, W.A.; Mueller, C.J.

    1985-01-01

    A comprehensive review of emergency ac power systems in nuclear generating plants (the vast majority of these plants contain redundant diesel generator systems) delineates several operational areas that can be improved by instituting a reliability assurance program (RAP), which initially upgrades the diesel generator performance and provides for ongoing monitoring and maintenance based upon alert levels

  14. The politics of place: presidential voting patterns and Providers' prescription of emergency contraception.

    Science.gov (United States)

    Cleland, Kelly; Wagner, Brandon; Batur, Pelin; McNamara, Megan; Wu, Justine; Rothberg, Michael B

    2018-05-17

    The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. This study seeks to assess whether political alignment of a provider's county is associated with provider attitudes and behaviors regarding EC. We analyzed survey data collected from 1313 healthcare providers from February 2013 to April 2014 at 14 academic medical centers in the United States. Using logistic regression, we estimated associations between the county political alignment of a provider's practice and his or her EC-related beliefs and practices: 1) if the provider is aware of the most effective EC methods; 2) if knowing that a hypothetical EC method prevented implantation would make a provider less likely to prescribe that method because of personal ethical or religious reasons; and 3) if the provider prescribes any form of EC in his or her practice. In multivariate models, a one percentage-point increase in county Republican vote share was associated with a 2.9% decrease in the odds of a provider prescribing EC, after accounting for provider knowledge and attitudes about EC. EC provides a critical last chance to prevent pregnancy after unprotected sex, yet women living in Republican-leaning counties may face difficulty obtaining EC from healthcare providers. Programs seeking to improve access to EC should focus on areas likely to have fewer providers willing to prescribe EC, which may be those that are more Republican-leaning. The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. Women living in Republican-leaning counties may face difficulty obtaining emergency contraception from healthcare providers. Copyright © 2018. Published by Elsevier Inc.

  15. Evaluating an australian emergency nurse practitioner candidate training program.

    Science.gov (United States)

    Plath, Sharyn J; Wright, Mary; Hocking, Julia

    2017-11-01

    Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.

  16. Emergency management: Concepts and strategies for effective programs

    OpenAIRE

    Lucus, Valerie

    2007-01-01

    Review of Emergency Management: Concepts and Strategies for Effective Programs By Lucien G. Canton, CEM. By taking a different perspective on local government emergency management programs, this book presents the vision for a very different model--one that includes an independent emergency manager leading an enterprise-wide program focused on strategies that promote disaster resilient communities.

  17. Recruiting Fathers to Parenting Programs: Advice from Dads and Fatherhood Program Providers

    Science.gov (United States)

    Stahlschmidt, Mary Jo; Threlfall, Jennifer; Seay, Kristen D.; Lewis, Ericka M.; Kohl, Patricia L.

    2014-01-01

    The benefits of high-quality father-child relationships for fathers and children alike are well documented. While evidence suggests parenting programs can improve the quality of father-child relationships, few fathers participate in such programs. This qualitative study aims to fill the gap in knowledge on best practices for recruiting urban African American fathers, a group of fathers with unique parenting challenges, to parenting programs. Focus groups were conducted with 29 fathers to gain their perspectives on recruitment strategies. Semi-structured interviews were also conducted with a nationwide sample of 19 fatherhood program providers to learn about their most successful recruitment strategies. Recruitment strategies based on emergent themes from the focus groups and interviews are presented here. Themes included using word-of-mouth recruitment, increasing advertising, targeting advertising specifically to urban African American fathers, providing transportation and incentives, recruiting through the courts, collaborating with other community agencies, and offering parenting programming along with other programming valued by fathers such as employment assistance. Implications for developing strategies for recruiting urban African American fathers to parenting programs are discussed. PMID:24791035

  18. Recruiting Fathers to Parenting Programs: Advice from Dads and Fatherhood Program Providers.

    Science.gov (United States)

    Stahlschmidt, Mary Jo; Threlfall, Jennifer; Seay, Kristen D; Lewis, Ericka M; Kohl, Patricia L

    2013-10-01

    The benefits of high-quality father-child relationships for fathers and children alike are well documented. While evidence suggests parenting programs can improve the quality of father-child relationships, few fathers participate in such programs. This qualitative study aims to fill the gap in knowledge on best practices for recruiting urban African American fathers, a group of fathers with unique parenting challenges, to parenting programs. Focus groups were conducted with 29 fathers to gain their perspectives on recruitment strategies. Semi-structured interviews were also conducted with a nationwide sample of 19 fatherhood program providers to learn about their most successful recruitment strategies. Recruitment strategies based on emergent themes from the focus groups and interviews are presented here. Themes included using word-of-mouth recruitment, increasing advertising, targeting advertising specifically to urban African American fathers, providing transportation and incentives, recruiting through the courts, collaborating with other community agencies, and offering parenting programming along with other programming valued by fathers such as employment assistance. Implications for developing strategies for recruiting urban African American fathers to parenting programs are discussed.

  19. Emergency operating procedure upgrade program and audit results

    International Nuclear Information System (INIS)

    Graham, P.D.

    1989-01-01

    This paper describes the method and results of upgrading the River Bend station boiling water reactor 6 emergency operating procedures (EOPs). The upgrade program replaced difficult-to-implement narrative procedures with well-developed flowcharts. The flowcharts eliminate a number of human factors problems, are user friendly, provide for easy implementation, and provide technical information in a clear, concise format. Positive results were seen immediately. The operating crews found the flowcharts to be clear, understandable, and usable. Simulator training and EOP implementation became something that the operators no longer dreaded, and their confidence in their ability to control emergency situations was greatly improved. The paper provides a summary of the EOP upgrade program

  20. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Israel, Kerling; Leandre, Fernet; Pierre, Sosthène; Bollman, Brennan; Marsh, Regan H

    2018-04-06

    In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program's success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

  1. Tactical emergency medical support programs: a comprehensive statewide survey.

    Science.gov (United States)

    Bozeman, William P; Morel, Benjamin M; Black, Timothy D; Winslow, James E

    2012-01-01

    Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. We sought to measure the current prevalence and specific characteristics of TEMS programs in a comprehensive fashion in a single southeastern state. North Carolina emergency medical services (EMS) systems have county-based central EMS oversight; each system was surveyed by phone and e-mail. The presence and selected characteristics of TEMS programs were recorded. U.S. Census data were used to measure the population impact of the programs. All of the 101 EMS systems statewide were successfully contacted. Thirty-three counties (33%) have TEMS programs providing medical support to 56 local law enforcement agencies as well as state and federal agencies. TEMS programs tend to be located in more populated urban and suburban areas, serving a population base of 5.9 million people, or 64% of the state's population. Tactical medics in the majority of these programs (29/33; 88%) are not sworn law enforcement officers. Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.

  2. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  3. Development of CSA N1600-14: general requirements for nuclear emergency management programs

    Energy Technology Data Exchange (ETDEWEB)

    Sellar, C. [Canadian Standards Association Group, Mississauga, ON (Canada); Coles, J. [Ontario Power Generation, Darlington, ON (Canada)

    2014-07-01

    CSA Group has published a new standard on General requirements for nuclear emergency management programs (CSA N1600-14). The standard establishes criteria for the emergency management programs of on- and off-site organizations to address nuclear emergencies at Canadian nuclear power plants (NPPs). It provides the requirements to develop, implement, evaluate, maintain, and continuously improve a nuclear emergency management program for prevention and mitigation, preparedness, response, and recovery from a nuclear emergency at a NPP. This paper discusses the development of the standard, and provides the key drivers, structure, scope, and outline of the standard, while highlighting key features, impacts, and benefits. (author)

  4. General RMP Guidance - Chapter 8: Emergency Response Program

    Science.gov (United States)

    If you have a Program 2 or 3 process at your facility, 40 CFR Part 68 (risk management program) requires an emergency response program in place if employees respond to some releases involving regulated toxic or flammable substances.

  5. Financial and economic considerations for emergency response providers.

    Science.gov (United States)

    Liong, Anne S; Liong, Samuel U

    2010-12-01

    Catastrophic events often threaten or cause depletion of resources. It is generally accepted that changes inherent to disasters are stressful. The Conservation of Resources Theory predicts that positive and negative changes in resources will have markedly different effects.28 This theory proposes that resource losses are psychologically stressful, whereas resource gains buffer against the effects of resource loss. For first responders, the level of preparedness is crucial. Investments in planning, training, and logistics are necessary to mitigate the stress associated with a crisis. Stress is also related to not knowing the future of their loved ones if death or permanent incapacity occurs, hence specific laws and financial resources provide a safety net to dependents of first responders and survivors. This kind of safety gives the first responders peace of mind and assurance that the future of their dependents will not be jeopardized. Incentives that are offered let the first responders know that they are valued and appreciated. Indeed, financial support considerably helps first responders before, during, and after catastrophic events. It assists them to cope with stress at the individual level and allows them to become more resilient; this resonates to the community and country in which they serve and enhances their potential to save lives and prevent disabilities. Copyright © 2010 Elsevier Inc. All rights reserved.

  6. Emergency medicine program targets "brain drain" in Ethiopia ...

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

    2016-04-29

    Apr 29, 2016 ... ... (TAAAC-EM) project, access to emergency medicine is increasing for Ethiopians. With IDRC support, the TAAAC-EM postgraduate emergency medicine training program ... From hospitals to herbalists: Rx herbal medicines.

  7. 76 FR 12127 - Emergency Homeowners' Loan Program: Announcement of Activation of Program and Availability of...

    Science.gov (United States)

    2011-03-04

    ... are not limited to: Developing and disseminating program marketing materials; Providing an overview of... sale, deed-in-lieu of foreclosure, or traditional sale of home. B. Intermediary to Perform Funds... modification, short sale, deed-in-lieu of foreclosure, or traditional sale of home. 2. Repayment of Emergency...

  8. Current status on educational program for radiation emergency medical preparedness in Korea

    International Nuclear Information System (INIS)

    Kim, E. S.; Kong, H. J.; Noh, J. H.; Kim, C. S.

    2002-01-01

    There are several educational programs in worldwide for the user of radiation, radioisotopes, and nuclear power plant. REAC/TS is one of the most famous centers for radiation emergency personnel. REMPAN, one of the World Health Organization is also to promote the medical preparedness for radiation accident and provide advice and assistance in the case of radiation accident and radiological emergency. There are a variety of educational programs of radiation emergency, but not many programs of medical preparedness in Korea. Therefore, it is introduced here Korean current environment and future direction of educational programs for the radiation emergency medical preparedness

  9. LED provides engineering and electrooptics support to the Laser Program

    International Nuclear Information System (INIS)

    Pehrson, D.

    1985-01-01

    The work of the Laser Engineering Division is reviewed. The division provides engineering and electrooptics support to the laser program. The laser program has been an integral part of the efforts to explore the potential of lasers in harnessing thermonuclear fusion for energy and for defense-related physics studies and in efficiently separating fissile fuels

  10. Providing Homeless Adults with Advantage: A Sustainable University Degree Program

    Science.gov (United States)

    Sinatra, Richard; Lanctot, Melissa Kim

    2016-01-01

    A university partnered with the New York City Department of Homeless Services (NYC DHS) to provide cohorts of adults a 60-credit Associate Degree Program in Business Administration over a 2-year period. Results of two cohorts of 30 Advantage Academy Program graduates revealed significant improvement in College Board AccuPlacer (ACPL) Arithmetic…

  11. Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

    Science.gov (United States)

    Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

    2016-05-01

    Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  12. Planning guidance for the Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

    Shumpert, B.L.; Watson, A.P.; Sorensen, J.H. [and others

    1995-02-01

    This planning guide was developed under the direction of the U.S. Army and the Federal Emergency Management Agency (FEMA) which jointly coordinate and direct the development of the Chemical Stockpile Emergency Preparedness Program (CSEPP). It was produced to assist state, local, and Army installation planners in formulating and coordinating plans for chemical events that may occur at the chemical agent stockpile storage locations in the continental United States. This document provides broad planning guidance for use by both on-post and off-post agencies and organizations in the development of a coordinated plan for responding to chemical events. It contains checklists to assist in assuring that all important aspects are included in the plans and procedures developed at each Chemical Stockpile Disposal Program (CSDP) location. The checklists are supplemented by planning guidelines in the appendices which provide more detailed guidance regarding some issues. The planning guidance contained in this document will help ensure that adequate coordination between on-post and off-post planners occurs during the planning process. This planning guide broadly describes an adequate emergency planning base that assures that critical planning decisions will be made consistently at every chemical agent stockpile location. This planning guide includes material drawn from other documents developed by the FEMA, the Army, and other federal agencies with emergency preparedness program responsibilities. Some of this material has been developed specifically to meet the unique requirements of the CSEPP. In addition to this guidance, other location-specific documents, technical studies, and support studies should be used as needed to assist in the planning at each of the chemical agent stockpile locations to address the specific hazards and conditions at each location.

  13. Current emergency programs for nuclear installations in Japan

    International Nuclear Information System (INIS)

    Chino, Masamichi

    2007-01-01

    Large effort has been taken for nuclear emergency programs in Japan especially after the JCO accident. A special law for nuclear emergency was established after the accident. The law extended the scope of emergency preparedness to fuel cycle facilities, research reactors, etc. and clarified the roles and responsibilities of the national government, local governments and license holders. For initial responses, the action levels and action procedures are defined based on environmental doses and specific initial events of NPPs. A senior specialist was dispatched to each site for nuclear emergency and a facility 'Off-site center' to be used as the local emergency headquator was designated at each site. This paper describes the structure of emergency program, responsibility of related organizations and the definition of unusual events for notification and emergency. Emergency preparedness, emergency radiation monitoring and computer-based prediction of on- and off-site situation are also addressed. (author)

  14. High Altitude Platforms for Disaster Recovery: Capabilities, Strategies, and Techniques for Providing Emergency Telecommunications

    Energy Technology Data Exchange (ETDEWEB)

    Juan D. Deaton

    2008-05-01

    Natural disasters and terrorist acts have significant potential to disrupt emergency communication systems. These emergency communication networks include first-responder, cellular, landline, and emergency answering services such as 911, 112, or 999. Without these essential emergency communications capabilities, search, rescue, and recovery operations during a catastrophic event will be severely debilitated. High altitude platforms could be fitted with telecommunications equipment and used to support these critical communications missions once the catastrophic event occurs. With the ability to be continuously on station, HAPs provide excellent options for providing emergency coverage over high-risk areas before catastrophic incidents occur. HAPs could also provide enhanced 911 capabilities using either GPS or reference stations. This paper proposes potential emergency communications architecture and presents a method for estimating emergency communications systems traffic patterns for a catastrophic event.

  15. Remember the Drive Home? An Assessment of Emergency Providers' Sleep Deficit.

    Science.gov (United States)

    Ferguson, Brian A; Shoff, Hugh W; McGowan, Jennifer E; Huecker, Martin R

    2018-01-01

    Sleep deprivation decreases work performance and predisposes workers to deleterious health outcomes. We sought to evaluate sleep hygiene and fatigue among emergency physicians. In March-June 2016, physicians and residents at an academic emergency medicine program were invited to complete a survey evaluating sleep and alertness. Six attending physicians and 26 residents completed the survey. Among six personal priorities, sleep ranked fourth behind family, work, and leisure. 75% stated poor sleep impedes effectiveness as a physician while 53% noted difficulty falling asleep before a night shift. In the last three months, 39% of subjects forgot driving home from a shift, and 34% had fallen asleep while driving. 34% used medications to assist with sleep (including melatonin (36%), alcohol (27%), and prescription drugs (9%)). Most providers attested to phone (88%) and television exposure (69%) immediately prior to goal sleep onset. Despite sleep being identified as a priority among EM physicians, deleterious habits remain. Poor sleep affects perceived effectiveness and personal safety, as evidenced by a significant portion of providers falling asleep on the commute home. Night shift is the chief obstacle to optimal sleep hygiene.

  16. Factors that influence medical student selection of an emergency medicine residency program: implications for training programs.

    Science.gov (United States)

    Love, Jeffrey N; Howell, John M; Hegarty, Cullen B; McLaughlin, Steven A; Coates, Wendy C; Hopson, Laura R; Hern, Gene H; Rosen, Carlo L; Fisher, Jonathan; Santen, Sally A

    2012-04-01

    of applicants to EM residency programs employed a balance of geographic location factors with individual program factors in selecting a residency program. Specific program characteristics represent the greatest opportunity to maximize the success of the immediate interview experience/season, while others provide potential for strategic planning over time. A working knowledge of these results empowers program directors to make informed decisions while providing an appreciation for the limitations in attracting applicants. © 2012 by the Society for Academic Emergency Medicine.

  17. Hazardous materials transportation and emergency response programs

    International Nuclear Information System (INIS)

    Joy, D.S.; Fore, C.S.

    1983-01-01

    This presentation consists of the following visual aids; (1) detailed routing capabilities of truck, rail, barge; (2) legislative data base for hazardous materials; and (3) emergency response of accident site Eddyville, Kentucky (airports in vicinity of Eddyville, KY)

  18. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    OpenAIRE

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

  19. Non-physician providers as clinical providers in cystic fibrosis: survey of U.S. programs.

    Science.gov (United States)

    Brown, Rebekah F; Willey-Courand, Donna Beth; George, Cindy; McMullen, Ann; Dunitz, Jordan; Slovis, Bonnie; Perkett, Elizabeth

    2013-04-01

    Non-physician providers (NPPs) including nurse practitioners (NPs) and physician assistants (PAs) are important members of CF care teams, but limited data exist about the extent NPPs are involved in CF care. A subcommittee was established by the CF Foundation to gather information about current involvement of NPPs. Surveys were sent to adult, pediatric and affiliate CF program directors (PDs) and NPPs working in US CF programs. Responses were received from 108 PDs (49% pediatric, 34% adult, 17% affiliate). Overall, 53% of the 108 programs had NPPs and 70% had or planned to hire NPPs. Reasons for NPP use included ideal clinical role (75%), expansion of services (72%), and physician shortage (40%). The survey collected 73 responses from NPPs (96% NPs, 4% PAs) who worked in pediatric (49%), adult (29%), affiliate (3%), or multiple programs (19%). Training occurred on the job in 88% and from prior CF experience in 21%. NPPs provided coverage in outpatient clinics (82%), inpatient care (64%), and weekend and/or night call (22%). In addition to clinical roles, NPPs are involved in education (95%), research (81%), and leadership (55%). The major obstacle reported by PDs and NPPs was billing with only 12% of programs reporting NPP salaries covered by billing revenue alone. Salary support included hospital support (67%), billing (39%), center grant (35%), and other grant/contract (25%). NPPs bill for outpatient and inpatient care in 65% and 28% of programs, respectively. NPPs are working with physicians in many centers and have the potential to help meet the increasing clinical workforce demands. Further evaluation of financial issues is indicated to continue the support of NPP jobs in CF. Roles and expectations need to be clearly defined. Initial and ongoing training standards and opportunities should be explored. Copyright © 2012 Wiley Periodicals, Inc.

  20. Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

    Directory of Open Access Journals (Sweden)

    Robert J. Steeps

    2017-05-01

    Full Text Available Introduction: The number of community paramedic (CP programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program. Methods: We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05. Results: Of the 350 EMS professionals receiving an invitation, 283 (81% participated. Of those participants, 165 (70% indicated that they understood what a CP program entails. One hundred thirty-five (58% stated they were likely to attend additional education in order to become a CP, 152 (66% were willing to perform CP duties, and 175 (75% felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03 and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p

  1. The emergency medical programs of japan and foreign countries for radiation accidents in nuclear power stations

    International Nuclear Information System (INIS)

    Aoki, Yoshiro

    1994-01-01

    In our country, the medical emergency programs for the people living near nuclear power stations are well organized, however, preparation of medical staffs who are well trained is considered to be not sufficient. In the USA, on call 24 hours response to a radiological emergency is provided and funded by Department of Energy(DOE) or electric companies. Especially, REAC/TS is a part of DOE response network, in which there are provided well-trained physicians, nurses, health physicists, coordinators and support personnels. In United Kingdom, National Radiological Protection Board(NRPB) is responsible to a radiological emergency program. Each nuclear power station has its own emergency program consisting of a team of physicians, nurses and health physicists. In France, French Atomic Energy Commission (CEA) is a responsible agency for a radiological emergency program. On call 24 hours response to a radiological emergency is provided in Fontenay-aux Roses Institute and Curie Institute. Curie Institute also responds to radiological emergencies in other countries at the request of WHO. In Germany(West Germany), compulsory assurance system covers a radiological emergency program and a radiological protection. There are seven centers in West Germany, in which well-trained medical staffs are provided against radiological injuries. In this report, I tried to propose a new concept about emergency medical programs for nuclear power station accidents in Japan. I think it is a very urgent theme to provide on call 24 hours radiological emergency program, in which patients suffered from acute radiation sickness with internal contamination or contaminated radiation burns will be treated without any trouble. We have to make our best efforts to complete basic or clinical research about radiation injuries including bone marrow transplantation, radioprotectors, chelating agents and radiation burns etc. (J.P.N.)

  2. Time to standardise levels of care amongst Out-of-Hospital Emergency Care providers in Africa

    OpenAIRE

    Mould-Millman, N.K.; Stein, C.; Wallis, L.A.

    2016-01-01

    The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life suppor...

  3. Ebola: Emergency preparedness and perceived response of Malaysian health care providers.

    Science.gov (United States)

    Rajiah, Kingston; Maharajan, Mari Kannan; Binti Samsudin, Sarah Zakiah; Tan, Choo Lin; Tan Yen Pei, Adeline; Wong San Ying, Audrey

    2016-12-01

    We studied the emergency preparedness and perceived response for Ebola virus disease among various health care providers in Malaysia using a self-report questionnaire. Most of the health care providers felt that they were able to respond to Ebola virus disease and were aware of the level of preparedness needed during emergency. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Is there a duty for private employers to provide emergency mental health care services?

    Science.gov (United States)

    Langlieb, Tammara F; Langlieb, Alan M; Everly, George S

    2006-01-01

    This article presents a discussion of whether employers in private companies have a duty to provide an emergency action plan with a mental health component for its employees. It discusses basic negligence concepts and focuses mainly on the "duty of care" component of negligence. It then applies the negligence concepts to private employers and discusses how private companies arguably might have a duty under the laws of negligence to provide employees with an emergency action plan, specifically a plan including mental health provisions.

  5. Emergency medical support for a manned stratospheric balloon test program.

    Science.gov (United States)

    Blue, Rebecca S; Norton, Sean C; Law, Jennifer; Pattarini, James M; Antonsen, Erik L; Garbino, Alejandro; Clark, Jonathan B; Turney, Matthew W

    2014-10-01

    Red Bull Stratos was a commercial program that brought a test parachutist, protected by a full-pressure suit, in a stratospheric balloon with pressurized capsule to over 127,582 ft (38,969 m), from which he free fell and subsequently parachuted to the ground. Given that the major risks to the parachutist included ebullism, negative Gz (toe-to-head) acceleration exposure from an uncontrolled flat spin, and trauma, a comprehensive plan was developed to recover the parachutist under nominal conditions and to respond to any medical contingencies that might have arisen. In this report, the project medical team describes the experience of providing emergency medical support and crew recovery for the manned balloon flights of the program. The phases of flight, associated risks, and available resources were systematically evaluated. Six distinct phases of flight from an Emergency Medical Services (EMS) standpoint were identified. A Medical Support Plan was developed to address the risks associated with each phase, encompassing personnel, equipment, procedures, and communications. Despite geographical, communications, and resource limitations, the medical team was able to implement the Medical Support Plan, enabling multiple successful manned balloon flights to 71,615 ft (21,828 m), 97,221 ft (29,610 m), and 127,582 ft (38,969 m). The experience allowed refinement of the EMS and crew recovery procedures for each successive flight and could be applied to other high altitude or commercial space ventures.

  6. A reliability program for emergency diesel generators at nuclear power plants: Program structure

    International Nuclear Information System (INIS)

    Lofgren, E.V.; DeMoss, G.M.; Fragola, J.R.; Appignani, P.L.; Delarche, G.; Boccio, J.

    1988-04-01

    The purpose of this report is to provide technical guidelines for NRC staff use in the development of positions for evaluating emergency diesel generator (EDG) reliability programs. Such reviews will likely result following resolution of USI A-44 and GSI B-56. The diesel generator reliability program is a management system for achieving and maintaining a selected (or target) level of reliability. This can be achieved by: (1) understanding the factors that control the EDG reliability and (2) then applying reliability and maintenance techniques in the proper proportion to achieve selected performance goals. The concepts and guidelines discussed in this report are concepts and approaches that have been successful in applications where high levels of reliability must be maintained. Both an EDG reliability program process and a set of review items for NRC use are provided. The review items represent a checklist for reviewing EDG reliability programs. They do not, in themselves, constitute a reliability program. Rather, the review items are those distinctive features of a reliability program that must be present for the program to be effective

  7. Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.

    Science.gov (United States)

    Harper, Cynthia C; Speidel, J Joseph; Drey, Eleanor A; Trussell, James; Blum, Maya; Darney, Philip D

    2012-02-01

    The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles. We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception. The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians. Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method. III.

  8. 78 FR 25013 - Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment

    Science.gov (United States)

    2013-04-29

    .... ACTION: Proposed rule. SUMMARY: This proposed rule would revise the Incentive Reward Program provisions... significant of these revisions include: changing the Incentive Reward Program potential reward amount for... related to the Incentive Reward Program. Frank Whelan, (410) 786-1302, for issues related to provider...

  9. RMP Guidance for Warehouses - Chapter 8: Emergency Response Program

    Science.gov (United States)

    Implementing an emergency response program along with your risk management plan may be required if you have at least one Program 2 or 3 process in place, and if your employees will respond to some releases involving regulated toxic or flammable substances.

  10. EMSC program manager survey on education of prehospital providers.

    Science.gov (United States)

    Ngo, Thuy L; Belli, Karen; Shah, Manish I

    2014-01-01

    Although pediatric-specific objectives for the initial education of prehospital providers have been established, uniform implementation of these objectives and guidelines for hours of required pediatric continuing education (CE) for prehospital providers have not been established. To examine the content and number of hours of pediatric-specific education that prehospital providers receive during initial certification and recertification. Second, to identify barriers to implementing specific requirements for pediatric education of prehospital providers. Electronic surveys were sent to 55 EMS for Children (EMSC) State Partnership grantee program managers inquiring about the certification and recertification processes of prehospital providers and barriers to receiving pediatric training in each jurisdiction. We had a 91% response rate for our survey. Specified pediatric education hours exist in more states and territories for recertification (63-67%) than initial certification (41%). Limitations in funding, time, instructors, and accessibility are barriers to enhancing pediatric education. Modifying statewide policies on prehospital education and increasing hands-on training may overcome identified barriers.

  11. Preliminary program evaluation of emergency department HIV prevention counseling.

    Science.gov (United States)

    Sitlinger, Andrea P; Lindsell, Christopher J; Ruffner, Andrew H; Wayne, D Beth; Hart, Kimberly W; Trott, Alexander T; Fichtenbaum, Carl J; Lyons, Michael S

    2011-07-01

    Controversy surrounds the linkage of prevention counseling with emergency department (ED)-based HIV testing. Further, the effectiveness and feasibility of prevention counseling in the ED setting is unknown. We investigate these issues by conducting a preliminarily exploration of several related aspects of our ED's HIV prevention counseling and testing program. Our urban, academic ED provides formal client-centered prevention counseling in conjunction with HIV testing. Five descriptive, exploratory observations were conducted, involving surveys and analysis of electronic medical records and programmatic data focused on (1) patient perception and feasibility of prevention counseling in the ED, (2) patient perceptions of the need to link prevention counseling with testing, and (3) potential effectiveness of providing prevention counseling in conjunction with ED-based HIV testing. Of 110 ED patients surveyed after prevention counseling and testing, 98% believed privacy was adequate, and 97% reported that their questions were answered. Patients stated that counseling would lead to improved health (80%), behavioral changes (72%), follow-up testing (77%), and discussion with partners (74%). However, 89% would accept testing without counseling, 32% were willing to seek counseling elsewhere, and 26% preferred not to receive the counseling. Correct responses to a 16-question knowledge quiz increased by 1.6 after counseling (95% confidence interval 1.3 to 12.0). The program completed counseling for 97% of patients tested; however, 6% of patients had difficulty recalling the encounter and 13% denied received testing. Among patients undergoing repeated testing, there was no consistent change in self-reported risk behaviors. Participants in the ED prevention counseling and testing program considered counseling acceptable and useful, though not required. Given adequate resources, prevention counseling can be provided in the ED, but it is unlikely that all patients benefit

  12. Mixed Waste Integrated Program emerging technology development

    International Nuclear Information System (INIS)

    Berry, J.B.; Hart, P.W.

    1994-01-01

    The US Department of Energy (DOE) is responsible for the management and treatment of its mixed low-level wastes (MLLW). MLLW are regulated under both the Resource Conservation and Recovery Act and various DOE orders. Over the next 5 years, DOE will manage over 1.2 m 3 of MLLW and mixed transuranic (MTRU) wastes. In order to successfully manage and treat these mixed wastes, DOE must adapt and develop characterization, treatment, and disposal technologies which will meet performance criteria, regulatory approvals, and public acceptance. Although technology to treat MLLW is not currently available without modification, DOE is committed to developing such treatment technologies and demonstrating them at the field scale by FY 1997. The Office of Research and Development's Mixed Waste Integrated Program (MWIP) within the DOE Office of Environmental Management (EM), OfFice of Technology Development, is responsible for the development and demonstration of such technologies for MLLW and MTRU wastes. MWIP advocates and sponsors expedited technology development and demonstrations for the treatment of MLLW

  13. Mixed Waste Integrated Program emerging technology development

    Energy Technology Data Exchange (ETDEWEB)

    Berry, J.B. [Oak Ridge National Lab., TN (United States); Hart, P.W. [USDOE, Washington, DC (United States)

    1994-06-01

    The US Department of Energy (DOE) is responsible for the management and treatment of its mixed low-level wastes (MLLW). MLLW are regulated under both the Resource Conservation and Recovery Act and various DOE orders. Over the next 5 years, DOE will manage over 1.2 m{sup 3} of MLLW and mixed transuranic (MTRU) wastes. In order to successfully manage and treat these mixed wastes, DOE must adapt and develop characterization, treatment, and disposal technologies which will meet performance criteria, regulatory approvals, and public acceptance. Although technology to treat MLLW is not currently available without modification, DOE is committed to developing such treatment technologies and demonstrating them at the field scale by FY 1997. The Office of Research and Development`s Mixed Waste Integrated Program (MWIP) within the DOE Office of Environmental Management (EM), OfFice of Technology Development, is responsible for the development and demonstration of such technologies for MLLW and MTRU wastes. MWIP advocates and sponsors expedited technology development and demonstrations for the treatment of MLLW.

  14. Assessing the New Competencies for Resident Education: A Model from an Emergency Medicine Program.

    Science.gov (United States)

    Reisdorff, Earl J.; Hayes, Oliver W.; Carlson, Dale J.; Walker, Gregory L.

    2001-01-01

    Based on the experience of Michigan State University's emergency medicine residency program, proposes a practical method for modifying an existing student evaluation format. The model provides a template other programs could use in assessing residents' acquisition of the knowledge, skills, and attitudes reflected in the six general competencies…

  15. Factors influencing the suicide intervention skills of emergency medical services providers

    OpenAIRE

    Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

    2017-01-01

    ABSTRACT Background: Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. Aims: To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Method: Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey asses...

  16. Emergency medical assistance programs for nuclear power reactors

    International Nuclear Information System (INIS)

    Linnemann, R.E.; Mettler, F.A. Jr.

    1977-01-01

    This paper deals with a simple but practical medical support of geographically distributed nuclear reactors in isolated areas. A staff of experts at a centre devote their full attention to accident prevention and preparedness at reactor sites. They establish and maintain emergency medical programs at reactor sites and nearby support hospitals. The emphasis is on first aid and emergency treatment by medical attendants who are not and cannot be experts in radiation but do know how to treat patients. (author)

  17. A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

    Science.gov (United States)

    Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

    2006-09-01

    Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

  18. Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program.

    Science.gov (United States)

    Kant, Rebecca E; Vejar, Maria; Parnes, Bennett; Mulder, Joy; Daddato, Andrea; Matlock, Daniel D; Lum, Hillary D

    2018-05-03

    This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. Published by Elsevier Inc.

  19. Training programs for emergency response personnel at Hanford

    International Nuclear Information System (INIS)

    Oscarson, E.E.

    1979-01-01

    The Three Mile Island reactor accident has focused attention on emergency planning and preparedness including selection and training of personnel. At Hanford, Pacific Northwest Laboratory (PNL) is in the unique position of providing emergency response personnel, planning, training and equipment not only for its own organization and facilities but also for the Hanford Site in general, as well as the Interagency Radiological Assistance Plan (IRAP) Region 8 Team. Team members are chosen for one or more of the emergency teams based upon professional education and/or experience as well as interest, aptitude and specialized knowledge. Consequently, the initial training orientation of each new team member is not directed toward general professional ability, but rather toward specialized knowledge required to carry out their assigned emergency tasks. Continual training and practice is necessary to maintain the interest and skills for effectively coping with major emergencies. The types of training which are conducted include: tests of emergency systems and/or procedures; drills involving plant employees and/or emergency team members (e.g., activation of emergency notification systems); short training sessions on special topics; and realistic emergency exercises involving the simulation of major accidents wherein the emergency team must solve specific problems on a real time basis

  20. Provision of prehospital emergency medical services in Punjab, Pakistan: Case study of a public sector provider.

    Science.gov (United States)

    Sriram, Veena M; Naseer, Rizwan; Hyder, Adnan A

    2017-12-01

    The availability and quality of emergency medical services in low- and middle-income countries, including Pakistan, are extremely limited. New models for prehospital emergency medical services provision have recently emerged across multiple sectors, and research on these models is urgently needed to inform current and future emergency medical services systems in low-resource settings. The objective of this case study was to provide a comprehensive description of the organizational structure and service delivery model of a public sector provider in the Punjab Province of Pakistan, Rescue 1122, with a focus on operations in Lahore. We used case study methodology to systematically describe the organizational model of Rescue 1122. Qualitative data were collected during an in-person site visit to Lahore in June 2013. Three sources were utilized-semi-structured in-depth interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. Rescue 1122 is based on a legal framework that provides public financing for EMS, resulting in financial stability for the service. The organization has also reportedly taken positive steps in engaging with communities, and in coordinating across EMS, fire and rescue. We noted benefits and challenges in scaling up the service to all districts in Punjab. Finally, some areas of improvement include supply chain management and expanded data utilization. Our case study highlights key components of the model, areas for strengthening, and opportunities for further research. Rescue 1122 provides an example of a government-financed and operated emergency medical system in a low-resource setting. Copyright © 2017. Published by Elsevier Inc.

  1. College Student Utilization of a Comprehensive Psychiatric Emergency Program

    Science.gov (United States)

    Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

    2013-01-01

    The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

  2. Medical error identification, disclosure, and reporting: do emergency medicine provider groups differ?

    Science.gov (United States)

    Hobgood, Cherri; Weiner, Bryan; Tamayo-Sarver, Joshua H

    2006-04-01

    To determine if the three types of emergency medicine providers--physicians, nurses, and out-of-hospital providers (emergency medical technicians [EMTs])--differ in their identification, disclosure, and reporting of medical error. A convenience sample of providers in an academic emergency department evaluated ten case vignettes that represented two error types (medication and cognitive) and three severity levels. For each vignette, providers were asked the following: 1) Is this an error? 2) Would you tell the patient? 3) Would you report this to a hospital committee? To assess differences in identification, disclosure, and reporting by provider type, error type, and error severity, the authors constructed three-way tables with the nonparametric Somers' D clustered on participant. To assess the contribution of disclosure instruction and environmental variables, fixed-effects regression stratified by provider type was used. Of the 116 providers who were eligible, 103 (40 physicians, 26 nurses, and 35 EMTs) had complete data. Physicians were more likely to classify an event as an error (78%) than nurses (71%; p = 0.04) or EMTs (68%; p error to the patient (59%) than physicians (71%; p = 0.04). Physicians were the least likely to report the error (54%) compared with nurses (68%; p = 0.02) or EMTs (78%; p error types, identification, disclosure, and reporting increased with increasing severity. Improving patient safety hinges on the ability of health care providers to accurately identify, disclose, and report medical errors. Interventions must account for differences in error identification, disclosure, and reporting by provider type.

  3. Osteopathic emergency medicine programs infrequently publish in high-impact emergency medicine journals.

    Science.gov (United States)

    Baskin, Sean M; Lin, Christina; Carlson, Jestin N

    2014-11-01

    Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. We performed a retrospective literature review using the Journal Citation Report database and identified the top five journals in the category of 'Emergency Medicine' by their 2011 Impact Factor. We examined all publications from each journal for 2011. For each article we recorded article type, authors' names, position of authorship (first, senior or other), the author's degree and affiliated institution. We present the data in raw numbers and percentages. The 2011 EM journals with the highest impact factor were the following: Annals of Emergency Medicine, Resuscitation, Journal of Trauma, Injury, and Academic Emergency Medicine. Of the 9,298 authors published in these journals in 2011; 1,309 (15%) claimed affiliation with U.S.-based EM programs, of which 16 (1%) listed their affiliations with eight different osteopathic EM programs. The 16 authors claimed affiliation with 8 of 46 osteopathic EM programs (17%), while 1,301 authors claimed affiliation with 104 of 148 (70%) U.S.-based allopathic programs. Authors from osteopathic EM programs are under-represented in the top EM journals. With the pending ACGME/AOA merger, there is a significant opportunity for improvement in the rate of publication of osteopathic EM programs in top tier EM journals.

  4. Training in Emergency Obstetrics: A Needs Assessment of U.S. Emergency Medicine Program Directors

    Directory of Open Access Journals (Sweden)

    Daniel W. Robinson

    2017-12-01

    Full Text Available Introduction Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs. Methods We sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH, shoulder dystocia, and breech presentation through email invitations to all program directors (PD of U.S. EM residency programs. The survey focused on curricular details as well as the comfort level of the PDs in the preparation of their graduating residents to treat obstetrical emergencies and normal vaginal deliveries. Results Our survey had a 55% return rate (n=105/191. Of the residencies responding, 75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2–4 weeks long occurring in post-graduate year one. The most common teaching method was didactics (84.1–98.1%, followed by oral cases for pre-eclampsia (48% and PPH (37.2%, and homemade simulation for shoulder dystocia (37.5% and breech delivery (33.3%. The PDs’ comfort about residency graduate skills was highest for normal spontaneous vaginal delivery, pre-eclampsia, and PPH. PDs were not as comfortable about their graduates’ skill in handling shoulder dystocia or breech delivery. Conclusion Our survey found that PDs are less comfortable in their graduates’ ability to perform non-routine emergency obstetrical procedures.

  5. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

    OpenAIRE

    Lee, Sungmin; Lee, Chanam; Rodiek, Susan

    2017-01-01

    Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 201...

  6. National Energy Board Emergency Management Program : annex to Natural Resources Canada Civil Emergency Plan no. 004

    International Nuclear Information System (INIS)

    Lever, G.; LeMay, R.

    2006-01-01

    As a matter of primary public interest, safety is included in the National Energy Board's (NEB) mandate. The Board is responsible for ensuring companies involved with energy development and pipelines comply with regulations concerning the safety of employees, the public, and the environment. The purpose of the NEB's Emergency Management Program is to establish a prompt and coordinated response to an emergency which occurs at any facility or operation regulated by the NEB; promote safety and security and assure compliance with regulatory requirements in order to protect the public, workers, property and the environment during the life cycle of facilities and operations; and, have a documented set of procedures that accomplish these objectives. The Board ensures that companies identify and manage the potential hazards associated with their facilities; conduct a risk analysis of those hazards; and, manage the risks in order to protect the public and personnel, the security of the facilities and the environment. All companies under the Board's jurisdiction are responsible for developing and maintaining an Emergency Response and Preparedness Program for all aspects of their operations. In the event an emergency occurs, the regulated company is responsible for responding to the emergency and coordinating emergency response activities. Typically, the NEB responds on site to incidents that result in death or serious injury; involve a significant release of hydrocarbons; could result in potential or real impact due to loss of service; pose imminent threats identified by Public Safety and Emergency Preparedness Canada or other agencies; attract significant media attention, or on the advice of Natural Resources Canada or other federal Agencies. The first part of this document described the initial response check list while the second part outlined the Emergency response framework. 2 tabs., 3 figs., 15 appendices

  7. Where There is No EMS: Lay Providers in Emergency Medical Services Care - EMS as a Public Health Priority.

    Science.gov (United States)

    Debenham, Sierra; Fuller, Matthew; Stewart, Matthew; Price, Raymond R

    2017-12-01

    By 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks. Debenham S , Fuller M , Stewart M , Price RR . Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593-595.

  8. Error identification, disclosure, and reporting: practice patterns of three emergency medicine provider types.

    Science.gov (United States)

    Hobgood, Cherri; Xie, Jipan; Weiner, Bryan; Hooker, James

    2004-02-01

    To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%), and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNs, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialogue with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhanced teamwork training will be required to further the transformation of the ED into a high-reliability organization.

  9. Factors influencing the suicide intervention skills of emergency medical services providers.

    Science.gov (United States)

    Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

    2017-01-01

    Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. EMS: Emergency medical services; SIRI: Suicide intervention response inventory.

  10. When the visit to the emergency department is medically nonurgent: provider ideologies and patient advice.

    Science.gov (United States)

    Guttman, N; Nelson, M S; Zimmerman, D R

    2001-03-01

    It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.

  11. Providing Appropriate Technology for Emerging Markets: Case Study on China’s Solar Thermal Industry

    Directory of Open Access Journals (Sweden)

    Jianghua Zhou

    2017-01-01

    Full Text Available Building on a case study of five Chinese solar thermal companies and one association, our study aims to understand how the innovator’s choices regarding the use of technology and organizational practices for new product development enable companies to design and diffuse appropriate technology in emerging markets. The study uncovers two critical factors that enhance the appropriateness of technology: redefining the identity of technology and building a local supply system. Our analysis shows that synergic innovation in both architecture and component leads to the appropriate functionalities desired by emerging markets. Moreover, modular design and the building of a local supply system enhance the process appropriateness of technology. Our study provides an empirical basis for advocating going beyond minor adaptations of existing products to creating appropriate technology for emerging markets, and extends our understandings of the upstream process of designing appropriate technology. Moreover, the emphasis on the local supply system reflects a holistic framework for shaping and delivering appropriate technology, expanding the existing research focus on the perspective of the technology itself. Our research also has managerial implications that may help firms tap into emerging markets.

  12. 48 CFR 1604.7201 - FEHB Program Large Provider Agreements.

    Science.gov (United States)

    2010-10-01

    ... FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Large Provider... into any Large Provider Agreement; and (ii) Not less than 60 days before exercising renewals or other...

  13. Out-of-hospital emergency care providers' work and challenges in a changing care environment.

    Science.gov (United States)

    Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2018-03-01

    Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

  14. Geriatric hip fracture management: keys to providing a successful program.

    Science.gov (United States)

    Basu, N; Natour, M; Mounasamy, V; Kates, S L

    2016-10-01

    Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

  15. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    Science.gov (United States)

    Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

    2016-01-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

  16. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    Directory of Open Access Journals (Sweden)

    Jennifer L. Wiler, MD, MBA

    2016-03-01

    Full Text Available In 2007, the Centers for Medicaid and Medicare Services (CMS created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS. As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM. For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  17. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

    Science.gov (United States)

    Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

    2016-03-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  18. Risk classification priorities in an emergency unit and outcomes of the service provided

    Directory of Open Access Journals (Sweden)

    Rafael Silva Marconato

    2017-12-01

    Full Text Available ABSTRACT Objective: to check the association of the proposed priorities of the institutional protocol of risk classification with the outcomes and evaluate the profile of the care provided in an emergency unit. Method: observational epidemiological study based on data from the computerized files of a Reference Emergency Unit. Care provided to adults was evaluated regarding risk classification and outcomes (death, hospitalization and hospital discharge based on the information recorded in the emergency bulletin. Results: the mean age of the 97,099 registered patients was 43.4 years; 81.5% cases were spontaneous demand; 41.2% had been classified as green, 15.3% yellow, 3.7% blue, 3% red and 36.and 9% had not received a classification; 90.2% of the patients had been discharged, 9.4% hospitalized and 0.4% had died. Among patients who were discharged, 14.7% had been classified as yellow or red, 13.6% green or blue, and 1.8% as blue or green. Conclusion: the protocol of risk classification showed good sensitivity to predict serious situations that can progress to death or hospitalization.

  19. Utilization of underground coal gasification to provide electric power and emerging nations

    International Nuclear Information System (INIS)

    Boysen, J.E.; Beaver, F.W.; Schmit, C.R.; Daly, D.J.; Groenewold, G.H.

    1992-01-01

    Underground coal gasification (UCG) is a process conceived over a hundred years ago and used successfully, since the 1940s, to generate low-Btu gas for electric power production. The process is applicable to many coal resources that cannot, for a variety of reasons, be economically produced. While UCG cannot compete economically with conventional oil gas, and coal reserves, emerging nations requiring electric power for development of an industrial infrastructure may provide the niche market that is necessary for the commercial development of UCG. Recent UCG field testing, conducted in the United States, demonstrated that UCG could be successfully conducted without adverse environmental impact. This testing also resulted in increased understanding of the interactions between the UCG process and the local hydrogeological environment. With this knowledge, the probability of successful commercial UCG development can be increased by selecting a UCG site with hydrogeologically and economically favorable properties. And approach for commercial UCG development for producing electric power in emerging nations is presented

  20. Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.

    Science.gov (United States)

    Schilling, Samantha; Murray, Ashlee; Mollen, Cynthia J; Wedin, Tara; Fein, Joel A; Scribano, Philip V

    2017-07-03

    The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care. We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached. Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all. Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.

  1. Climate Literacy and Cyberlearning: Emerging Platforms and Programs

    Science.gov (United States)

    McCaffrey, M. S.; Wise, S. B.; Buhr, S. M.

    2009-12-01

    With the release of the Essential Principles of Climate Science Literacy: A Guide for Individuals and Communities in the Spring of 2009, an important step toward an shared educational and communication framework about climate science was achieved. Designed as a living document, reviewed and endorsed by the thirteen federal agencies in the U.S. Climate Change Science Program (now U.S. Global Change Research Program), the Essential Principles of Climate Literacy complement other Earth system literacy efforts. A variety of emerging efforts have begun to build on the framework using a variety of cyberlearning tools, including an online Climate Literacy course developed by Education and Outreach group at CIRES, the Cooperative Institute for Research in Environmental Sciences, and the Independent Learning program of the Continuing Education Division at the University of Colorado at Boulder. The online course, piloted during the Summer of 2009 with formal classroom teachers and informal science educators, made use of the online Climate Literacy Handbook, which was developed by CIRES Education and Outreach and the Encyclopedia of Earth, which is supported by the National Council for Science and the Environment and hosted by Boston University. This paper will explore challenges and opportunities in the use of cyberlearning tools to support climate literacy efforts, highlight the development of the online course and handbook, and note related emerging cyberlearning platforms and programs for climate literacy, including related efforts by the Climate Literacy Network, the NASA Global Climate Change Education programs, the National STEM Education Distributed Learning (NSDL) and AAAS Project 2061.

  2. Radioactive source recovery program responses to neutron source emergencies

    International Nuclear Information System (INIS)

    Dinehart, S.M.; Hatler, V.A.; Gray, D.W.; Guillen, A.D.

    1997-01-01

    Recovery of neutron sources containing Pu 239 and Be is currently taking place at Los Alamos National Laboratory. The program was initiated in 1979 by the Department of Energy (DOE) to dismantle and recover sources owned primarily by universities and the Department of Defense. Since the inception of this program, Los Alamos has dismantled and recovered more than 1000 sources. The dismantlement and recovery process involves the removal of source cladding and the chemical separation of the source materials to eliminate neutron emissions. While this program continues for the disposal of 239 Pu/Be sources, there is currently no avenue for the disposition of any sources other than those containing Pu 239 . Increasingly, there have been demands from agencies both inside and outside the Federal Government and from the public to dispose of unwanted sources containing 238 Pu/Be and 241 Am/Be. DOE is attempting to establish a formal program to recover these sources and is working closely with the Nuclear Regulatory Commission (NRC) on a proposed Memorandum of Understanding to formalize an Acceptance Program. In the absence of a formal program to handle 238 Pu/Be and 241 Am/Be neutron sources, Los Alamos has responded to several emergency requests to receive and recover sources that have been determined to be a threat to public health and safety. This presentation will: (1) review the established 239 Pu neutron source recovery program at Los Alamos, (2) detail plans for a more extensive neutron source disposal program, and (3) focus on recent emergency responses

  3. Children's safety initiative: a national assessment of pediatric educational needs among emergency medical services providers.

    Science.gov (United States)

    Hansen, Matthew; Meckler, Garth; Dickinson, Caitlyn; Dickenson, Kathryn; Jui, Jonathan; Lambert, William; Guise, Jeanne-Marie

    2015-01-01

    Emergency medical services (EMS) providers may have critical knowledge gaps in pediatric care due to lack of exposure and training. There is currently little evidence to guide educators to the knowledge gaps that most need to be addressed to improve patient safety. The objective of this study was to identify educational needs of EMS providers related to pediatric care in various domains in order to inform development of curricula. The Children's Safety Initiative-EMS performed a three-phase Delphi survey on patient safety in pediatric emergencies among providers and content experts in pediatric emergency care, including physicians, nurses, and prehospital providers of all levels. Each round included questions related to educational needs of providers or the effect of training on patient safety events. We identified knowledge gaps in the following domains: case exposure, competency and knowledge, assessment and decision making, and critical thinking and proficiency. Individual knowledge gaps were ranked by portion of respondents who ranked them "highly likely" (Likert-type score 7-10 out of 10) to contribute to safety events. There were 737 respondents who were included in analysis of the first phase of the survey. Paramedics were 50.8% of respondents, EMT-basics/first responders were 22%, and physicians 11.4%. The top educational priorities identified in the final round of the survey include pediatric airway management, responder anxiety when working with children, and general pediatric skills among providers. The top three needs in decision-making include knowing when to alter plans mid-course, knowing when to perform an advanced airway, and assessing pain in children. The top 3 technical or procedural skills needs were pediatric advanced airway, neonatal resuscitation, and intravenous/intraosseous access. For neonates, specific educational needs identified included knowing appropriate vital signs and preventing hypothermia. This is the first large-scale Delphi

  4. Providing Effective Professional Development: Lessons from the Eisenhower Program.

    Science.gov (United States)

    Porter, Andrew C.; Garet, Michael S.; Desimone, Laura M.; Birman, Beatrice F.

    2003-01-01

    Reports on two studies evaluating the effectiveness of the federal government's Eisenhower Professional Development Program. Describes high quality professional development of in-service teachers, changes in teaching practice, six key practices identified in literature, and the relationship between district policies and the quality of professional…

  5. How does a Belgian health care provider deal with a request for emergency contraception?

    Science.gov (United States)

    Peremans, Lieve; Verhoeven, Veronique; Philips, Hilde; Denekens, Joke; Van Royen, Paul

    2007-12-01

    To evaluate how Belgian health care providers deal with a request for emergency contraception. In 2002-2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay. All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents. The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.

  6. Osteopathic Emergency Medicine Programs Infrequently Publish in High-Impact Emergency Medicine Journals

    OpenAIRE

    Baskin, Sean M; Lin, Christina; Carlson, Jestin N

    2014-01-01

    Introduction: Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. Methods: We performed a retrospective literature re...

  7. Civil Defense, U. S. A.: A Programmed Orientation to Civil Defense. Unit 4. Warning, Emergency Operations, and Support Programs.

    Science.gov (United States)

    Defense Civil Preparedness Agency (DOD), Battle Creek, MI.

    The need for, and a description of, emergency functions required to save lives and protect property in nuclear or natural disasters are presented. Topics discussed include: (1) The Civil Defense Warning System, (2) Introduction to the Emergency Operations Program, (3) Five subprograms of the Emergency Operations Program, (4) Emergency Operations…

  8. Contraception Initiation in the Emergency Department: A Pilot Study on Providers' Knowledge, Attitudes, and Practices.

    Science.gov (United States)

    Liles, Iyanna; Haddad, Lisa B; Lathrop, Eva; Hankin, Abigail

    2016-05-01

    Almost half of all pregnancies in the United States are unintended; these pregnancies are associated with adverse outcomes. Many reproductive-age females seek care in the emergency department (ED), are at risk of pregnancy, and are amenable to contraceptive services in this setting. Through a pilot study, we sought to assess ED providers' current practices; attitudes; and knowledge of emergency contraception (EC) and nonemergency contraception (non-EC), as well as barriers with respect to contraception initiation. ED physicians and associate providers in Georgia were e-mailed a link to an anonymous Internet questionnaire using state professional databases and contacts. The questionnaire included Likert scales with multiple-choice questions to assess study objectives. Descriptive statistics were generated as well as univariate analyses using χ(2) and Fisher exact tests. A total of 1232 providers were e-mailed, with 119 questionnaires completed. Participants were predominantly physicians (80%), men (59%), and individuals younger than 45 years (59%). Common practices were referrals (96%), EC prescriptions (77%), and non-EC prescriptions (40%). Common barriers were perceived as low likelihood for follow-up (63%), risk of complications (58%), and adverse effects (51%). More than 70% of participants correctly identified the highly effective contraceptive methods, 3% identified the correct maximum EC initiation time, and 42% correctly recognized pregnancy as a higher risk than hormonal contraception use for pulmonary embolism. Most ED providers in this pilot study referred patients for contraception; however, there was no universal contraceptive counseling and management. Many ED providers in this study had an incorrect understanding of the efficacy, risks, and eligibility associated with contraceptive methods. This lack of understanding may affect patient access and be a barrier to patient care.

  9. Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability.

    Science.gov (United States)

    Spielberg, Freya; Kurth, Ann E; Severynen, Anneleen; Hsieh, Yu-Hsiang; Moring-Parris, Daniel; Mackenzie, Sara; Rothman, Richard

    2011-06-01

    Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

  10. Development and Implementation of an Ultrasound-Guided Peripheral Intravenous Catheter Program for Emergency Nurses.

    Science.gov (United States)

    Edwards, Courtney; Jones, Jodi

    2018-01-01

    Emergency medical care often necessitates placement of peripheral intravenous (PIV) catheters. When traditional methods for obtaining PIV access are not successful, ultrasound guidance is a rescue technique for peripheral vascular placement that improves the quality of patient care. The aim of this training program was to develop a process where emergency nurses would be competent to perform ultrasound guided PIV to improve the quality of patient care delivered while reducing throughput time. Administrative program development required creating a nursing practice statement, procedure guideline, operational plan, and competency validation. A training program comprising both didactic and hands-on training was developed and provided by emergency medicine physicians with formal ultrasound fellowship training. In determining whether the training program was adequate in preparing the student to place an ultrasound-guided PIV, 92.9% of students "agreed" or "strongly agreed." In having confidence in their ability to obtain an ultrasound guided PIV catheter placement, 35.7% of respondents "agreed" and 64.3% "strongly agreed." In finding it difficult to be successful in achieving ultrasound guided PIV catheter placement, 71.4% of students "strongly disagreed" and 14.3% "disagreed." All students (100%) felt it was a feasible task to train nurses to successfully place ultrasound-guided PIV catheters and 71.4% of students strongly support continuing to provide this training program and competency validation. Establishment of an effective didactic and hands-on training program resulted in emergency department nurses becoming competent in placement of ultrasound guided PIV catheters to provide optimal patient care. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  11. The APT program plan: Providing an assured tritium production capability

    International Nuclear Information System (INIS)

    Lisowski, P.W.; Anderson, J.L.; Bishop, W.P.; Boggs, B.; Hall, K.

    1996-01-01

    Tritium is a radioactive hydrogen isotope used in all U.S. nuclear weapons. Because the half-life of tritium is short, 12.3 yr, it must be periodically replenished. To provide a new source, the U.S. Department of Energy (DOE) is sponsoring conceptual design and engineering development and demonstration activities for a plant that will use a high-power proton linear accelerator to produce tritium and will go on-line no later than 2007. The APT project is in the process of completing the conceptual design for a tritium production plant. In addition, there are several important areas under engineering development and demonstration that will ensure an efficient, cost-effective plant design and provide an adequate margin of tritium production. Information provided from this work will be used by the DOE in its 1998 choice of production technology implementation

  12. The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers' Practice Patterns

    Directory of Open Access Journals (Sweden)

    Schmitz, Gillian R

    2013-02-01

    Full Text Available AbstractObjectives: Cutaneous abscesses are commonly treated in the emergency department (ED. Although incision and drainage (I&D remains the standard treatment, there is little high quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage, that could be managed in an ED or outpatient setting.Methods: Four hundred and seventy four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED.Results: In total, 350 providers responded to the survey (74%. One hundred eighty nine respondents (54% were attending physicians, 135 (39% were residents and 26 (7% were mid-level providers. Most providers (76% used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. Only 48% of responders routinely used irrigation after I&D. Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73% only prescribed antibiotics if certain historical factors or physical findings were present on exam. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcal aureus (47%. Follow up visits were most frequently recommended at 48 hours unless wound was

  13. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider.

    Science.gov (United States)

    Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S

    2011-02-01

    PRIMARY CARE PROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking.

  14. Train Repathing in Emergencies Based on Fuzzy Linear Programming

    Directory of Open Access Journals (Sweden)

    Xuelei Meng

    2014-01-01

    Full Text Available Train pathing is a typical problem which is to assign the train trips on the sets of rail segments, such as rail tracks and links. This paper focuses on the train pathing problem, determining the paths of the train trips in emergencies. We analyze the influencing factors of train pathing, such as transferring cost, running cost, and social adverse effect cost. With the overall consideration of the segment and station capability constraints, we build the fuzzy linear programming model to solve the train pathing problem. We design the fuzzy membership function to describe the fuzzy coefficients. Furthermore, the contraction-expansion factors are introduced to contract or expand the value ranges of the fuzzy coefficients, coping with the uncertainty of the value range of the fuzzy coefficients. We propose a method based on triangular fuzzy coefficient and transfer the train pathing (fuzzy linear programming model to a determinate linear model to solve the fuzzy linear programming problem. An emergency is supposed based on the real data of the Beijing-Shanghai Railway. The model in this paper was solved and the computation results prove the availability of the model and efficiency of the algorithm.

  15. Train repathing in emergencies based on fuzzy linear programming.

    Science.gov (United States)

    Meng, Xuelei; Cui, Bingmou

    2014-01-01

    Train pathing is a typical problem which is to assign the train trips on the sets of rail segments, such as rail tracks and links. This paper focuses on the train pathing problem, determining the paths of the train trips in emergencies. We analyze the influencing factors of train pathing, such as transferring cost, running cost, and social adverse effect cost. With the overall consideration of the segment and station capability constraints, we build the fuzzy linear programming model to solve the train pathing problem. We design the fuzzy membership function to describe the fuzzy coefficients. Furthermore, the contraction-expansion factors are introduced to contract or expand the value ranges of the fuzzy coefficients, coping with the uncertainty of the value range of the fuzzy coefficients. We propose a method based on triangular fuzzy coefficient and transfer the train pathing (fuzzy linear programming model) to a determinate linear model to solve the fuzzy linear programming problem. An emergency is supposed based on the real data of the Beijing-Shanghai Railway. The model in this paper was solved and the computation results prove the availability of the model and efficiency of the algorithm.

  16. A reliability program for emergency diesel generators at nuclear power plants: Maintenance, surveillance, and condition monitoring

    International Nuclear Information System (INIS)

    Lofgren, E.V.; Henderson, W.; Burghardt, D.; Kripps, L.; Rothleder, B.

    1988-12-01

    This report is a companion report on NUREG/CR-5078, Volume 1, ''A Reliability Program for Emergency Diesel Generators at Nuclear Power Plants: Program Structure.'' The purpose of this report is to provide technical findings and insights related to: failure evaluation, troubleshooting, maintenance, surveillance, and condition monitoring. Examples and recommendations are provided for each of these areas based on actual emergency diesel generator (EDG) operating experience and the opinions of diesel generator experts. This report expands the more general guidance provided in Volume 1. In addition, a discussion of EDG interactions with other plant systems (e.g., instrument, air, service water, dc power) is provided since experience has shown that these support systems and their operation can adversely affect EDG reliability. Portions of this report have been designed for use by onsite personnel for evaluating operational characteristics of EDGs. 5 refs., 8 figs., 7 tabs

  17. Integrated model for providing tactical emergency medicine support (TEMS): analysis of 120 tactical situations.

    Science.gov (United States)

    Vainionpää, T; Peräjoki, K; Hiltunen, T; Porthan, K; Taskinen, A; Boyd, J; Kuisma, M

    2012-02-01

    Various models for organising tactical emergency medicine support (TEMS) in law enforcement operations exist. In Helsinki, TEMS is organised as an integral part of emergency medical service (EMS) and applied in hostage, siege, bomb threat and crowd control situations and in other tactical situations after police request. Our aim was to analyse TEMS operations, patient profile, and the level of on-site care provided. We conducted a retrospective cohort study of TEMS operations in Helsinki from 2004 to 2009. Data were retrieved from EMS, hospital and dispatching centre files and from TEMS reports. One hundred twenty TEMS operations were analysed. Median time from dispatching to arrival on scene was 10 min [Interquartile Range (IQR) 7-14]. Median duration of operations was 41 min (IQR 19-63). Standby was the only activity in 72 operations, four patients were dead on arrival, 16 requests were called off en route and patient examination or care was needed in 28 operations. Twenty-eight patients (records retrieved) were alive on arrival and were classified as trauma (n = 12) or medical (n = 16). Of traumas, two sustained a gunshot wound, one sustained a penetrating abdominal wound, three sustained medium severity injuries and nine sustained minor injuries. There was neither on-scene nor in-hospital mortality among patients who were alive on arrival. The level of on-site care performed was basic life support in all cases. The results showed that TEMS integrated to daily EMS services including safe zone working only was a feasible, rapid and efficient way to provide medical support to law enforcement operations. © 2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  18. Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions

    Directory of Open Access Journals (Sweden)

    Adam C Pomerleau

    2016-11-01

    Full Text Available INTRODUCTION: Our study sought to examine the opioid analgesic (OA prescribing decisions of emergency department (ED providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication, and hypothetical analgesic-prescribing decisions for their patients, family members, and themselves for different painful conditions. RESULTS: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]. A majority of these providers (82%; 95% CI = [77-87] took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71] agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25] would for an adult patient, 13% (95% CI = [10-16] would for an adult family member, and 6% (95% CI = [4-8] indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89] would prescribe OA for an adult patient, 75% (95% CI = [71-79] for an adult family member, and 52% (95% CI = [47-57] would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. CONCLUSION: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA

  19. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

    Science.gov (United States)

    Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

    2017-06-01

    Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (phistorical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  20. The role of programmed and emergent mechanisms of coordination

    DEFF Research Database (Denmark)

    Prætorius, Thim

    Hospitals face substantial coordination challenges. To meet this hospitals more and more use standardized work processes such as care pathways. By drawing on recent coordination theory that increasingly emphasizes the role of lateral and emergent interactions alongside traditional, programmed...... mechanisms of coordination, this paper finds that standardized work processes such as care pathways should be considered as a bundle of coordination mechanisms—plans and rules, objects, routines, roles and proximity—rather than a mechanism of its own. The bundle builds the accountability, predictability...... and common understanding needed to coordinate standardized care tasks. The analysis lends theoretical insights to the traditional view that see standardized work processes as programmed processes. For health care workers who design, implement and use care pathways to solve care tasks, the analysis calls...

  1. Ontario's emergency department process improvement program: the experience of implementation.

    Science.gov (United States)

    Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

    2015-06-01

    In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the

  2. 77 FR 36014 - Initial Test Program of Emergency Core Cooling Systems for Boiling-Water Reactors

    Science.gov (United States)

    2012-06-15

    ... NUCLEAR REGULATORY COMMISSION [NRC-2012-0134] Initial Test Program of Emergency Core Cooling... for public comment draft regulatory guide (DG), DG-1277, ``Initial Test Program of Emergency Core..., entitled, ``Initial Test Program of Emergency Core Cooling Systems for Boiling-Water Reactors,'' is...

  3. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider

    Directory of Open Access Journals (Sweden)

    Nidhi Mehrotra

    2011-02-01

    Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room

  4. A statewide model program to improve emergency department readiness for pediatric care.

    Science.gov (United States)

    Cichon, Mark E; Fuchs, Susan; Lyons, Evelyn; Leonard, Daniel

    2009-08-01

    Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. Since 1985, federally funded Emergency Medical Services for Children (EMSC) programs in each state have been working to improve the quality of pediatric emergency care. The Health Resources and Services Administration now requires that all EMSC grantees report on specific performance measures. This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.

  5. Crisis Reliability Indicators Supporting Emergency Services (CRISES): A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

    Science.gov (United States)

    Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Rhoads, Richard; Carson, Chris A

    2016-01-01

    Crisis and emergency psychiatric services are an integral part of the healthcare system, yet there are no standardized measures for programs providing these services. We developed the Crisis Reliability Indicators Supporting Emergency Services (CRISES) framework to create measures that inform internal performance improvement initiatives and allow comparison across programs. The framework consists of two components-the CRISES domains (timely, safe, accessible, least-restrictive, effective, consumer/family centered, and partnership) and the measures supporting each domain. The CRISES framework provides a foundation for development of standardized measures for the crisis field. This will become increasingly important as pay-for-performance initiatives expand with healthcare reform.

  6. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Victoria Weston

    2017-04-01

    Full Text Available Introduction: Emergency department (ED crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. Methods: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI. Secondary outcomes were defined as differences in median ED length of stay (LOS, median door-to-provider (DTP time, proportion of left without being seen (LWBS, and proportion of “very good” overall patient satisfaction scores. Results: Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs equated to a gain (ROI: 54% for resident TLPs and a loss (ROI: −31% for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317% and for attending TLPs (ROI: 86%. Median DTP time for resident TLPs was significantly lower (p<0.0001 than attending or historical control. Proportion of “very good” patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  7. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky. The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: an emergency management plan, with emphasis on the catastrophic earthquake; an Emergency Operations Center Duty Roster Manual; an Integrated Automated Emergency Management Information System (IAEMIS); and a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6, Volume III -- Chapter 7, and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume I, provides an introduction, summary and recommendations, and the emergency operations center direction and control

  8. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients.

    Science.gov (United States)

    Polak, Rani; Phillips, Edward M; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S; Burg, Tracey; Eisenberg, David

    2016-01-01

    Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges.

  9. Health-related Culinary Education: A Summary of Representative Emerging Programs for Health Professionals and Patients

    Science.gov (United States)

    Phillips, Edward M.; Nordgren, Julia; La Puma, John; La Barba, Julie; Cucuzzella, Mark; Graham, Robert; Harlan, Timothy S.; Burg, Tracey; Eisenberg, David

    2016-01-01

    Background: Beneficial correlations are suggested between food preparation and home food preparation of healthy choices. Therefore, there is an emergence of culinary medicine (CM) programs directed at both patients and medical professionals which deliver education emphasizing skills such as shopping, food storage, and meal preparation. Objective: The goal of this article is to provide a description of emerging CM programs and to imagine how this field can mature. Methods: During April 2015, 10 CM programs were identified by surveying CM and lifestyle medicine leaders. Program directors completed a narrative describing their program's structure, curricula, educational design, modes of delivery, funding, and cost. Interviews were conducted in an effort to optimize data collection. Results: All 10 culinary programs deliver medical education curricula educating 2654 health professionals per year. Educational goals vary within the domains of (1) provider's self-behavior, (2) nutritional knowledge and (3) prescribing nutrition. Six programs deliver patients' curricula, educating 4225 individuals per year. These programs' content varies and focuses on either specific diets or various culinary behaviors. All the programs' directors are health professionals who are also either credentialed chefs or have a strong culinary background. Nine of these programs offer culinary training in either a hands-on or visual demonstration within a teaching kitchen setting, while one delivers remote culinary tele-education. Seven programs track outcomes using various questionnaires and biometric data. Conclusions: There is currently no consensus about learning objectives, curricular domains, staffing, and facility requirements associated with CM, and there has been little research to explore its impact. A shared strategy is needed to collectively overcome these challenges. PMID:26937315

  10. Emergency fuels utilization guidebook. Alternative Fuels Utilization Program

    Energy Technology Data Exchange (ETDEWEB)

    1980-08-01

    The basic concept of an emergency fuel is to safely and effectively use blends of specification fuels and hydrocarbon liquids which are free in the sense that they have been commandeered or volunteered from lower priority uses to provide critical transportation services for short-duration emergencies on the order of weeks, or perhaps months. A wide variety of liquid hydrocarbons not normally used as fuels for internal combustion engines have been categorized generically, including limited information on physical characteristics and chemical composition which might prove useful and instructive to fleet operators. Fuels covered are: gasoline and diesel fuel; alcohols; solvents; jet fuels; kerosene; heating oils; residual fuels; crude oils; vegetable oils; gaseous fuels.

  11. Emergency Management Operations Process Mapping: Public Safety Technical Program Study

    Science.gov (United States)

    2011-02-01

    services Operational Activity Collect and Manage Cash Donations Once activated, refer cash donations to appropriate voluntary organizations...recovery operations. Operational Activity Conduct Euthanasia /Disposal Provide humane methods to euthanize affected animals to stop the spread of the...issue stop movement orders, and initiate animal vaccination and treatment programs, euthanasia efforts, or other protective measures designed to control

  12. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

    Directory of Open Access Journals (Sweden)

    Sungmin Lee

    2017-02-01

    Full Text Available Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS. Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA were analyzed at the census tract level (n = 264. Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

  13. Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers.

    Science.gov (United States)

    Lee, Sungmin; Lee, Chanam; Rodiek, Susan

    2017-02-08

    Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

  14. Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study.

    Science.gov (United States)

    Glasier, Anna; Manners, Rachel; Loudon, Joanna C; Muir, Aileen

    2010-12-01

    UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use. Mystery shopper study. EC was unobtainable from 5/40 pharmacies (12.5%), refused because of "contraindications" in 7 (17.5%) and offered in 28 (70%). Most pharmacists appeared nonjudgemental, over 75% asked appropriate questions about eligibility, and over 90% gave appropriate advice about use. EC was universally refused beyond 72 h after sex but universally provided when the date of the last menstrual period was uncertain. Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC. The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying. Copyright © 2010 Elsevier Inc. All rights reserved.

  15. Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

    Directory of Open Access Journals (Sweden)

    Colleen Diane Fant

    2017-12-01

    appropriateness of the curriculum.ConclusionWe present here a core curriculum in pediatric emergency care for district hospital level providers in Kenya which can be used as a framework for further development and implementation of training programs throughout sub-Saharan Africa.

  16. Trasax '90: An integrated transportation emergency response exercise program involving transuranic waste shipments

    International Nuclear Information System (INIS)

    Kouba, S.; Everitt, J.

    1991-01-01

    Over the last five years, the US Department of Energy (DOE), and several states and numerous local governments have been preparing for the transportation of transuranic (TRU) waste to be shipped to the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico, near Carlsbad. Seven western states, represented by the Western Governors' Association (WGA), submitted a report to the US Congress that discussed the concerns of their constituents related to the transportation of TRU waste through their communities. One of the three major concerns identified was emergency preparedness. Initial funding to resolve concerns identified in the WGA report to Congress was provided by the US Department of Transportation. Upon receiving funding, lead states were assigned responsibilities to devise programs aimed at increasing public confidence in the areas of most concern. The responsibility for emergency response readiness, as demonstrated through a program of training and responding to simulated accident scenarios, was accepted by the state of Colorado. The state of Colorado laid out an exercise program which expanded upon the DOE training programs already offered to emergency responders along Colorado's designated TRU-waste transportation corridor. The ongoing program included a full-scale field exercise staged in Colorado Springs and dubbed, ''TRANSAX '90.''

  17. Globalizing Technical Communication Programs: Visions, Challenges, and Emerging Directions

    DEFF Research Database (Denmark)

    Maylath, Bruce; Mousten, Birthe; Vandepitte, Sonia

    Speakers Maylath, Mousten and Vandepitte, co-authors of two chapters on what they call the Trans-Atlantic Project, will describe the programmatic framework for establishing the collaborative partnerships in which students studying technical writing in the U.S. work with students studying...... help achieve common program objectives, particularly in regard to intercultural negotiation and mediation processes. In addition, they will describe how they met course-specific objectives. For the technical writing course, such objectives included broadening students' awareness of the needs of readers...... translation in Europe to create procedural documents in Danish, Dutch, English, French, German and/or Italian. They will provide guidelines for  how international partnerships of this kind can be established between technical communication programs and translation programs anywhere, even in the abscence...

  18. Optimization of in-vivo monitoring program for radiation emergency response

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Wi Ho; Kim, Jong Kyung [Dept. of Nuclear Engineering, Hanyang University, Seoul (Korea, Republic of)

    2016-12-15

    In case of radiation emergencies, internal exposure monitoring for the members of public will be required to confirm internal contamination of each individual. In-vivo monitoring technique using portable gamma spectrometer can be easily applied for internal exposure monitoring in the vicinity of the on-site area. In this study, minimum detectable doses (MDDs) for '1'3'4Cs, {sup 137}Cs, and {sup 131}I were calculated adjusting minimum detectable activities (MDAs) from 50 to 1,000 Bq to find out the optimal in-vivo counting condition. DCAL software was used to derive retention fraction of Cs and I isotopes in the whole body and thyroid, respectively. A minimum detectable level was determined to set committed effective dose of 0.1 mSv for emergency response. We found that MDDs at each MDA increased along with the elapsed time. 1,000 Bq for {sup 134}Cs and {sup 137}Cs, and 100 Bq for {sup 131}I were suggested as optimal MDAs to provide in-vivo monitoring service in case of radiation emergencies. In-vivo monitoring program for emergency response should be designed to achieve the optimal MDA suggested from the present work. We expect that a reduction of counting time compared with routine monitoring program can achieve the high throughput system in case of radiation emergencies.

  19. Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

    Science.gov (United States)

    Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

    2015-07-01

    Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty

  20. Accreditation of emerging oral health professions: options for dental therapy education programs.

    Science.gov (United States)

    Gelmon, Sherril B; Tresidder, Anna Foucek

    2011-01-01

    The study explored the options for accreditation of educational programs to prepare a new oral health provider, the dental therapist. A literature review and interviews of 10 content experts were conducted. The content experts represented a wide array of interests, including individuals associated with the various dental stakeholder organizations in education, accreditation, practice, and licensure, as well as representatives of non-dental accrediting organizations whose experience could inform the study. Development of an educational accreditation program for an emerging profession requires collaboration among key stakeholders representing education, practice, licensure, and other interests. Options for accreditation of dental therapy education programs include establishment of a new independent accrediting agency; seeking recognition as a committee within the Commission on Accreditation of Allied Health Education Programs; or working with the Commission on Dental Accreditation (CODA) to create a new accreditation program within CODA. These options are not mutually exclusive, and more than one accreditation program could potentially exist. An educational accreditation program is built upon a well-defined field, where there is a demonstrated need for the occupation and for accreditation of educational programs that prepare individuals to enter that occupation. The fundamental value of accreditation is as one player in the overall scheme of improving the quality of higher education delivered to students and, ultimately, the delivery of health services. Leaders concerned with the oral health workforce will need to consider future directions and the potential roles of new oral health providers as they determine appropriate directions for educational accreditation for dental therapy.

  1. Why providers participate in clinical trials: considering the National Cancer Institute's Community Clinical Oncology Program.

    Science.gov (United States)

    McAlearney, Ann Scheck; Song, Paula H; Reiter, Kristin L

    2012-11-01

    The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute's Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Interviewees expressed both "altruistic" and "self-interested" motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. 78 FR 72089 - Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee...

    Science.gov (United States)

    2013-12-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6051-N] Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount... period entitled ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening...

  3. Genomic analysis of the Kiwifruit pathogen Pseudomonas syringae pv. actinidiae provides insight into the origins of an emergent plant disease.

    Directory of Open Access Journals (Sweden)

    Honour C McCann

    Full Text Available The origins of crop diseases are linked to domestication of plants. Most crops were domesticated centuries--even millennia--ago, thus limiting opportunity to understand the concomitant emergence of disease. Kiwifruit (Actinidia spp. is an exception: domestication began in the 1930s with outbreaks of canker disease caused by P. syringae pv. actinidiae (Psa first recorded in the 1980s. Based on SNP analyses of two circularized and 34 draft genomes, we show that Psa is comprised of distinct clades exhibiting negligible within-clade diversity, consistent with disease arising by independent samplings from a source population. Three clades correspond to their geographical source of isolation; a fourth, encompassing the Psa-V lineage responsible for the 2008 outbreak, is now globally distributed. Psa has an overall clonal population structure, however, genomes carry a marked signature of within-pathovar recombination. SNP analysis of Psa-V reveals hundreds of polymorphisms; however, most reside within PPHGI-1-like conjugative elements whose evolution is unlinked to the core genome. Removal of SNPs due to recombination yields an uninformative (star-like phylogeny consistent with diversification of Psa-V from a single clone within the last ten years. Growth assays provide evidence of cultivar specificity, with rapid systemic movement of Psa-V in Actinidia chinensis. Genomic comparisons show a dynamic genome with evidence of positive selection on type III effectors and other candidate virulence genes. Each clade has highly varied complements of accessory genes encoding effectors and toxins with evidence of gain and loss via multiple genetic routes. Genes with orthologs in vascular pathogens were found exclusively within Psa-V. Our analyses capture a pathogen in the early stages of emergence from a predicted source population associated with wild Actinidia species. In addition to candidate genes as targets for resistance breeding programs, our findings

  4. Continuity of operations planning in college athletic programs: The case for incorporating Federal Emergency Management Guidelines.

    Science.gov (United States)

    Hall, Stacey A; Allen, Brandon L; Phillips, Dennis

    2016-01-01

    College athletic departments have a responsibility to provide a safe environment for student-athletes; however, most colleges do not have a crisis management plan that includes procedures for displaced student-athletes or alternate facilities to perform athletic events. Continuity of operations planning ensures athletic programs are equipped to maintain essential functions during, or shortly after, a disruption of operations due to possible hazards. Previous studies have identified a lack of emergency preparedness and continuity planning in college athletic departments. The purpose of this article is to illustrate in detail one approach to disaster planning for college athletic departments, namely the Federal Emergency Management Agency (FEMA) continuity of operations framework. By adhering to FEMA guidelines and promoting a best practices model, athletic programs can effectively plan to address potential hazards, as well as protect the organization's brand, image, and financial sustainability after a crisis event.

  5. Environmental and emergency response capabilities of Los Alamos Scientific Laboratory's radiological air sampling program

    International Nuclear Information System (INIS)

    Gunderson, T.C.

    1980-05-01

    Environmental and emergency response radiological air sampling capabilities of the Environmental Surveillance Group at Los Alamos Scientific Laboratory are described. The air sampling program provides a supplementary check on the adequacy of containment and effluent controls, determines compliance with applicable protection guides and standards, and assesses potential environmental impacts on site environs. It also allows evaluation of potential individual and total population doses from airborne radionuclides that may be inhaled or serve as a source of external radiation. The environmental program is sufficient in scope to detect fluctuations and long-term trends in atmospheric levels of radioactivity originating onsite. The emergency response capabilities are designed to respond to both onsite unplanned releases and atmospheric nuclear tests

  6. Summer of Seasons Workshop Program for Emerging Educators in Earth System Science

    Science.gov (United States)

    Chaudhury, S. Raj

    2002-01-01

    Norfolk State University BEST Lab successfully hosted three Summer of Seasons programs from 1998-2001. The Summer of Seasons program combined activities during the summer with additional seminars and workshops to provide broad outreach in the number of students and teachers who participated. Lessons learned from the each of the first two years of this project were incorporated into the design of the final year's activities. The "Summer of Seasons" workshop program provided emerging educators with the familiarity and knowledge to utilize in the classroom curriculum materials developed through NASA sponsorship on Earth System Science. A special emphasis was placed on the use of advanced technologies to dispel the commonly held misconceptions regarding seasonal, climactic and global change phenomena.

  7. 76 FR 2686 - Video Programming and Emergency Access Advisory Committee; Announcement of Establishment and...

    Science.gov (United States)

    2011-01-14

    ... FEDERAL COMMUNICATIONS COMMISSION [DA 10-2320] Video Programming and Emergency Access Advisory... appointment of members of the Video Programming and Emergency Access Advisory Committee (``Committee'' or... change of the Committee's popular name to the Video Programming Accessibility Advisory Committee (``VPAAC...

  8. Emerging Connections: Quantum & Classical Optics Incubator Program Book

    Energy Technology Data Exchange (ETDEWEB)

    Lesky, Marcia [Optical Society of America, Washington, DC (United States)

    2016-11-06

    The Emerging Connections: Quantum & Classical Optics Incubator was a scientific meeting held in Washington, DC on 6-8 November 2016. This Incubator provided unique and focused experiences and valuable opportunities to discuss advances, challenges and opportunities regarding this important area of research. Quantum optics and classical optics have coexisted for nearly a century as two distinct, but consistent descriptions of light in their respective domains. Recently, a number of detailed examinations of the structure of classical light beams have revealed that effects widely thought to be solely quantum in origin also have a place in classical optics. These new quantum-classical connections are informing classical optics in meaningful ways specifically by expanding understanding of optical coherence. Simultaneously, relationships discovered with classical light beams now also serve as a vehicle to illuminate concepts that no longer solely belong to the quantum realm. Interference, polarization, coherence, complementarity and entanglement are a partial list of elementary notions that now appear to belong to both quantum and classical optics. The goal of this meeting was to bring emerging quantum-classical links into wider view and to indicate directions in which forthcoming and future work would promote discussion and lead to a more unified understanding of optics.

  9. Reducing emergency department waiting times by adjusting work shifts considering patient visits to multiple care providers

    NARCIS (Netherlands)

    Sinreich, D.; Jabali, O.; Dellaert, N.P.

    2012-01-01

    Reducing Emergency Department (ED) overcrowding in the hope of improving the ED's operational efficiency and health care delivery ranks high on every health care decision maker's wish list. The current study concentrates on developing efficient work shift schedules that make the best use of current

  10. The performance implications of outsourcing customer support to service providers in emerging versus established economies

    NARCIS (Netherlands)

    Raassens, N.; Wuyts, S.H.K.; Geyskens, I.

    Recent discussions in the business press query the contribution of customer-support outsourcing to firm performance. Despite the controversy surrounding its performance implications, customer-support outsourcing is still on the rise, especially to emerging markets. Against this backdrop, we study

  11. The performance implications of outsourcing customer support to service providers in emerging versus established economies

    NARCIS (Netherlands)

    Raassens, N.; Wuyts, S.; Geyskens, I.

    2014-01-01

    Recent discussions in the business press query the contribution of customer-support outsourcing to firm performance. Despite the controversy surrounding its performance implications, customer-support outsourcing is still on the rise, especially to emerging markets. Against this backdrop, we study

  12. Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

    Science.gov (United States)

    Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

    2015-01-01

    Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous

  13. Pop-up Library Makerspace: academic libraries provide flexible, supportive space to explore emerging technologies.

    OpenAIRE

    Groves, Antony

    2016-01-01

    The word Makerspace is a general term for a place where people get together to make things, create things and\\ud learn together. Antony Groves presents a look at a recent university library experiment hosting a pop-up makerspace. Working with local edtech leaders MakerClub and colleagues the library organised a two-hour workshop which offered the opportunity for students and staff to explore emerging technologies.

  14. 'REACTS'. A pragmatic approach for providing medical care and physician education for radiation emergencies

    International Nuclear Information System (INIS)

    Lushbaugh, C.C.; Andrews, G.A.; Huebner, K.F.; Cloutier, R.J.; Beck, W.L.; Berger, J.D.

    1976-01-01

    Because serious radiation incidents have been rare, few medical personnel (notably only some in France, Russia, Belgium, Canada, Yugoslavia, Japan, Great Britain and the United States) have first-hand experience in radiation-accident management. The generation of physicians who participated in those accidents now needs to pass on the bits of knowledge that were gleaned from them. These case histories are difficult for the local, non-radiology physician to obtain when he is called upon to help formulate the medical-emergency response plan required everywhere for licensing power reactors. The Radiation Emergency Assistance Center and Training Site (REACTS) in Oak Ridge, Tennessee, supported by the US Energy Research and Development Administration, is designed to meet these medical and educational needs. REACTS, located in the Oak Ridge Hospital of the Methodist Church, is not involved in the hospital's daily community functions except insofar as REACTS is the radiation emergency arm of the area's major disaster plan. Its dual mission is training physicians, nurses, and paramedical emergency personnel in radiation-accident management, and treating irradiated and contaminated persons. Its training activities are carried out by the Special Training Division of Oak Ridge Associated Universities. Formal courses in radiation medicine and health physics and practical laboratory experience are now conducted twice a year for physicians. They will be expanded in the future to include training of paramedical personnel. Follow-up studies of radiation-accident survivors are carried out in REACTS to ensure the preservation of valuable human data and radiation-accident experiences. This unique facility and its staff are dedicated to meet the needs of the far-flung public and private medical domains in the United States for nuclear-production energy

  15. Changing the paradigm of emergency response: The need for first-care providers.

    Science.gov (United States)

    Bobko, Joshua P; Kamin, Richard

    2015-01-01

    There is a major gap in the security of the critical infrastructure - civilian medical response to atypical emergencies. Clear evidence demonstrates that, despite ongoing improvements to the first-responder system, there exists an inherent delay in the immediate medical care at the scene of an emergency. This delay can only be reduced through a societal shift in reliance on police and fire response and by extending the medical system into all communities. Additionally, through analysis of military data, it is known that immediately addressing the common injury patterns following a traumatic event will save lives. The predictable nature of these injuries, coupled with an unavoidable delay in the arrival of first responders, necessitates the need for immediate care on scene. Initial care is often rendered by bystanders, typically armed only with basic first-aid training based on medical emergencies and does not adequately address the traumatic injury patterns seen in disasters. Implementing an approach similar to the American Cardiac Arrest Act can improve outcomes to traumatic events. This paper analyses the latest data on active shooter incidents and proposes that the creation of a network of trauma-trained medic extenders would improve all communities' resilience to catastrophic disaster.

  16. Effectiveness of a brief educational workshop intervention among primary care providers at 6 months: uptake of dental emergency supporting resources.

    Science.gov (United States)

    Skapetis, Tony; Gerzina, Tania M; Hu, Wendy; Cameron, W Ian

    2013-01-01

    Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop participants, 63% of whom were in rural or remote practice and engaged in providing primary care medical services, returned responses at 6 months on the perceived usefulness of the dental emergencies resource. Thirty percent of clinicians had used the dental emergencies resource within the six-month follow-up period. Significance was demonstrated between professional category and use of the resource, with emergency registrars utilising this resource most and GPs the least. The Dental Handbook, specifically designed for ED use, and tooth-filling material contained within this resource, were deemed the most useful components. There were overall positive open-ended question responses regarding the usefulness of the resource, especially when it was made available to clinicians who had attended the education workshops. Utilisation and perceived usefulness of a supporting resource at 6 months are indicators of the effectiveness of a short workshop educational intervention in the management of

  17. Assessing Program Efficiency: A Time and Motion Study of the Mental Health Emergency Care — Rural Access Program in NSW Australia

    Directory of Open Access Journals (Sweden)

    Emily Saurman

    2014-07-01

    Full Text Available The Mental Health Emergency Care-Rural Access Program (MHEC-RAP is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time is spent completing clinical paperwork. This finding emphasizes the importance of these services to program efficiency and the need to address variability of service provision to impact capacity. Currently, there is no efficiency benchmark for emergency telepsychiatry programs. Findings suggest that MHEC-RAP could increase its activity without affecting program responsiveness. T&M studies not only determine activity and time expenditure, but have a wider application assessing program efficiency by understanding, defining, and calculating capacity. T&M studies can inform future program development of MHEC-RAP and similar telehealth programs, both in Australia and overseas.

  18. 47 CFR 76.1503 - Carriage of video programming providers on open video systems.

    Science.gov (United States)

    2010-10-01

    ... service showing that the Notice of Intent has been served on all local cable franchising authorities... video programming provider within five business days of receiving a written request from the provider...

  19. Technology Assessment and Roadmap for the Emergency Radiation Dose Assessment Program

    Energy Technology Data Exchange (ETDEWEB)

    Turteltaub, K W; Hartman-Siantar, C; Easterly, C; Blakely, W

    2005-10-03

    A Joint Interagency Working Group (JIWG) under the auspices of the Department of Homeland Security Office of Research and Development conducted a technology assessment of emergency radiological dose assessment capabilities as part of the overall need for rapid emergency medical response in the event of a radiological terrorist event in the United States. The goal of the evaluation is to identify gaps and recommend general research and development needs to better prepare the Country for mitigating the effects of such an event. Given the capabilities and roles for responding to a radiological event extend across many agencies, a consensus of gaps and suggested development plans was a major goal of this evaluation and road-mapping effort. The working group consisted of experts representing the Departments of Homeland Security, Health and Human Services (Centers for Disease Control and the National Institutes of Health), Food and Drug Administration, Department of Defense and the Department of Energy's National Laboratories (see appendix A for participants). The specific goals of this Technology Assessment and Roadmap were to: (1) Describe the general context for deployment of emergency radiation dose assessment tools following terrorist use of a radiological or nuclear device; (2) Assess current and emerging dose assessment technologies; and (3) Put forward a consensus high-level technology roadmap for interagency research and development in this area. This report provides a summary of the consensus of needs, gaps and recommendations for a research program in the area of radiation dosimetry for early response, followed by a summary of the technologies available and on the near-term horizon. We then present a roadmap for a research program to bring present and emerging near-term technologies to bear on the gaps in radiation dose assessment and triage. Finally we present detailed supporting discussion on the nature of the threats we considered, the status of

  20. Technology Assessment and Roadmap for the Emergency Radiation Dose Assessment Program

    International Nuclear Information System (INIS)

    Turteltaub, K W; Hartman-Siantar, C; Easterly, C; Blakely, W

    2005-01-01

    A Joint Interagency Working Group (JIWG) under the auspices of the Department of Homeland Security Office of Research and Development conducted a technology assessment of emergency radiological dose assessment capabilities as part of the overall need for rapid emergency medical response in the event of a radiological terrorist event in the United States. The goal of the evaluation is to identify gaps and recommend general research and development needs to better prepare the Country for mitigating the effects of such an event. Given the capabilities and roles for responding to a radiological event extend across many agencies, a consensus of gaps and suggested development plans was a major goal of this evaluation and road-mapping effort. The working group consisted of experts representing the Departments of Homeland Security, Health and Human Services (Centers for Disease Control and the National Institutes of Health), Food and Drug Administration, Department of Defense and the Department of Energy's National Laboratories (see appendix A for participants). The specific goals of this Technology Assessment and Roadmap were to: (1) Describe the general context for deployment of emergency radiation dose assessment tools following terrorist use of a radiological or nuclear device; (2) Assess current and emerging dose assessment technologies; and (3) Put forward a consensus high-level technology roadmap for interagency research and development in this area. This report provides a summary of the consensus of needs, gaps and recommendations for a research program in the area of radiation dosimetry for early response, followed by a summary of the technologies available and on the near-term horizon. We then present a roadmap for a research program to bring present and emerging near-term technologies to bear on the gaps in radiation dose assessment and triage. Finally we present detailed supporting discussion on the nature of the threats we considered, the status of technology

  1. Telemedicine: an enhanced emergency care program for older adults

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2014-07-01

    Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models

  2. A comparative evaluation of the process of developing and implementing an emergency department HIV testing program

    Directory of Open Access Journals (Sweden)

    Weiser Sheri

    2011-03-01

    Full Text Available Abstract Background The 2006 Centers for Disease Control and Prevention (CDC HIV testing guidelines recommend screening for HIV infection in all healthcare settings, including the emergency department (ED. In urban areas with a high background prevalence of HIV, the ED has become an increasingly important site for identifying HIV infection. However, this public health policy has been operationalized using different models. We sought to describe the development and implementation of HIV testing programs in three EDs, assess factors shaping the adoption and evolution of specific program elements, and identify barriers and facilitators to testing. Methods We performed a qualitative evaluation using in-depth interviews with fifteen 'key informants' involved in the development and implementation of HIV testing in three urban EDs serving sizable racial/ethnic minority and socioeconomically disadvantaged populations. Testing program HIV prevalence ranged from 0.4% to 3.0%. Results Three testing models were identified, reflecting differences in the use of existing ED staff to offer and perform the test and disclose results. Factors influencing the adoption of a particular model included: whether program developers were ED providers, HIV providers, or both; whether programs took a targeted or non-targeted approach to patient selection; and the extent to which linkage to care was viewed as the responsibility of the ED. A common barrier was discomfort among ED providers about disclosing a positive HIV test result. Common facilitators were a commitment to underserved populations, the perception that testing was an opportunity to re-engage previously HIV-infected patients in care, and the support and resources offered by the medical setting for HIV-infected patients. Conclusions ED HIV testing is occurring under a range of models that emerge from local realities and are tailored to institutional strengths to optimize implementation and overcome provider

  3. Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury.

    Science.gov (United States)

    Poncet, Frédérique; Pradat-Diehl, Pascale; Lamontagne, Marie-Eve; Alifax, Anne; Fradelizi, Pascaline; Barette, Maude; Swaine, Bonnie

    2017-09-01

    A holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. This study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. We used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. We included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). Participant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality

  4. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department.

    Science.gov (United States)

    Weiner, Scott G; Griggs, Christopher A; Mitchell, Patricia M; Langlois, Breanne K; Friedman, Franklin D; Moore, Rebecca L; Lin, Shuo Cheng; Nelson, Kerrie P; Feldman, James A

    2013-10-01

    We compare emergency provider impression of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assess change in opioid pain reliever prescribing after prescription drug monitoring program review, and examine clinical factors associated with suspected drug-seeking behavior. This was a prospective observational study of emergency providers assessing a convenience sample of patients aged 18 to 64 years who presented to either of 2 academic medical centers with chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to 4 opioid prescriptions by greater than or equal to 4 providers in the 12 months before emergency department evaluation. Emergency providers completed data forms recording their impression of the likelihood of drug-seeking behavior, patient characteristics, and plan for prescribing pre- and post-prescription drug monitoring program review. Descriptive statistics were generated. We calculated agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program definition, and sensitivity, specificity, and positive predictive value of emergency provider impression, using prescription drug monitoring program criteria as the criterion standard. A multivariate logistic regression analysis was conducted to determine clinical factors associated with drug-seeking behavior. Thirty-eight emergency providers with prescription drug monitoring program access participated. There were 544 patient visits entered into the study from June 2011 to January 2013. There was fair agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program (κ=0.30). Emergency providers had sensitivity 63.2% (95% confidence interval [CI] 54.8% to 71.7%), specificity 72.7% (95% CI 68.4% to 77.0%), and positive predictive value 41.2% (95% CI 34.4% to 48

  5. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

    Science.gov (United States)

    Cotner, Bridget A; Ottomanelli, Lisa; O'Connor, Danielle R; Trainor, John K

    2018-06-01

    In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified. Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes. Some barriers to implementation occurred throughout the study, such as Veterans' lack of motivation and providers' difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team. Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

  6. System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package

    Science.gov (United States)

    Schnase, John L. (Inventor); Duffy, Daniel Q. (Inventor); Tamkin, Glenn S. (Inventor)

    2016-01-01

    A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

  7. Rallying the troops: a four-step guide to preparing a residency program for short-term weather emergencies.

    Science.gov (United States)

    Chow, Grant V; Hayashi, Jennifer; Hirsch, Glenn A; Christmas, Colleen

    2011-04-01

    Weather emergencies present a multifaceted challenge to residents and residency programs. Both the individual trainee and program may be pushed to the limits of physical and mental strain, potentially jeopardizing core competencies of patient care and professionalism. Although daunting, the task of preparing for these events should be a methodical process integrated into every residency training program. The core elements of emergency preparation with regard to inpatient services include identifying and staffing critical positions, motivating residents to consider the needs of the group over those of the individual, providing for basic needs, and planning activities in order to preserve team morale and facilitate recovery. The authors outline a four-step process in preparing a residency program for an anticipated short-term weather emergency. An example worksheet for emergency planning is included. With adequate preparation, residency training programs can maintain the highest levels of patient care, professionalism, and esprit de corps during weather emergencies. When managed effectively, emergencies may present an opportunity for professional growth and a sense of unity for those involved.

  8. Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.

    Science.gov (United States)

    Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren

    2009-04-01

    The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must

  9. Medicare program; requirements for the Medicare incentive reward program and provider enrollment. Final rule.

    Science.gov (United States)

    2014-12-05

    This final rule implements various provider enrollment requirements. These include: Expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to "backbill" for services performed prior to enrollment.

  10. 76 FR 54072 - Emergency Assistance for Livestock, Honeybees, and Farm-Raised Fish Program, Livestock Indemnity...

    Science.gov (United States)

    2011-08-31

    ... for Livestock, Honeybees, and Farm-Raised Fish Program, Livestock Indemnity Program, and General... clarifying amendments and corrections to the regulations for the Emergency Assistance for Livestock, Honeybees, and Farm-Raised Fish Program (ELAP) and the Livestock Indemnity Program (LIP) to clarify when...

  11. 5 CFR 630.1104 - Donations from a leave bank to an emergency leave transfer program.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Donations from a leave bank to an emergency leave transfer program. 630.1104 Section 630.1104 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Emergency Leave Transfer Program § 630.1104 Donations...

  12. Devolution's policy impact on non-emergency medical transportation in State Children's Health Insurance Programs.

    Science.gov (United States)

    Borders, Stephen; Blakely, Craig; Ponder, Linda; Raphael, David

    2011-01-01

    Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent.

  13. The women in emergency medicine mentoring program: an innovative approach to mentoring.

    Science.gov (United States)

    Welch, Julie L; Jimenez, Heather L; Walthall, Jennifer; Allen, Sheryl E

    2012-09-01

    Women in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine. To describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine. The program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004-2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the program's goals were tracked. A total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement. This innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring.

  14. Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

    Science.gov (United States)

    Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

    2015-01-01

    Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management

  15. User and provider perspectives on emergency obstetric care in a tanzanian rural setting

    DEFF Research Database (Denmark)

    Sørensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke

    2011-01-01

    The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems...

  16. Functional Foods Programs Serve as a Vehicle to Provide Nutrition Education to Groups

    Science.gov (United States)

    Cirignano, Sherri M.

    2011-01-01

    An increase in consumer interest in functional foods provides an opportunity for FCS educators to use this topic in Extension programming to promote current nutrition recommendations. The Functional Foods for Life Educational Programs (FFL) are a curriculum of six evidence-based mini-seminars that highlight specific functional foods that have the…

  17. Office of Academic Assessment provides workshops on the program assessment process

    OpenAIRE

    Williams, Meghan

    2008-01-01

    The Office of Academic Assessment is once again providing a series of workshops on the program assessment process during the spring semester. The workshops will offer a wide range of resources to assist faculty and administrators as they focus on teaching and learning in their programs.

  18. Development of a recovery education program for inpatient mental health providers.

    Science.gov (United States)

    Chen, Shu-Ping; Krupa, Terry; Lysaght, Rosemary; McCay, Elizabeth; Piat, Myra

    2014-12-01

    Mental health system transformation toward a recovery-orientation has created a demand for education to equip providers with recovery competencies. This report describes the development of a recovery education program designed specifically for inpatient providers. Part 1 of the education is a self-learning program introducing recovery concepts and a recovery competency framework; Part 2 is a group-learning program focusing on real-life dilemmas and applying the Appreciative Inquiry approach to address these clinical dilemmas. A pilot study with a pretest/posttest design was used to evaluate the program. Participants included 26 inpatient multidisciplinary providers from 3 hospitals. The results showed participants' improvement on recovery knowledge (z = -2.55, p = .011) after the self-learning program. Evaluations of the group-learning program were high (4.21 out of 5). These results support continued efforts to refine the program. Inpatient providers could use this program to lead interprofessional practice in promoting recovery. (c) 2014 APA, all rights reserved.

  19. Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership.

    Science.gov (United States)

    Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James

    2009-01-01

    The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.

  20. 75 FR 8391 - Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)

    Science.gov (United States)

    2010-02-24

    ... Conversion Program (ALCP) provides funding for the physical costs of converting some or all the units of an... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-10] Assisted Living Conversion... rehabilitate, modernize, or retrofit aging structure, common areas, or individual dwelling units through the...

  1. Emerging and encouraging trends in e-prescribing adoption among providers and pharmacies.

    Science.gov (United States)

    Gabriel, Meghan E; Furukawa, Michael F; Vaidya, Varun

    2013-09-01

    The objective of this study is to describe the growth in provider (physician, nurse practitioner, and physician assistant) adoption of e-prescribing and the growth in pharmacies actively accepting e-prescriptions using nationally representative data from December 2008 to December 2012. Additionally, this study explored e-prescribing adoption variation by urban and rural counties. Descriptive analysis of nationally representative, transactional e-prescribing data. Data for this analysis were from Surescripts. Surescripts is a leading e-prescription network utilized by a majority of all chain, franchise, or independently owned pharmacies in the United States routing prescriptions for more than 240 million patients through their network. The total number of prescribers, including physicians, nurse practitioners, and physician assistants e-prescribing via an electronic health record (EHR) on the Surescripts network has increased from 7% to 54%. Additionally, the number of pharmacies actively accepting e-prescriptions is 94%. These increases in pharmacies actively accepting e-prescriptions and the provider's eprescribing mirror the increase in the volume of e-prescriptions sent on the Surescripts network. This analysis shows that the vast majority of pharmacies in the United States are able to accept e-prescriptions and over half of providers are e-prescribing via an EHR.

  2. Residential immersive life skills programs for youth with disabilities: service providers' perceptions of change processes.

    Science.gov (United States)

    King, Gillian; McPherson, Amy; Kingsnorth, Shauna; Stewart, Debra; Glencross-Eimantas, Tanya; Jones-Galley, Kimberlea; Morrison, Andrea; Isihi, Ana Maria; Gorter, Jan Willem

    2015-05-01

    Residential immersive life skills (RILS) programs are designed to equip youth with physical disabilities with the foundational life skills required to assume adult roles. The objective was to determine RILS service providers' perceptions of the active ingredients of the intervention change process. Thirty-seven service providers from various disciplines completed measures to assess expertise status and participated in qualitative interviews. Qualitative themes were derived, and similarities and differences in themes were identified for blinded groups of novices, intermediates, and experts. The three main themes, reflecting change processes, were: (a) creating a supportive program atmosphere with multiple opportunities for learning, (b) using strategies to support, encourage, and engage youth, and (c) intentionally fostering youth experiences of skill development, social interaction, and pride in accomplishment. In contrast to the novices, experts displayed a more holistic perspective and paid attention to higher-order issues such as providing opportunities and enabling youth. The findings indicate how RILS service providers work to create a program atmosphere and employ strategies to intentionally foster particular youth experiences. The findings explicate service providers' theories of practice, the intentional design of RILS program environments to bring about client change, and the value of service provider expertise. Implications for Rehabilitation Service providers of youth independence-oriented life skills programs can intentionally create a learning-oriented and supportive program atmosphere by using non-directive, coaching/guiding, and engagement strategies Youth experiences of skill development, shared experience with others, and pride in accomplishment can be cultivated by providing a range of learning opportunities, including choice making, problem-solving, and skill mastery Compared to more novice service providers, experts discussed managing the

  3. "Let Me Tell You About My…" Provider Self-Disclosure in the Emergency Department Builds Patient Rapport.

    Science.gov (United States)

    Zink, Korie L; Perry, Marcia; London, Kory; Floto, Olivia; Bassin, Benjamin; Burkhardt, John; Santen, Sally A

    2017-01-01

    As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED) provider self-disclosure on patients' rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers' communication skills. We compared patients' ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (pself-disclosure (47.1%). Patients reported that they would like to hear about their providers' experiences with a similar chief complaint (64.4% of patients), their providers' education (49%), family (33%), personal life (21%) or an injury/ailment unlike their own (18%). Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction.

  4. [MD PhD programs: Providing basic science education for ophthalmologists].

    Science.gov (United States)

    Spaniol, K; Geerling, G

    2015-06-01

    Enrollment in MD PhD programs offers the opportunity of a basic science education for medical students and doctors. These programs originated in the USA where structured programs have been offered for many years, but now German universities also run MD PhD programs. The MD PhD programs provided by German universities were investigated regarding entrance requirements, structure and financing modalities. An internet and telephone-based search was carried out. Out of 34 German universities 22 offered MD PhD programs. At 15 of the 22 universities a successfully completed course of studies in medicine was required for enrollment, 7 programs admitted medical students in training and 7 programs required a medical doctoral thesis, which had to be completed with at least a grade of magna cum laude in 3 cases. Financing required scholarships in many cases. Several German universities currently offer MD PhD programs; however, these differ considerably regarding entrance requirements, structure and financing. A detailed analysis investigating the success rates of these programs (e.g. successful completion and career paths of graduates) would be of benefit.

  5. Treating exposure to chemical warfare agents: implications for health care providers and community emergency planning.

    Science.gov (United States)

    Munro, N B; Watson, A P; Ambrose, K R; Griffin, G D

    1990-01-01

    Current treatment protocols for exposure to nerve and vesicant agents found in the U.S. stockpile of unitary chemical weapons are summarized, and the toxicities of available antidotes are evaluated. The status of the most promising of the new nerve agent antidotes is reviewed. In the U.S. atropine and pralidoxime compose the only approved antidote regimen for organophosphate nerve agent poisoning. Diazepam may also be used if necessary to control convulsions. To avoid death, administration must occur within minutes of substantial exposure together with immediate decontamination. Continuous observation and repeated administration of antidotes are necessary as symptoms warrant. Available antidotes do not necessarily prevent respiratory failure or incapacitation. The toxicity of the antidotes themselves and the individualized nature of medical care preclude recommending that autoinjectors be distributed to the general public. In addition, precautionary administration of protective drugs to the general population would not be feasible or desirable. No antidote exists for poisoning by the vesicant sulfur mustard (H, HD, HT); effective intervention can only be accomplished by rapid decontamination followed by palliative treatment of symptoms. British anti-Lewisite (BAL) (2,3-dimercapto-1-propanolol) is the antidote of choice for treatment of exposure to Lewisite, another potent vesicant. Experimental water-soluble BAL analogues have been developed that are less toxic than BAL. Treatment protocols for each antidote are summarized in tabular form for use by health care providers. PMID:2088748

  6. How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

    Science.gov (United States)

    Doty, Christopher I; Roppolo, Lynn P; Asher, Shellie; Seamon, Jason P; Bhat, Rahul; Taft, Stephanie; Graham, Autumn; Willis, James

    2015-11-01

    The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs. No best practices for the formation of CCCs currently exist. We seek to determine common structures of CCCs recently formed in the Council of Emergency Medicine Residency Directors (CORD) member programs and identify unique structures that have been developed. In this descriptive study, an 18-question survey was distributed via the CORD listserv in the late fall of 2013. Each member program was asked questions about the structure of its CCC. These responses were analyzed with simple descriptive statistics. A total of 116 of the 160 programs responded, giving a 73% response rate. Of responders, most (71.6%) CCCs are chaired by the associate or assistant program director, while a small number (14.7%) are chaired by a core faculty member. Program directors (PDs) chair 12.1% of CCCs. Most CCCs are attended by the PD (85.3%) and selected core faculty members (78.5%), leaving the remaining committees attended by any core faculty. Voting members of the CCC consist of the residency leadership either with the PD (53.9%) or without the PD (36.5%) as a voting member. CCCs have an average attendance of 7.4 members with a range of three to 15 members. Of respondents, 53.1% of CCCs meet quarterly while 37% meet monthly. The majority of programs (76.4%) report a system to match residents with a faculty mentor or advisor. Of respondents, 36% include the resident's faculty mentor or advisor to discuss a particular resident. Milestone summaries (determination of level for each milestone) are the primary focus of discussion (93.8%), utilizing multiple sources of information. The substantial variability and diversity found in our CORD survey of CCC structure

  7. 75 FR 16623 - Emergency Management for Higher Education Grant Program

    Science.gov (United States)

    2010-04-01

    ... range of campus problems including sexual assault, arson, robbery, harassment, simple assault, binge... framework of the four phases of emergency management (Prevention-Mitigation, Preparedness, Response, and..., enhance, implement, and evaluate campus-based and/or community-based prevention strategies to reduce high...

  8. From nuclides to nerve gas: The development of the Chemical Stockpile Emergency Preparedness Exercise Program

    International Nuclear Information System (INIS)

    Gant, K.S.; Adler, M.V.

    1991-01-01

    The Army and the Federal Emergency Management Agency established the Chemical Stockpile Emergency Preparedness Program (CSEPP), to improve emergency preparedness around each location storing the nation's aging stockpile of unitary chemical weapons. The CSEPP requires that a series of exercises be conducted at each location on a regular schedule. The CSEPP exercise program drew upon the existing Army and civilian exercises. Merging the exercise traditions of both the communities and installations into a joint exercise program acceptable to both sides and the particular nature of the hazard required a number of adjustments in the usual approaches. 14 refs., 1 fig

  9. Policy maker and provider knowledge and attitudes regarding the provision of emergency contraceptive pills within Lao PDR

    Directory of Open Access Journals (Sweden)

    Hansana Visanou

    2010-07-01

    Full Text Available Abstract Background The Ministry of Health (MOH launched the National Reproductive Health Policy in 2005, which included recommendations regarding the use of emergency contraceptive pills (ECP. However, ECP have not yet been introduced officially in the public sector of the Lao PDR. Thus, their availability is limited. Understanding the knowledge of ECP and attitudes about their provision, barriers to use, and availability among health providers and policy makers is essential to successfully incorporate ECP into reproductive health services. Methods Qualitative research methods using in-depth interviews were employed to collect data from policy makers and health providers (auxiliary medical staff, nurses, and medical doctors. Altogether, 10 policy makers, 22 public providers, and 10 providers at private clinics were interviewed. Content analysis was applied to analyze the transcribed data. Results The majority of policy makers and health care providers had heard about ECP and supported their introduction in the public sector. However, their knowledge was poor, many expressed inconsistent attitudes, and their ability to meet the demand of potential users is limited. Conclusions There is a need to train health providers and policy makers on emergency contraception and improve their knowledge about ECP, especially regarding the correct timing of use and the availability of methods. In addition, the general public must be informed of the attributes, side effects, and availability of ECP, and policy makers must facilitate the approval of ECP by the Lao Food and Drug Administration. These interventions could lead to increased access to and demand for ECP.

  10. 77 FR 56712 - Agency Information Collection (Homeless Providers Grant and Per Diem Program) Activities Under...

    Science.gov (United States)

    2012-09-13

    ... Providers Grant and Per Diem Program) Activities Under OMB Review AGENCY: Veterans Health Administration... Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503, (202) 395... . Please refer to ``OMB Control No. 2900-0554.'' SUPPLEMENTARY INFORMATION: Titles: a. Homeless Providers...

  11. Providing Staff Training and Programming to Support People with Disabilities: An Academic Library Case Study

    Science.gov (United States)

    Brannen, Michelle H.; Milewski, Steven; Mack, Thura

    2017-01-01

    This case study explores services academic libraries provide to students with disabilities and the impact these can have on the success and experience of these students. The study focuses on staff training and outreach programming. The authors examine the academic library literature surrounding these topics, provide examples of programming…

  12. 47 CFR 64.606 - VRS and IP Relay provider and TRS program certification.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false VRS and IP Relay provider and TRS program... Services and Related Customer Premises Equipment for Persons With Disabilities § 64.606 VRS and IP Relay... including notification in the Federal Register. (2) VRS and IP Relay provider. Any entity desiring to...

  13. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    Full Text Available Routine HIV screening in emergency department (ED settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor.We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1 no screening program; 2 an ED provider-based program; and 3 an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%. Undiagnosed HIV prevalence (0.4% and linkage to care rates (80% were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs.Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY and the Counselor strategy (compared to the Provider strategy had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs.The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in

  14. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Science.gov (United States)

    Walensky, Rochelle P; Morris, Bethany L; Reichmann, William M; Paltiel, A David; Arbelaez, Christian; Donnell-Fink, Laurel; Katz, Jeffrey N; Losina, Elena

    2011-01-01

    Routine HIV screening in emergency department (ED) settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor. We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1) no screening program; 2) an ED provider-based program; and 3) an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%). Undiagnosed HIV prevalence (0.4%) and linkage to care rates (80%) were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs. Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening) had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY) and the Counselor strategy (compared to the Provider strategy) had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs. The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in situations

  15. The California Seafloor Mapping ProgramProviding science and geospatial data for California's State Waters

    Science.gov (United States)

    Johnson, S. Y.; Cochrane, G. R.; Golden, N. E.; Dartnell, P.; Hartwell, S. R.; Cochran, S. A.; Watt, J. T.

    2017-12-01

    The California Seafloor Mapping Program (CSMP) is a collaborative effort to develop comprehensive bathymetric, geologic, and habitat maps and data for California's State Waters, which extend for 1,350 km from the shoreline to 5.6 km offshore. CSMP began in 2007 when the California Ocean Protection Council and NOAA allocated funding for high-resolution bathymetric mapping to support the California Marine Life Protection Act and update nautical charts. Collaboration and support from the USGS and other partners has led to development and dissemination of one of the world's largest seafloor-mapping datasets. CSMP data collection includes: (1) High-resolution bathymetric and backscatter mapping using swath sonar sensors; (2) "Ground-truth" imaging from a sled mounted with video and still cameras; (3) High-resolution seismic-reflection profiling at 1 km line spacing. Processed data are all publicly available. Additionally, 25 USGS map and datasets covering one third of California's coast have been published. Each publication contains 9 to 12 pdf map sheets (1:24,000 scale), an explanatory pamphlet, and a catalog of digital geospatial data layers (about 15 to 25 per map area) with web services. Map sheets display bathymetry, backscatter, perspective views, habitats, groundtruth imagery, seismic profiles, sediment distribution and thickness, and onshore-offshore geology. The CSMP goal is to serve a large constituency, ranging from senior GIS analysts in large agencies, to local governments with limited resources, to non-governmental organizations, the private sector, and concerned citizens. CSMP data and publications provide essential science and data for ocean and coastal management, stimulate and enable research, and raise public education and awareness of coastal and ocean issues. Specific applications include: Delineation and designation of marine protected areas Characterization and modeling of benthic habitats and ecosystems Updating nautical charts Earthquake hazard

  16. A Survey of Graduates of Combined Emergency Medicine-Pediatrics Residency Programs: An Update.

    Science.gov (United States)

    Strobel, Ashley M; Chasm, Rose M; Woolridge, Dale P

    2016-10-01

    In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. We sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs. We surveyed 71 graduates from three EM-PEDS residences in the United States. All respondents consider their combined training to be an asset when seeking a job, 92% find it to be an asset to their career, and 88% think it provided added flexibility to job searches. The most commonly reported shortcoming was their ineligibility for the PEM sub-board certification. The lack of this designation was perceived to be a detriment to securing academic positions in dedicated children's hospitals. When surveyed regarding which training offers the better skill set for the practice of PEM, 90% (44/49) stated combined EM-PEDS training. When asked which training track gives them the better professional advancement in PEM, 52% (23/44) chose combined EM-PEDS residency, 27% (12/44) chose a pediatrics residency followed by a PEM fellowship, and 25% (11/44) chose an EM residency then a PEM fellowship. No EM-PEDS respondents considered PEM fellowship training after the completion of the dual training program. EM-PEDS graduates found combined training to be an asset in their career. They felt that it provided flexibility in job searches, and that it was ideal training for the skill set required for the practice of PEM. EM-PEDS graduates' practices varied, including mixed settings, free-standing children's hospitals, and community emergency departments. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries

    Science.gov (United States)

    Burke, Laura G; Wild, Robert C; Orav, E John; Hsia, Renee Y

    2018-01-01

    Objective There has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED). Design, setting and participants Observational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012. Outcomes measures Billing intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling. Results High-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (−0.68% per year; 95% CI −0.71% to −0.65%; Pbilled as high intensity

  18. Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

    Science.gov (United States)

    Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

    2016-08-01

    The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

  19. Hanford Site Welding Program Successfully Providing A Single Site Function For Use By Multiple Contractors

    International Nuclear Information System (INIS)

    Cannell, G.R.

    2009-01-01

    The Department of Energy, Richland Operations (DOE-RL) recently restructured its Hanford work scope, awarding two new contracts over the past several months for a total of three contracts to manage the sites cleanup efforts. DOE-RL met with key contractor personnel prior to and during contract transition to ensure site welding activities had appropriate oversight and maintained code compliance. The transition also provided an opportunity to establish a single site-wide function that would provide welding and materials engineering services to the Hanford site contractors: CH2M HILL Plateau Remediation Company (CHPRC); Mission Support Alliance (MSA); Washington River Protection Solutions (WRPS); and Washington Closure Hanford (WCH). Over the years, multiple and separate welding programs (amongst the several contractors) existed at the Hanford site leading to inefficiencies resulting from duplication of administrative efforts, maintenance of welding procedures, welder performance certifications, etc. The new, single program eliminates these inefficiencies. The new program, co-managed by two of the sites' new contractors, the CHPRC ('owner' of the program and responsible for construction welding services) and the MSA (provides maintenance welding services), provides more than just the traditional construction and maintenance welding services. Also provided, are welding engineering, specialty welding development/qualification for the closure of radioactive materials containers and materials evaluation/failure analysis. The following describes the new Hanford site welding program.

  20. Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care.

    Science.gov (United States)

    Ameh, Charles A; Kerr, Robert; Madaj, Barbara; Mdegela, Mselenge; Kana, Terry; Jones, Susan; Lambert, Jaki; Dickinson, Fiona; White, Sarah; van den Broek, Nynke

    2016-01-01

    Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this. We evaluated knowledge and skills among 5,939 healthcare providers before and after 3-5 days 'skills and drills' training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR. 99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (phealthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.

  1. Lessons learned from the special inspection program for emergency operating procedures: Conducted March--October 1988

    International Nuclear Information System (INIS)

    1989-04-01

    The results of the team inspections conducted during 1988 for the Nuclear Regulatory Commission (NRC) Emergency Operating Procedures (EOPs) Inspection Program are summarized in this report. Inspection results are discussed in relation to past staff guidance provided to utilities for upgrade of EOPs. In this report the NRC presents information of particular interest to the nuclear power industry regarding concerns that were identified during the EOP team inspections and restates the staff's previous guidance in a format that more clearly illustrates the consequences of programmatic weaknesses. The information contained in this report is provided so that licensees may take advantage of the lessons learned from the EOP inspection effort. This report does not impose any new requirements related to the upgrading of EOPs. 7 refs

  2. Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Garrett DePalma

    2018-02-01

    Full Text Available The opioid epidemic is the most significant modern-day, public health crisis. Physicians and lawmakers have developed methods and practices to curb opioid use. This article describes one method, prescription drug monitoring programs (PDMP, through the lens of how to optimize use for emergency departments (ED. EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. These improvements may help improve clinical decision-making for emergency physicians through better data, data presentation, and accessibility.

  3. Consumer and provider responses to a computerized version of the Illness Management and Recovery Program.

    Science.gov (United States)

    Wright-Berryman, Jennifer L; Salyers, Michelle P; O'Halloran, James P; Kemp, Aaron S; Mueser, Kim T; Diazoni, Amanda J

    2013-12-01

    To explore mental health consumer and provider responses to a computerized version of the Illness Management and Recovery (IMR) program. Semistructured interviews were conducted to gather data from 6 providers and 12 consumers who participated in a computerized prototype of the IMR program. An inductive-consensus-based approach was used to analyze the interview responses. Qualitative analysis revealed consumers perceived various personal benefits and ease of use afforded by the new technology platform. Consumers also highly valued provider assistance and offered several suggestions to improve the program. The largest perceived barriers to future implementation were lack of computer skills and access to computers. Similarly, IMR providers commented on its ease and convenience, and the reduction of time intensive material preparation. Providers also expressed that the use of technology creates more options for the consumer to access treatment. The technology was acceptable, easy to use, and well-liked by consumers and providers. Clinician assistance with technology was viewed as helpful to get clients started with the program, as lack of computer skills and access to computers was a concern. Access to materials between sessions appears to be desired; however, given perceived barriers of computer skills and computer access, additional supports may be needed for consumers to achieve full benefits of a computerized version of IMR. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  4. Emergent Toxins in North Atlantic Temperate Waters: A Challenge for Monitoring Programs and Legislation

    Directory of Open Access Journals (Sweden)

    Marisa Silva

    2015-03-01

    Full Text Available Harmful Algal Blooms (HAB are complex to manage due to their intermittent nature and their severe impact on the economy and human health. The conditions which promote HAB have not yet been fully explained, though climate change and anthropogenic intervention are pointed as significant factors. The rise of water temperature, the opening of new sea canals and the introduction of ship ballast waters all contribute to the dispersion and establishment of toxin-producing invasive species that promote the settling of emergent toxins in the food-chain. Tetrodotoxin, ciguatoxin, palytoxin and cyclic imines are commonly reported in warm waters but have also caused poisoning incidents in temperate zones. There is evidence that monitoring for these toxins exclusively in bivalves is simplistic and underestimates the risk to public health, since new vectors have been reported for these toxins and as well for regulated toxins such as PSTs and DSTs. In order to avoid public health impacts, there is a need for adequate monitoring programs, a need for establishing appropriate legislation, and a need for optimizing effective methods of analysis. In this review, we will compile evidence concerning emergent marine toxins and provide data that may indicate the need to restructure the current monitoring programs of HAB.

  5. Emergent Toxins in North Atlantic Temperate Waters: A Challenge for Monitoring Programs and Legislation

    Science.gov (United States)

    Silva, Marisa; Pratheepa, Vijaya K.; Botana, Luis M.; Vasconcelos, Vitor

    2015-01-01

    Harmful Algal Blooms (HAB) are complex to manage due to their intermittent nature and their severe impact on the economy and human health. The conditions which promote HAB have not yet been fully explained, though climate change and anthropogenic intervention are pointed as significant factors. The rise of water temperature, the opening of new sea canals and the introduction of ship ballast waters all contribute to the dispersion and establishment of toxin-producing invasive species that promote the settling of emergent toxins in the food-chain. Tetrodotoxin, ciguatoxin, palytoxin and cyclic imines are commonly reported in warm waters but have also caused poisoning incidents in temperate zones. There is evidence that monitoring for these toxins exclusively in bivalves is simplistic and underestimates the risk to public health, since new vectors have been reported for these toxins and as well for regulated toxins such as PSTs and DSTs. In order to avoid public health impacts, there is a need for adequate monitoring programs, a need for establishing appropriate legislation, and a need for optimizing effective methods of analysis. In this review, we will compile evidence concerning emergent marine toxins and provide data that may indicate the need to restructure the current monitoring programs of HAB. PMID:25785464

  6. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India.

    Science.gov (United States)

    Lindquist, Benjamin; Strehlow, Matthew C; Rao, G V Ramana; Newberry, Jennifer A

    2016-07-08

    Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.

  7. 75 FR 80762 - Medicare Program; Emergency Medical Treatment and Labor Act: Applicability to Hospital and...

    Science.gov (United States)

    2010-12-23

    ... [CMS-1350-ANPRM] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act... Emergency Medical Treatment and Labor Act (EMTALA). Specifically, this document serves as a request for... available to persons without Federal government identification, commenters are encouraged to leave their...

  8. 77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital...

    Science.gov (United States)

    2012-02-02

    ... [CMS-1350-NC] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA... the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients... available to persons without Federal government identification, commenters are encouraged to leave their...

  9. 76 FR 2700 - National Protection and Programs Directorate; National Emergency Communications Plan (NECP) Goal...

    Science.gov (United States)

    2011-01-14

    ... Programs Directorate (NPPD)/Office of Cybersecurity and Communications (CS&C)/Office of Emergency Communications (OEC) will submit the following Information Collection Request to the Office of Management and... Directorate; National Emergency Communications Plan (NECP) Goal 2 Performance Report AGENCY: National...

  10. The EMERGE Summer Program: Supporting Incoming Freshmen's Success in Mathematics Developmental Coursework

    Science.gov (United States)

    Bird, Katherine; Oppland-Cordell, Sarah; Hibdon, Joseph

    2016-01-01

    This paper describes the development, results, and future directions of the mathematics component of the EMERGE Summer Program at Northeastern Illinois University. Initiated summer 2014, EMERGE offered English and mathematics sessions for incoming freshmen. The mathematics session aimed to strengthen participants' mathematical foundations,…

  11. E-learning for grass-roots emergency public health personnel: Preliminary lessons from a national program in China.

    Science.gov (United States)

    Xu, Wangquan; Jiang, Qicheng; Qin, Xia; Fang, Guixia; Hu, Zhi

    2016-07-19

    In China, grass-roots emergency public health personnel have relatively limited emergency response capabilities and they are constantly required to update their professional knowledge and skills due to recurring and new public health emergencies. However, professional training, a principal solution to this problem, is inadequate because of limitations in manpower and financial resources at grass-roots public health agencies. In order to provide a cost-effective and easily expandable way for grass-roots personnel to acquire knowledge and skills, the National Health Planning Commission of China developed an emergency response information platform and provided trial access to this platform in Anhui and Heilongjiang provinces in China. E-learning was one of the modules of the platform and this paper has focused on an e-learning pilot program. Results indicated that e-learning had satisfactorily improved the knowledge and ability of grass-roots emergency public health personnel, and the program provided an opportunity to gain experience in e-course design and implementing e-learning. Issues such as the lack of personalized e-courses and the difficulty of evaluating the effectiveness of e-learning are topics for further study.

  12. ACHP | Federal Emergency Management Agency Historic Preservation Program

    Science.gov (United States)

    /ehp/hp/fema386-6.shtm FEMA's Historic Preservation Policies and Guidance: http://www.fema.gov /environmental-planning-and-historic-preservation-program/femas-historic-preservation-policies Homeowner Flood Insurance Affordability Act: http://www.fema.gov/media-library/assets/documents/93074 Updated February 8

  13. Working at the intersection of context, culture, and technology: Provider perspectives on antimicrobial stewardship in the emergency department using electronic health record clinical decision support.

    Science.gov (United States)

    Chung, Phillip; Scandlyn, Jean; Dayan, Peter S; Mistry, Rakesh D

    2017-11-01

    Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado. We reviewed and coded the data using constant comparative analysis and framework analysis until a final set of themes emerged. Two dominant perceptions shaped providers' perspectives on ASPs in the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained decision-making autonomy. Clinicians identified structural barriers to ASPs, such as pace of the ED, and various beliefs that shaped patterns of practice, including accommodating the prescribing decisions of other providers and managing parental expectations. Recommendations to enhance uptake focused on designing a simple yet flexible user interface, providing clinicians with performance data, and on-boarding clinicians to enhance buy-in. Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks.

    Science.gov (United States)

    Silver, Marc T; Sterns, Laurence D; Piccini, Jonathan P; Joung, Boyoung; Ching, Chi-Keong; Pickett, Robert A; Rabinovich, Rafael; Liu, Shufeng; Peterson, Brett J; Lexcen, Daniel R

    2015-03-01

    Implantable cardioverter-defibrillator (ICD) shocks are associated with increased anxiety, health care utilization, and potentially mortality. The purpose of the Shock-Less Study was to determine if providing feedback reports to physicians on their adherence to evidence-based shock reduction programming could improve their programming behavior and reduce shocks. Shock-Less enrolled primary prevention (PP) and secondary prevention (SP) ICD patients between 2009 and 2012 at 118 study centers worldwide and followed patients longitudinally after their ICD implant. Center-specific therapy programming reports (TPRs) were delivered to each center 9 to 12 months after their first enrollment. The reports detailed adherence to evidence-based programming targets: number of intervals to detect ventricular fibrillation (VF NID), longest treatment interval (LTI), supraventricular tachycardia (SVT) discriminators (Wavelet, PR Logic), SVT limit, Lead Integrity Alert (LIA), and antitachycardia pacing (ATP). Clinicians programmed ICDs at their discretion. The primary outcome measure was the change in utilization of evidence-based shock reduction programming before (phase I, n = 2694 patients) and after initiation of the TPR (phase II, n = 1438 patients). Patients implanted after feedback reports (phase II) were up to 20% more likely to have their ICDs programmed in line with evidence-based shock reduction programming (eg, VF NID in PP patients 30/40 in 33.5% vs 18.6%, P programming feedback reports improves adherence to evidence-based shock reduction programming and is associated with lower risk of ICD shocks. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. The development of web program for providing RI-biomics technical information

    International Nuclear Information System (INIS)

    KI, Na Kyung; Kim, Joo Yeon; Jang, Sol Ah; Park, Tai Jin

    2014-01-01

    For designing the model of the web program, the demand survey for the technology and information has been performed for the students of the related departments, industrialists and researchers. And, the survey, such as advantages and disadvantages, for the current situations has been examined through comparison and analysis by the establishment type and operational process for the present operating web programs having the similar functions in Korea. The contents and web program for the technology and information system have been also developed by the question investigation and the expert opinions. This system for RI-Biomics has been developed by focusing the convenience for the information provision and the information search as the first constructing direction. Information has been collected by the operator in our institute and making contract with Global Trend Briefing of KISTI in Korea. The information collection in the web program has been designed as the direction regularly provided with RSS. Information has been then analyzed by constructing the expert pool provided from the advisory committee for the technology and information, and using them. The publicity for this web program has been performed by webzines and then it is noted that the publicity programs such as some events should be regularly developed when expanded and advanced to a community in future

  16. Training Veterans to Provide Peer Support in a Weight-Management Program: MOVE!

    Science.gov (United States)

    Haynes-Maslow, Lindsey; Carr, Carol; Orr, Melinda; Kahwati, Leila C.; Weiner, Bryan J.; Kinsinger, Linda

    2013-01-01

    Introduction The Veterans Health Administration (VHA) has implemented MOVE!, a weight-management program for veterans designed to address the increasing proportion of overweight and obese veterans. The objective of our study was to determine whether peer support employing motivational interviewing (MI) could positively influence lifestyle changes, thus expanding the reach of the MOVE! program. We describe the initial evaluation of the peer training program. Methods We developed an MI peer counselor training program for volunteer veterans, the “Buddies” program, to provide one-on-one telephone support for veterans enrolled in MOVE!. Buddies were recruited at 5 VHA sites and trained to provide peer support for the 6-month MOVE! intervention. We used a DVD to teach MI skills and followed with 2 to 3 booster sessions. We observed training, conducted pre- and posttraining surveys, and debriefed focus groups to assess training feasibility. Results Fifty-six Buddies were trained. Results indicate positive receipt of the program (89% reported learning about peer counseling and 87% reported learning communication skills). Buddies showed a small improvement in MI self-efficacy on posttraining surveys. We also identified key challenges to learning MI and training implementation. Conclusions MI training is feasible to implement and acceptable to volunteer Buddies. Trainers must assess how effectively volunteers learn MI skills in order to enhance its effective use in health promotion. PMID:24199738

  17. The Cambia Sojourns Scholars Leadership Program: Conversations with Emerging Leaders in Palliative Care.

    Science.gov (United States)

    Cruz-Oliver, Dulce M; Bernacki, Rachelle; Cooper, Zara; Grudzen, Corita; Izumi, Seiko; Lafond, Deborah; Lam, Daniel; LeBlanc, Thomas W; Tjia, Jennifer; Walter, Jennifer

    2017-08-01

    There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.

  18. Program Experiences of Adults with Autism, Their Families, and Providers: Findings from a Focus Group Study

    Science.gov (United States)

    Koffer Miller, Kaitlin H.; Mathew, Mary; Nonnemacher, Stacy L.; Shea, Lindsay L.

    2018-01-01

    A growing number of individuals with autism spectrum disorder are aging into adulthood. In the United States, Medicaid is the primary payer for services for adults with autism spectrum disorder, yet there are few funded programs that provide dedicated supports to this population. This study examined the experiences of adults with autism spectrum…

  19. Interdependence between measures of extent and severity of myocardial perfusion defects provided by automatic quantification programs

    DEFF Research Database (Denmark)

    El-Ali, Henrik Hussein; Palmer, John; Carlsson, Marcus

    2005-01-01

    To evaluate the accuracy of the values of lesion extent and severity provided by the two automatic quantification programs AutoQUANT and 4D-MSPECT using myocardial perfusion images generated by Monte Carlo simulation of a digital phantom. The combination between a realistic computer phantom and a...

  20. Interprofessional SDM train-the-trainer program "Fit for SDM": provider satisfaction and impact on participation.

    Science.gov (United States)

    Körner, Mirjam; Ehrhardt, Heike; Steger, Anne-Kathrin; Bengel, Jürgen

    2012-10-01

    The aim of the study was to evaluate the interprofessional SDM training program "Fit for SDM" in medical rehabilitation, which was implemented in two steps: (1) university staff trained providers in executive positions as trainers and (2) the providers trained their staff. For the evaluation of the first step a questionnaire for shared decision-making (SDM) skills and satisfaction with the training was completed by the providers in executive positions. A staff survey was used in a cluster-randomized controlled study to determine the overall impact of the train-the-trainer program on internal and external participation in the team. The providers in the six clinics evaluated their SDM competences and satisfaction very positively after training (step 1). External participation was enhanced by application of the training content, with significant changes recorded for females and nurses in particular. However, it had no direct influence on internal participation. This is the first interprofessional SDM train-the-trainer program in Germany to bridge interprofessionalism (internal participation) and SDM (external participation); it was implemented successfully and evaluated positively. Establishing interprofessional SDM training programs should be encouraged for all health care professionals. Implementation in the interprofessional setting should consider interprofessional team factors. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. An Evaluation of Past Special Education Programs and Services Provided to Incarcerated Young Offenders

    Science.gov (United States)

    Ingalls, Lawrence; Hammond, Helen; Trussell, Robert P.

    2011-01-01

    This study investigated the past special education programs and services provided to children and youth who later became incarcerated. Participants in this study were inmates from a medium security state correctional facility in the southwest region of the United States. All inmates involved in this study were identified as having a disability and…

  2. The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception.

    Science.gov (United States)

    Dermish, Amna I; Turok, David K

    2013-07-01

    Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.

  3. What does remediation and probation status mean? A survey of emergency medicine residency program directors.

    Science.gov (United States)

    Weizberg, Moshe; Smith, Jessica L; Murano, Tiffany; Silverberg, Mark; Santen, Sally A

    2015-01-01

    process of remediation and probation. The definition of these terms and the actions triggered are variable across programs. Based on these findings, suggestions toward a standardized approach for remediation and probation in GME programs are provided. © 2014 by the Society for Academic Emergency Medicine.

  4. 7 CFR 1486.100 - What is the Emerging Markets Program?

    Science.gov (United States)

    2010-01-01

    ... include activities such as feasibility studies, market research, sector assessments, orientation visits... intended primarily to support export market development efforts of the private sector, but the Program's... 7 Agriculture 10 2010-01-01 2010-01-01 false What is the Emerging Markets Program? 1486.100...

  5. Neoliberal Global Assemblages: The Emergence of "Public" International High-School Curriculum Programs in China

    Science.gov (United States)

    Liu, Shuning

    2018-01-01

    Since 2010, the number of urban Chinese high-school students applying to US universities has rapidly grown. Many of these students have chosen emerging international curriculum programs established by elite public high schools in China. These programs prepare wealthy Chinese students for the US college application process by exposing them to an…

  6. Employee assistance programs: an employer's guide to emerging liability issues.

    Science.gov (United States)

    Parliman, G C; Edwards, E L

    1992-01-01

    Increasing numbers of employers are implementing employee assistance programs (EAPs) designed to assist employees with personal issues that affect their work performance. Studies show that EAPs can dramatically increase employee productivity, but the benefits from EAPs have been accompanied by a less welcome development: lawsuits filed against employers by employees who allege that they suffered harm in the course of obtaining services through their employers' EAPs. Although the potential for liability will always exist, the employer that adheres to certain guidelines will be able to minimize its risk and make its EAP well worth the investment.

  7. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers.

    Science.gov (United States)

    Kreinest, Michael; Gliwitzky, Bernhard; Schüler, Svenja; Grützner, Paul A; Münzberg, Matthias

    2016-05-14

    In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel. A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol. Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E

  8. Association of mandated language access programming and quality of care provided by mental health agencies.

    Science.gov (United States)

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  9. Best Practices in Physics Program Assessment: Should APS Provide Accreditation Standards for Physics?

    Science.gov (United States)

    Hodapp, Theodore

    The Phys21 report, ``Preparing Physics Students for 21st Century Careers,'' provides guidance for physics programs to improve their degree programs to make them more relevant for student career choices. Undertaking such changes and assessing impact varies widely by institution, with many departments inventing assessments with each periodic departmental or programmatic review. American Physical Society has embarked on a process to integrate information from Phys21, the results of other national studies, and educational research outcomes to generate a best-practices guide to help physics departments conduct program review, assessment, and improvement. It is anticipated that departments will be able to use this document to help with their role in university-level accreditation, and in making the case for improvements to departmental programs. Accreditation of physics programs could stem from such a document, and I will discuss some of the thinking of the APS Committee on Education in creating this guide, and how they are advising APS to move forward in the higher education landscape that is increasingly subject to standards-based evaluations. I will describe plans for the design, review, and dissemination of this guide, and how faculty can provide input into its development. This material is based upon work supported by the National Science Foundation under Grant No. 1540570. Opinions expressed do not necessarily reflect those of the NSF.

  10. Time providing care outside visits in a home-based primary care program.

    Science.gov (United States)

    Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

    2014-06-01

    To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  11. Emerging Business Models in Education Provisioning: A Case Study on Providing Learning Support as Education-as-a-Service

    Directory of Open Access Journals (Sweden)

    Loina Prifti

    2017-09-01

    Full Text Available This study aims to give a deeper understanding on emerging business models in the context of education. Industry 4.0/the Industrial Internet in general and especially recent advances in cloud computing enable a new kind of service offering in the education sector and lead to new business models for education: Education-as-a-Service (EaaS. Within EaaS, learning, and teaching contents are delivered as services. By combining a literature review with a qualitative case study, this paper makes a three-fold contribution to the field of business models in education: First, we provide a theoretical definition for a common understanding of EaaS. Second, we present the state-of-the-art research on this new paradigm. Third, in the case study we describe a “best practices” business model of an existing EaaS provider. These insights build a theoretical foundation for further research in this area. The paper concludes with a research agenda for further research in this emerging field.

  12. Cutting Edge PBPK Models and Analyses: Providing the Basis for Future Modeling Efforts and Bridges to Emerging Toxicology Paradigms

    Directory of Open Access Journals (Sweden)

    Jane C. Caldwell

    2012-01-01

    Full Text Available Physiologically based Pharmacokinetic (PBPK models are used for predictions of internal or target dose from environmental and pharmacologic chemical exposures. Their use in human risk assessment is dependent on the nature of databases (animal or human used to develop and test them, and includes extrapolations across species, experimental paradigms, and determination of variability of response within human populations. Integration of state-of-the science PBPK modeling with emerging computational toxicology models is critical for extrapolation between in vitro exposures, in vivo physiologic exposure, whole organism responses, and long-term health outcomes. This special issue contains papers that can provide the basis for future modeling efforts and provide bridges to emerging toxicology paradigms. In this overview paper, we present an overview of the field and introduction for these papers that includes discussions of model development, best practices, risk-assessment applications of PBPK models, and limitations and bridges of modeling approaches for future applications. Specifically, issues addressed include: (a increased understanding of human variability of pharmacokinetics and pharmacodynamics in the population, (b exploration of mode of action hypotheses (MOA, (c application of biological modeling in the risk assessment of individual chemicals and chemical mixtures, and (d identification and discussion of uncertainties in the modeling process.

  13. Perspectives of volunteers in emergency feeding programs on hunger, its causes, and solutions.

    Science.gov (United States)

    Edlefsen, Miriam S; Olson, Christine M

    2002-01-01

    To understand the social beliefs of volunteers in emergency feeding programs (EFPs) regarding hunger and whether volunteer experiences broadened understanding of hunger. An interpretivist paradigm and qualitative methods were used. Seventeen volunteers were recruited and interviewed from three EFPs. Interviews were analyzed using the constant comparative method. Volunteering in EFPs increased volunteers' awareness of the prevalence of hunger in their communities. More involved volunteers had a greater understanding of the life situations of the hungry. The volunteers felt that increasing self-sufficiency and private responses were appropriate solutions to hunger. The volunteers' attitudes and social beliefs were similar to those of the general public. Interventions that facilitate interaction between volunteers and clients, promote reflection on volunteer experiences, and provide alternative viewpoints on poverty are needed to broaden volunteers' understanding of hunger and food insecurity.

  14. Reliability of a structured interview for admission to an emergency medicine residency program.

    Science.gov (United States)

    Blouin, Danielle

    2010-10-01

    Interviews are most important in resident selection. Structured interviews are more reliable than unstructured ones. We sought to measure the interrater reliability of a newly designed structured interview during the selection process to an Emergency Medicine residency program. The critical incident technique was used to extract the desired dimensions of performance. The interview tool consisted of 7 clinical scenarios and 1 global rating. Three trained interviewers marked each candidate on all scenarios without discussing candidates' responses. Interitem consistency and estimates of variance were computed. Twenty-eight candidates were interviewed. The generalizability coefficient was 0.67. Removing the central tendency ratings increased the coefficient to 0.74. Coefficients of interitem consistency ranged from 0.64 to 0.74. The structured interview tool provided good although suboptimal interrater reliability. Increasing the number of scenarios improves reliability as does applying differential weights to the rating scale anchors. The latter would also facilitate the identification of those candidates with extreme ratings.

  15. Programming with models: modularity and abstraction provide powerful capabilities for systems biology.

    Science.gov (United States)

    Mallavarapu, Aneil; Thomson, Matthew; Ullian, Benjamin; Gunawardena, Jeremy

    2009-03-06

    Mathematical models are increasingly used to understand how phenotypes emerge from systems of molecular interactions. However, their current construction as monolithic sets of equations presents a fundamental barrier to progress. Overcoming this requires modularity, enabling sub-systems to be specified independently and combined incrementally, and abstraction, enabling generic properties of biological processes to be specified independently of specific instances. These, in turn, require models to be represented as programs rather than as datatypes. Programmable modularity and abstraction enables libraries of modules to be created, which can be instantiated and reused repeatedly in different contexts with different components. We have developed a computational infrastructure that accomplishes this. We show here why such capabilities are needed, what is required to implement them and what can be accomplished with them that could not be done previously.

  16. Are primary health care providers prepared to implement an anti-smoking program in Syria?

    Science.gov (United States)

    Asfar, Taghrid; Al-Ali, Radwan; Ward, Kenneth D; Vander Weg, Mark W; Maziak, Wasim

    2011-11-01

    To document primary health care (PHC) providers' tobacco use, and how this influences their smoking cessation practices and attitudes towards tobacco-control policies. Anonymous questionnaires were distributed to PHC providers in 7 randomly selected PHC centers in Aleppo, Syria. All PHC providers completed the questionnaires (100% response rate). A quarter of these providers smoke cigarettes and more than 10% smoke waterpipes. Physicians who smoke were less likely to advise patients to quit (OR=0.29; 95% CI, 0.09-0.95), assess their motivation to quit (OR=0.13, 95% CI=0.02-0.72), or assist them in quitting (OR=0.24, 95% CI=0.06-0.99). PHC providers who smoke were less likely to support a ban on smoking in PHC settings (68.2% vs. 89.1%) and in enclosed public places (68.2% vs. 86.1%) or increases in the price of tobacco products (43.2% vs. 77.4%) (PSyria and will negatively influence implementation of anti-smoking program in PHC settings. Smoking awareness and cessation interventions targeted to PHC providers, and training programs to build providers' competency in addressing their patients' smoking is crucial in Syria. Published by Elsevier Ireland Ltd.

  17. A Descriptive Analysis of the Use of Twitter by Emergency Medicine Residency Programs.

    Science.gov (United States)

    Diller, David; Yarris, Lalena M

    2018-02-01

    Twitter is increasingly recognized as an instructional tool by the emergency medicine (EM) community. In 2012, the Council of Residency Directors in Emergency Medicine (CORD) recommended that EM residency programs' Twitter accounts be managed solely by faculty. To date, little has been published regarding the patterns of Twitter use by EM residency programs. We analyzed current patterns in Twitter use among EM residency programs with accounts and assessed conformance with CORD recommendations. In this mixed methods study, a 6-question, anonymous survey was distributed via e-mail using SurveyMonkey. In addition, a Twitter-based search was conducted, and the public profiles of EM residency programs' Twitter accounts were analyzed. We calculated descriptive statistics and performed a qualitative analysis on the data. Of 168 Accreditation Council for Graduate Medical Education-accredited EM programs, 88 programs (52%) responded. Of those programs, 58% (51 of 88) reported having a program-level Twitter account. Residents served as content managers for those accounts in the majority of survey respondents (61%, 28 of 46). Most programs did not publicly disclose the identity or position of their Twitter content manager. We found a wide variety of applications for Twitter, with EM programs most frequently using Twitter for educational and promotional purposes. There is significant variability in the numbers of followers for EM programs' Twitter accounts. Applications and usage among EM residency programs are varied, and are frequently not consistent with current CORD recommendations.

  18. Examination of why some community pharmacists do not provide 72-hour emergency prescription drugs to Medicaid patients when prior authorization is not available.

    Science.gov (United States)

    Shepherd, Marvin D

    2013-09-01

    Existing federal law requires that a 72-hour emergency supply of a prescription drug be dispensed to Medicaid patients when prior authorization (PA) is not available and the medication is needed without delay. The pharmacist's role is to contact prescribers and inform them that PA is needed. If the prescriber cannot be reached, the pharmacist can dispense a 72-hour emergency supply. To determine (a) the reasons why some community pharmacy owners/managers, staff pharmacists, and technicians are not compliant with the law; (b) how often the decision is made; and (c) estimate how often pharmacies do not dispense the 72-hour emergency supply when PA is not available. A questionnaire was mailed to selected Texas community pharmacies. The instrument was developed by the researcher and reviewed by the Texas Medicaid Vendor Drug Program staff. The University of Texas, Office of Survey Research collected the data in September and October of 2011 by mail and online. The data were forwarded to the researcher for analyses. A total of 788 identified community pharmacies were mailed a packet containing 3 questionnaires to be completed by the pharmacist-in-charge, a staff pharmacist, and a pharmacy technician. There were 2 mailings of the questionnaire packet and follow-up telephone calls to nonrespondents. A total of 653 questionnaires were completed and returned from 288 community pharmacies (36.7%) out of 788 pharmacies that were mailed the questionnaire packets. A total of 368 (57.5%) completed questionnaires came from chain store pharmacy respondents and 272 (42.5%) questionnaires from independent pharmacy respondents. A total of 21.3% (n = 134) of the respondents indicated that they were not aware of the federal and state requirement to dispense a 72-hour emergency supply of a prescription drug to Medicaid patients when prior authorization (PA) is not available. A greater proportion of the chain store respondents (26.6%) were unaware of the requirement compared with the

  19. Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

    Science.gov (United States)

    Theising, Katie M; Fritschle, Traci L; Scholfield, Angelina M; Hicks, Emily L; Schymik, Michelle L

    2015-11-01

    Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95

  20. The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India.

    Science.gov (United States)

    Sikka, Veronica; Gautam, V; Galwankar, Sagar; Guleria, Randeep; Stawicki, Stanislaw P; Paladino, Lorenzo; Chauhan, Vivek; Menon, Geetha; Shah, Vijay; Srivastava, R P; Rana, B K; Batra, Bipin; Kalra, O P; Aggarwal, P; Bhoi, Sanjeev; Krishnan, S Vimal

    2017-01-01

    The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

  1. Some Programs Should Not Run on Laptops - Providing Programmatic Access to Applications Via Web Services

    Science.gov (United States)

    Gupta, V.; Gupta, N.; Gupta, S.; Field, E.; Maechling, P.

    2003-12-01

    Modern laptop computers, and personal computers, can provide capabilities that are, in many ways, comparable to workstations or departmental servers. However, this doesn't mean we should run all computations on our local computers. We have identified several situations in which it preferable to implement our seismological application programs in a distributed, server-based, computing model. In this model, application programs on the user's laptop, or local computer, invoke programs that run on an organizational server, and the results are returned to the invoking system. Situations in which a server-based architecture may be preferred include: (a) a program is written in a language, or written for an operating environment, that is unsupported on the local computer, (b) software libraries or utilities required to execute a program are not available on the users computer, (c) a computational program is physically too large, or computationally too expensive, to run on a users computer, (d) a user community wants to enforce a consistent method of performing a computation by standardizing on a single implementation of a program, and (e) the computational program may require current information, that is not available to all client computers. Until recently, distributed, server-based, computational capabilities were implemented using client/server architectures. In these architectures, client programs were often written in the same language, and they executed in the same computing environment, as the servers. Recently, a new distributed computational model, called Web Services, has been developed. Web Services are based on Internet standards such as XML, SOAP, WDSL, and UDDI. Web Services offer the promise of platform, and language, independent distributed computing. To investigate this new computational model, and to provide useful services to the SCEC Community, we have implemented several computational and utility programs using a Web Service architecture. We have

  2. National Assessment of Quality Programs in Emergency Medical Services.

    Science.gov (United States)

    Redlener, Michael; Olivieri, Patrick; Loo, George T; Munjal, Kevin; Hilton, Michael T; Potkin, Katya Trudeau; Levy, Michael; Rabrich, Jeffrey; Gunderson, Michael R; Braithwaite, Sabina A

    2018-01-01

    This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©. A convenience sample of respondents was enrolled between August and November, 2015. Univariate, bivariate and multiple logistic regression analyses were conducted to describe demographics and relationships between outcomes of interest and their covariates using SAS 9.3©. A total of 1,733 surveys were initiated and 1,060 surveys had complete or near-complete responses. This includes agencies from 45 states representing over 6.23 million 9-1-1 responses annually. Totals of 70.5% (747) agencies reported dedicated QI personnel, 62.5% (663) follow clinical metrics and 33.3% (353) participate in outside quality or research program. Medical director hours varied, notably, 61.5% (649) of EMS agencies had quality measures compared to fire-based agencies. Agencies in rural only environments were less likely to follow clinical quality metrics. (OR 0.47 CI 0.31 -0.72 p quality improvement resources, medical direction and specific clinical quality measures. More research is needed to understand the impact of this variation on patient care outcomes.

  3. 78 FR 63516 - Initial Test Program of Emergency Core Cooling Systems for New Boiling-Water Reactors

    Science.gov (United States)

    2013-10-24

    ... NUCLEAR REGULATORY COMMISSION [NRC-2012-0134] Initial Test Program of Emergency Core Cooling....79.1, ``Initial Test Program of Emergency Core Cooling Systems for New Boiling-Water Reactors.'' This... emergency core cooling systems (ECCSs) for boiling- water reactors (BWRs) whose licenses are issued after...

  4. An international fellowship training program in pediatric emergency medicine: establishing a new subspecialty in the Land of the Dragon.

    Science.gov (United States)

    Goldman, Ran D; Cheng, Adam; Jarvis, Anna; Keogh, Kelly; Lu, Guo-ping; Wang, Jian-she; Kissoon, Niranjan; Larson, Charles

    2011-12-01

    The health care system reform in the People's Republic of China has brought plans for establishment of a universal coverage for basic health services, including services for children. This effort demands significant change in health care planning. Pediatric emergency medicine (PEM) is not currently identified as a specialty in China, and emergency medicine systems suffer from lack of appropriate training.In 2006, the Centre for International Child Health and the Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada, initiated a fellowship training program in PEM for pediatricians working in emergency departments or critical care settings with the Children's Hospital of Fudan University, China. The main objective was to upgrade the professional and clinical experience of emergency physicians practicing PEM and build PEM capacity throughout China by training the future trainers. After selecting trainees, the program included a structured curriculum over 2 years of training in China by Canadian and Australian PEM faculty and then practical exposure to PEM in Canada. All trainees underwent a structured evaluation after their final rotation in Canada. A total of 12 trainees completed the first 2 program cycles. The trainees considered the "overall rating of the training experience" as "excellent" (10/12) or "good" (2/12). All trainees considered the program as a relevant training to their practice and felt it will change their practice. They reported the program to be effective, with excellent complexity of content. Despite its current success, the program faces challenges in the development of the new subspecialty and ensuring its acceptance among other health care providers and decision makers. Identification and preparation of a capable training force to lead educational activities in China are daunting tasks. Time constraints, funding, and language barriers are other challenges. Future effort should be focused on improving and sustaining

  5. Evaluation of a transit first-aid station providing emergency care to former Yugoslavian war victims evacuated in Ancona, Italy.

    Science.gov (United States)

    Prospero, E; Raffo, M; Appignanesi, R; Faccenda, G; Ronveaux, O; Annino; D'Errico, M M

    2000-03-01

    A first-aid station was implemented in Falconara Marittima airport (Ancona, Italy). It provided medical emergency care to war victims evacuated from former Yugoslavia in transit for further treatment. A descriptive analysis of the displaced population arriving at the first-aid station was performed using three independent datasets for administrative information, of which one included medical information. The implemented resources were also evaluated. From August 1993 to March 1995, 2272 displaced persons were registered at the first-aid station, out of which 54.2% were accompanying family members. Among those needing medical intervention (45.8% of total), most frequent diagnoses were traumatisms and burns (59.8%), neoplasms (15.6%), and congenital malformations (13.2%). The medical care provided at the first-aid station was most often basic: a medical examination alone was performed on 77.0% of the patients, and a minor dressing on 17.3%. Median length of stay was 1 day. Patients were sent to 30 different countries and 8% were forwarded to the local regional hospital. Deployed logistical resources exceeded by far actual needs but a lack of psychological assistance was observed, mainly for children. The agencies involved did not coordinate data sharing and follow-up information. The medical assistance to the war victims was efficient regarding provided care and timeliness. Effectiveness of such a programme could be improved by a better coordination between partners, allowing more adequate logistics according to appropriate epidemiological information.

  6. Feasibility of Spanish-language acquisition for acute medical care providers: novel curriculum for emergency medicine residencies.

    Science.gov (United States)

    Grall, Kristi H; Panchal, Ashish R; Chuffe, Eliud; Stoneking, Lisa R

    2016-01-01

    Language and cultural barriers are detriments to quality health care. In acute medical settings, these barriers are more pronounced, which can lead to poor patient outcomes. We implemented a longitudinal Spanish-language immersion curriculum for emergency medicine (EM) resident physicians. This curriculum includes language and cultural instruction, and is integrated into the weekly EM didactic conference, longitudinal over the entire 3-year residency program. Language proficiency was assessed at baseline and annually on the Interagency Language Roundtable (ILR) scale, via an oral exam conducted by the same trained examiner each time. The objective of the curriculum was improvement of resident language skills to ILR level 1+ by year 3. Significance was evaluated through repeated-measures analysis of variance. The curriculum was launched in July 2010 and followed through June 2012 (n=16). After 1 year, 38% had improved over one ILR level, with 50% achieving ILR 1+ or above. After year 2, 100% had improved over one level, with 90% achieving the objective level of ILR 1+. Mean ILR improved significantly from baseline, year 1, and year 2 (F=55, df =1; Planguage skills in EM residents. The curriculum improved EM-resident language proficiency above the goal in just 2 years. Further studies will focus on the effect of language acquisition on patient care in acute settings.

  7. Community Clinicians and the Veterans Choice Program for PTSD Care: Understanding Provider Interest During Early Implementation.

    Science.gov (United States)

    Finley, Erin P; Noël, Polly H; Mader, Michael; Haro, Elizabeth; Bernardy, Nancy; Rosen, Craig S; Bollinger, Mary; Garcia, Hector; Sherrieb, Kathleen; Pugh, Mary Jo V

    2017-07-01

    In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians. To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among "early adopters." Cross-sectional surveys with 2 samples: a stratified random sample of mental health and primary care prescribers and psychotherapists drawn from state licensing boards (Community Sample); and a stratified random sample of prescribers and psychotherapists identified as VCP-authorized providers (VCP-Authorized). Five hundred fifty-three respondents in the Community Sample and 115 in the VCP-Authorized (total, n=668; 21.1% response). Surveys assessed provider and practice characteristics, attitudes to VA and VCP, and experiences and satisfaction with the VCP; an open-ended survey item assessed providers' reasons for interest or lack of interest in VCP participation. Few providers reported VCP participation during this period. Interest in VCP participation was associated across provider groups with factors including being a veteran and receiving VA reimbursement; currently providing treatment for PTSD was associated with interest in VCP participation among psychotherapists, but not prescribers. Developing networks of VCP providers to serve Veterans with PTSD is likely to require targeting more receptive provider groups, reducing barriers to participation, and more effectively communicating the value of VCP participation to providers.

  8. Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia.

    Science.gov (United States)

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

    2016-06-01

    To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia. We conducted a cost analysis, modeling the costs and programmatic outcomes of the program's initial implementation in 3 districts of Tigray, Ethiopia. Costs were estimated from a review of program expense records, invoices, and interviews with health workers. Programmatic outcomes include number of injections and couple-year of protection (CYP) provided. We performed a sensitivity analysis on the average number of injections provided per month by community health workers (CHWs), the cost of the commodity, and the number of CHWs trained. The average programmatic CYP was US $17.91 for all districts with a substantial range from US $15.48-38.09 per CYP across districts. Direct service cost was estimated at US $2.96 per CYP. The cost per CYP was slightly sensitive to the commodity cost of the injectable contraceptives and the number of CHWs. The capacity of each CHW, measured by the number of injections sold, was a key input that drove the cost per CYP of this model. With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Do Pain Medicine Fellowship Programs Provide Education in Practice Management? A Survey of Pain Medicine Fellowship Programs.

    Science.gov (United States)

    Przkora, Rene; Antony, Ajay; McNeil, Andrew; Brenner, Gary J; Mesrobian, James; Rosenquist, Richard; Abouleish, Amr E

    2018-01-01

    We hypothesized that there is a gap between expectations and actual training in practice management for pain medicine fellows. Our impression is that many fellowships rely on residency training to provide exposure to business education. Unfortunately, pain management and anesthesiology business education are very different, as the practice settings are largely office- versus hospital-based, respectively. Because it is unclear whether pain management fellowships are providing practice management education and, if they do, whether the topics covered match the expectations of their fellows, we surveyed pain medicine program directors and fellows regarding their expectations and training in business management. A survey. Academic pain medicine fellowship programs. After an exemption was obtained from the University of Texas Medical Branch Institutional Review Board (#13-030), an email survey was sent to members of the Association of Pain Program Directors to be forwarded to their fellows. Directors were contacted 3 times to maximize the response rate. The anonymous survey for fellows contained 21 questions (questions are shown in the results). Fifty-nine of 84 program directors responded and forwarded the survey to their fellows. Sixty fellows responded, with 56 answering the survey questions. The responder rate is a limitation, although similar rates have been reported in similar studies. The majority of pain medicine fellows receive some practice management training, mainly on billing documentation and preauthorization processes, while most do not receive business education (e.g., human resources, contracts, accounting/financial reports). More than 70% of fellows reported that they receive more business education from industry than from their fellowships, a result that may raise concerns about the independence of our future physicians from the industry. Our findings support the need for enhanced and structured business education during pain fellowship. Business

  10. A Systematic Review of the Effects of Continuing Education Programs on Providing Clinical Community Pharmacy Services

    Science.gov (United States)

    Marques dos Reis, Tiago; Guidoni, Camilo Molino; Girotto, Edmarlon; Guerra, Marisabelle Lima; de Oliveira Baldoni, André; Leira Pereira, Leonardo Régis

    2016-01-01

    Objective. To summarize the effects of media methods used in continuing education (CE) programs on providing clinical community pharmacy services and the methods used to evaluate the effectiveness of these programs. Methods. A systematic review was performed using Medline, SciELO, and Scopus databases. The timeline of the search was 1990 to 2013. Searches were conducted in English, Portuguese, and Spanish. Results. Nineteen articles of 3990 were included. Fourteen studies used only one media method, and the live method (n=11) was the most frequent (alone or in combination). Only two studies found that the CE program was ineffective or partially effective; these studies used only the live method. Most studies used nonrobust, nonvalidated, and nonstandardized methods to measure effectiveness. The majority of studies focused on the effect of the CE program on modifying the knowledge and skills of the pharmacists. One study assessed the CE program’s benefits to patients or clients. Conclusion. No evidence was obtained regarding which media methods are the most effective. Robust and validated methods, as well as assessment standardization, are required to clearly determine whether a particular media method is effective. PMID:27402991

  11. The Cost of Providing Comprehensive HIV Treatment in PEPFAR-Supported Programs

    Science.gov (United States)

    Menzies, Nicolas A; Berruti, Andres A; Berzon, Richard; Filler, Scott; Ferris, Robert; Ellerbrock, Tedd V; Blandford, John M

    2011-01-01

    PEPFAR, national governments, and other stakeholders are investing unprecedented resources to provide HIV treatment in developing countries. This study reports empirical data on costs and cost trends in a large sample of HIV treatment sites. In 2006–2007, we conducted cost analyses at 43 PEPFAR-supported outpatient clinics providing free comprehensive HIV treatment in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam. We collected data on HIV treatment costs over consecutive 6-month periods from scale-up of dedicated HIV treatment services at each site. The study included all patients receiving HIV treatment and care at study sites (62,512 ART and 44,394 pre-ART patients). Outcomes were costs per-patient and total program costs, subdivided by major cost categories. Median annual economic costs were $202 (2009 USD) for pre-ART patients and $880 for ART patients. Excluding ARVs, per-patient ART costs were $298. Care for newly initiated ART patients cost 15–20% more than for established patients. Per-patient costs dropped rapidly as sites matured, with per-patient ART costs dropping 46.8% between first and second 6-month periods after the beginning of scale-up, and an additional 29.5% the following year. PEPFAR provided 79.4% of funding for service delivery, and national governments provided 15.2%. Treatment costs vary widely between sites, and high early costs drop rapidly as sites mature. Treatment costs vary between countries and respond to changes in ARV regimen costs and the package of services. While cost reductions may allow near-term program growth, programs need to weigh the trade-off between improving services for current patients and expanding coverage to new patients. PMID:21412127

  12. In-vivo job development training among peer providers of homeless veterans supported employment programs.

    Science.gov (United States)

    Gao, Ni; Dolce, Joni; Rio, John; Heitzmann, Carma; Loving, Samantha

    2016-06-01

    This column describes a goal-oriented, time-limited in vivo coaching/training approach for skills building among peer veterans vocational rehabilitation specialists of the Homeless Veteran Supported Employment Program (HVSEP). Planning, implementing, and evaluating the training approach for peer providers was intended, ultimately, to support veterans in their goal of returning to community competitive employment. The description draws from the training experience that aimed to improve the ability of peer providers to increase both rates of employment and wages of the homeless veterans using their services. Training peers using an in vivo training approach provided a unique opportunity for the veterans to improve their job development skills with a focus to support employment outcomes for the service users. Peers who received training also expressed that learning skills through an in vivo training approach was more engaging than typical classroom trainings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  13. Perception and analysis of the 5S program at a business service provider

    Directory of Open Access Journals (Sweden)

    André Luiz Emmel Silva

    2016-09-01

    Full Text Available Given the importance that the service sector represents in our economy, the application of concepts and techniques for its administration and models aimed at improving its quality is growing. This article aims to analyze the main aspects of the 5S program in the implementation phase and in the course of its evolution at a service company. The methodology used is qualitative, implemented through a case study structured in 6 steps. The company under study performs strongly on the national market and therefore has a large amount of documents circulating daily through different sectors, which generated the need to implement a methodology capable of streamlining document flow management and reducing the time spent on bureaucracy by its employees. The 5S program was shown to have brought the company greater administrative efficiency and a more pleasant, safe and organized working environment, motivating employees, reducing costs and providing competitive advantages.

  14. Effect of Medicaid disease management programs on emergency admissions and inpatient costs.

    Science.gov (United States)

    Conti, Matthew S

    2013-08-01

    To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.

  15. Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Jamnik Veronica

    2011-09-01

    Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.

  16. Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review.

    Science.gov (United States)

    Schneider, Anna; Weigl, Matthias

    2018-01-01

    Emergency departments (ED) are complex and dynamic work environments with various psychosocial work stressors that increase risks for providers' well-being. Yet, no systematic review is available which synthesizes the current research base as well as quantitatively aggregates data on associations between ED work factors and provider well-being outcomes. We aimed at synthesizing the current research base on quantitative associations between psychosocial work factors (classified into patient-/ task-related, organizational, and social factors) and mental well-being of ED providers (classified into positive well-being outcomes, affective symptoms and negative psychological functioning, cognitive-behavioural outcomes, and psychosomatic health complaints). A systematic literature search in eight databases was conducted in December 2017. Original studies were extracted following a stepwise procedure and predefined inclusion criteria. A standardized assessment of methodological quality and risk of bias was conducted for each study with the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. In addition to a systematic compilation of included studies, frequency and strength of quantitative associations were synthesized by means of harvest plots. Subgroup analyses for ED physicians and nurses were conducted. N = 1956 records were retrieved. After removal of duplicates, 1473 records were screened for titles and abstracts. 199 studies were eligible for full-text review. Finally, 39 original studies were included whereof 37 reported cross-sectional surveys. Concerning the methodological quality of included studies, the majority was evaluated as weak to moderate with considerable risk of bias. Most frequently surveyed provider outcomes were affective symptoms (e.g., burnout) and positive well-being outcomes (e.g., job satisfaction). 367 univariate associations and 370 multivariate associations were extracted with the majority being

  17. Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review.

    Directory of Open Access Journals (Sweden)

    Anna Schneider

    Full Text Available Emergency departments (ED are complex and dynamic work environments with various psychosocial work stressors that increase risks for providers' well-being. Yet, no systematic review is available which synthesizes the current research base as well as quantitatively aggregates data on associations between ED work factors and provider well-being outcomes.We aimed at synthesizing the current research base on quantitative associations between psychosocial work factors (classified into patient-/ task-related, organizational, and social factors and mental well-being of ED providers (classified into positive well-being outcomes, affective symptoms and negative psychological functioning, cognitive-behavioural outcomes, and psychosomatic health complaints.A systematic literature search in eight databases was conducted in December 2017. Original studies were extracted following a stepwise procedure and predefined inclusion criteria. A standardized assessment of methodological quality and risk of bias was conducted for each study with the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. In addition to a systematic compilation of included studies, frequency and strength of quantitative associations were synthesized by means of harvest plots. Subgroup analyses for ED physicians and nurses were conducted.N = 1956 records were retrieved. After removal of duplicates, 1473 records were screened for titles and abstracts. 199 studies were eligible for full-text review. Finally, 39 original studies were included whereof 37 reported cross-sectional surveys. Concerning the methodological quality of included studies, the majority was evaluated as weak to moderate with considerable risk of bias. Most frequently surveyed provider outcomes were affective symptoms (e.g., burnout and positive well-being outcomes (e.g., job satisfaction. 367 univariate associations and 370 multivariate associations were extracted with the

  18. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-09-28

    Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning

  19. Does a Nintendo Wii exercise program provide similar exercise demands as a traditional pulmonary rehabilitation program in adults with COPD?

    Science.gov (United States)

    LeGear, Tyler; LeGear, Mark; Preradovic, Dejan; Wilson, Geoffrey; Kirkham, Ashley; Camp, Pat G

    2016-05-01

    The chronic obstructive pulmonary disease (COPD) population can experience lower activity and fitness levels than the non-COPD population. The Nintendo Wii may be an appropriate at-home training device for the COPD population, which could be used as a supplement for a pulmonary rehabilitation program. This study was a randomized, within-subject, cross-over study involving 10 adults with COPD previously enrolled in St Paul's Hospital's pulmonary rehabilitation program. This study attempted to determine if specific Wii activities resulted in similar energy expenditures to that of a more traditional pulmonary rehabilitation activity. Participants completed two 15-min exercise interventions in a single session, with a washout period of 30 min in-between. The interventions were an experimental Wii intervention and a traditional treadmill intervention. There was no significant difference in total energy expenditure between the two 15-min exercise interventions [mean difference 36.3 joules; 95% confidence interval (CI): 31.4, 104]. There was no significant difference in heart rate (mean difference -0.167 beats per minute; 95% CI: -4.83, 4.50), rating of perceived exertion (mean difference 0.100; 95% CI: -0.416, 0.616) and Borg dyspnea scale (mean difference 0.267; 95% CI: -0.004, 0.537) between the two 15-min exercise interventions. There was a significant difference in SpO2 between the two 15-min exercise interventions (Wii intervention mean difference 2.33% > treadmill intervention; 95% CI: 1.52, 3.15). Gaming technology can provide an exercise program that has similar cardiovascular demands to traditional pulmonary rehabilitation programs for patients with COPD. Further research is necessary to address feasibility and long-term adherence. © 2014 John Wiley & Sons Ltd.

  20. Creating tomorrow's leaders today: the Emerging Nurse Leaders Program of the Texas Nurses Association.

    Science.gov (United States)

    Sportsman, Susan; Wieck, Lynn; Yoder-Wise, Patricia S; Light, Kathleen M; Jordan, Clair

    2010-06-01

    The Texas Nurses Association initiated an Emerging Nurse Leaders Program as an approach to engaging new nurses in the leadership of the professional association. This article explains the program's origin, the commitment of the Texas Nurses Association to this process, the implementation of the plan, and the discussions that launched a new way of connecting leaders across generations. Further, it is an approach that any professional organization can use to encourage the involvement of new leaders.

  1. Working Together to Connect Care: a metropolitan tertiary emergency department and community care program.

    Science.gov (United States)

    Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John

    2017-03-02

    Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a 'frequent attendee' was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of 'super users' is

  2. New Opportunitie s for Small Satellite Programs Provided by the Falcon Family of Launch Vehicles

    Science.gov (United States)

    Dinardi, A.; Bjelde, B.; Insprucker, J.

    2008-08-01

    The Falcon family of launch vehicles, developed by Space Exploration Technologies Corporation (SpaceX), are designed to provide the world's lowest cost access to orbit. Highly reliable, low cost launch services offer considerable opportunities for risk reduction throughout the life cycle of satellite programs. The significantly lower costs of Falcon 1 and Falcon 9 as compared with other similar-class launch vehicles results in a number of new business case opportunities; which in turn presents the possibility for a paradigm shift in how the satellite industry thinks about launch services.

  3. 1992 update of US EPA's Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program

    International Nuclear Information System (INIS)

    Lewis, N.M.; Barkley, N.P.; Williams, T.

    1992-01-01

    The Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program (ETP) has financially supported further development of bench- and pilot-scale testing and evaluation of innovative technologies for use at hazardous waste sites for five years. The ETP was established under the Superfund Amendments and Reauthorization Act (SARA) of 1986. The ETP complies with the goal of the SITE Program to promote, accelerate and make commercially available the development of alternative/innovative treatment technologies for use at Superfund sites. Technologies are submitted to the ETP through yearly solicitations for Preproposals. Applicants are asked to submit a detailed project proposal and a cooperative agreement application that requires Developer/EPA cost sharing. EPA co-funds selected Developers for one to two years. Second-year funding requires documentation of significant progress during the first year. Facilities, equipment, data collection, performance and development are monitored throughout the project. The US Department of Energy (DOE) and the US Air Force (USAF) are participants in the ETP. DOE has co-funded ETP projects since 1990 and the USAF since 1991. A goal of the ETP is to move developed technologies to the field-demonstration stage. A developer may be considered for participation in the SITE Demonstration Program if performance in the ETP indicates the technology is field-ready for evaluation. Six technology categories: biological, chemical, materials handling, physical, solidification/stabilization and thermal, are presently in the ETP. Technologies of primary interest to EPA are those that can treat complex mixtures of hazardous organic and inorganic contaminants and provide improved solids handling and/or pretreatment. An account of the background and progress of the ETP's first five years is presented in this paper. Technologies currently in the ETP are noted, and developers and EPA Project Managers, are listed. 4 refs., 11 figs., 6 tabs

  4. Developmental cascade models of a parenting-focused program for divorced families on mental health problems and substance use in emerging adulthood.

    Science.gov (United States)

    Wolchik, Sharlene A; Tein, Jenn-Yun; Sandler, Irwin N; Kim, Han-Joe

    2016-08-01

    A developmental cascade model from functioning in adolescence to emerging adulthood was tested using data from a 15-year longitudinal follow-up of 240 emerging adults whose families participated in a randomized, experimental trial of a preventive program for divorced families. Families participated in the program or literature control condition when the offspring were ages 9-12. Short-term follow-ups were conducted 3 months and 6 months following completion of the program when the offspring were in late childhood/early adolescence. Long-term follow-ups were conducted 6 years and 15 years after program completion when the offspring were in middle to late adolescence and emerging adulthood, respectively. It was hypothesized that the impact of the program on mental health and substance use outcomes in emerging adulthood would be explained by developmental cascade effects of program effects in adolescence. The results provided support for a cascade effects model. Specifically, academic competence in adolescence had cross-domain effects on internalizing problems and externalizing problems in emerging adulthood. In addition, adaptive coping in adolescence was significantly, negatively related to binge drinking. It was unexpected that internalizing symptoms in adolescence were significantly negatively related to marijuana use and alcohol use. Gender differences occurred in the links between mental health problems and substance use in adolescence and mental health problems and substance use in emerging adulthood.

  5. Nuclear power plant emergency preparedness: results from an evaluation of Michigan's potassium iodide distribution program.

    Science.gov (United States)

    Zwolinski, Laura R; Stanbury, Martha; Manente, Susan

    2012-10-01

    In 2009, the Michigan Department of Community Health (MDCH) made potassium iodide (KI), a nonprescription radio-protective drug, available by mailing vouchers redeemable at local pharmacies for KI tablets, at no cost to residents living within 10 miles of Michigan's 3 nuclear power plants (NPPs). MDCH conducted an evaluation of this program to determine Michigan's KI coverage and to assess general emergency preparedness among residents living near the NPPs. KI coverage was estimated based on redeemed voucher counts and the 2010 Census. Telephone surveys were administered to a random sample (N = 153) of residents living near Michigan's NPPs to evaluate general emergency preparedness, reasons for voucher use or nonuse, and KI knowledge. Only 5.3% of eligible residences redeemed KI vouchers. Most surveyed residents (76.5%) were aware of living near an NPP, yet 42.5% reported doing "nothing" to plan for an emergency. Almost half of surveyed voucher users did not know when to take KI or which body part KI protects. Among voucher nonusers, 48.0% were either unaware of the program or did not remember receiving a voucher. Additional efforts are needed to ensure that all residents are aware of the availability of KI and that recipients of the drug understand when and why it should be taken. Minimal emergency planning among residents living near Michigan's NPPs emphasizes the need for increased emergency preparedness and awareness. Findings are particularly salient given the March 2011 Fukushima Daiichi Nuclear Power Plant emergency in Japan.

  6. Descriptive study of external employee assistance program providers (EAP) in Japan.

    Science.gov (United States)

    Muto, Takashi; Haruyama, Yasuo; Higashi, Toshiaki

    2012-01-01

    The mental health problems of employees have become a major occupational health issue in Japan. External employee assistance program providers (EAP) have become important in mental health care for workers, but their activities are poorly documented. This descriptive study was undertaken to clarify the status and future tasks of EAP in Japan. The subjects were all EAP (n=27) registered in the Japanese Chapter of Employee Assistance Professionals Association. The questionnaire survey was conducted in January 2007. We received 13 replies, a response rate of 54.2%. Most EAP provided seminars, stress checks, stress management, counseling, and support for a return to work. The number of EAP contracted with small-scale enterprises was small. EAP communicated infrequently with companies. To promote the use of EAP, their advertising, education and training of staff, accumulation of scientific evidence, development of an official certification system for staff, and improvement of contents of EAP services were cited.

  7. Why Providers Participate in Clinical Trials: Considering the National Cancer Institute’s Community Clinical Oncology Program

    Science.gov (United States)

    McAlearney, Ann Scheck; Song, Paula H.; Reiter, Kristin L.

    2012-01-01

    Background The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute’s Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. Objectives This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. Research Methods We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Results Interviewees expressed both “altruistic” and “self-interested” motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. Conclusion The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. PMID:22925970

  8. Reliability constrained decision model for energy service provider incorporating demand response programs

    International Nuclear Information System (INIS)

    Mahboubi-Moghaddam, Esmaeil; Nayeripour, Majid; Aghaei, Jamshid

    2016-01-01

    Highlights: • The operation of Energy Service Providers (ESPs) in electricity markets is modeled. • Demand response as the cost-effective solution is used for energy service provider. • The market price uncertainty is modeled using the robust optimization technique. • The reliability of the distribution network is embedded into the framework. • The simulation results demonstrate the benefits of robust framework for ESPs. - Abstract: Demand response (DR) programs are becoming a critical concept for the efficiency of current electric power industries. Therefore, its various capabilities and barriers have to be investigated. In this paper, an effective decision model is presented for the strategic behavior of energy service providers (ESPs) to demonstrate how to participate in the day-ahead electricity market and how to allocate demand in the smart distribution network. Since market price affects DR and vice versa, a new two-step sequential framework is proposed, in which unit commitment problem (UC) is solved to forecast the expected locational marginal prices (LMPs), and successively DR program is applied to optimize the total cost of providing energy for the distribution network customers. This total cost includes the cost of purchased power from the market and distributed generation (DG) units, incentive cost paid to the customers, and compensation cost of power interruptions. To obtain compensation cost, the reliability evaluation of the distribution network is embedded into the framework using some innovative constraints. Furthermore, to consider the unexpected behaviors of the other market participants, the LMP prices are modeled as the uncertainty parameters using the robust optimization technique, which is more practical compared to the conventional stochastic approach. The simulation results demonstrate the significant benefits of the presented framework for the strategic performance of ESPs.

  9. 78 FR 79081 - Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid...

    Science.gov (United States)

    2013-12-27

    ... Conditions for Coverage CHAP Community Health Accreditation Program CMHC Community Mental Health Center COI... Pathology Services (Sec. 485.727) N. Emergency Preparedness Regulations for Community Mental Health Centers... Preparedness for Community Mental Health Centers (CMHCs)--Training and Testing (Sec. 485.920(d)) R. Conditions...

  10. From Charity to Security: The Emergence of the National School Lunch Program

    Science.gov (United States)

    Rutledge, Jennifer Geist

    2015-01-01

    This paper explores the historical formation of the National School Lunch Program (NSLP) in the United States and argues that programme emergence depended on the ability of policy entrepreneurs to link the economic concerns of agricultural production with the ideational concern of national security. Using a historical institutionalist framework…

  11. Innovative States: Emerging Family Support and Education Programs. Arkansas, Iowa, Oregon, Vermont, Washington. Second Edition.

    Science.gov (United States)

    Harvard Family Research Project, Cambridge, MA.

    The five states featured in this second edition of "Innovative States" were chosen because they reflect crucial elements in an emerging understanding of state policy making in family support and education. Creative state partnerships involving program development and funding are a key ingredient to successful endeavors. States rely on…

  12. Delivering MBA Programs in Emerging Markets: The Challenge of National Culture

    Science.gov (United States)

    Jones, Stephanie

    2013-01-01

    Increasingly, Western-style MBA programs are being delivered in emerging markets, as the developed countries become more and more saturated with MBAs and related offerings. This article, based on the global experience of the author in teaching and assessing MBA modules including thesis and dissertation research and writing, suggests approaches to…

  13. A proposed emergency management program for acute care facilities in response to a highly virulent infectious disease.

    Science.gov (United States)

    Petinaux, Bruno; Ferguson, Brandy; Walker, Milena; Lee, Yeo-Jin; Little, Gary; Parenti, David; Simon, Gary

    2016-01-01

    To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting.

  14. 76 FR 79067 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

    Science.gov (United States)

    2011-12-21

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN49 Payment or Reimbursement for Emergency..., authorize the Secretary of Veterans Affairs to reimburse eligible veterans for costs related to non-VA.... Specifically, section 1725 authorizes reimbursement for emergency treatment for eligible veterans with...

  15. Emergency Response Program Designing Based On Case Study ERP Regulations In Ilam Gas Refinery

    Directory of Open Access Journals (Sweden)

    Mehdi Tahmasbi

    2015-08-01

    Full Text Available The study of Emergency response plan designing is one of the most important prevention approaches in crisis management. This study aims to design emergency response plan based on case study ERP regulations in Ilam gas refinery. On the basis of risk assessment and identification techniques such as HAZOP and FMEA in Ilam gas refinery the risks have been prioritized and then according to this prioritization the design of possible scenarios which have the highest rate of occurrence and the highest level of damage has been separated. Possible scenarios were simulated with PHAST software. Then emergency response program has been designed for the special mode or similar cases. According to the internal emergency response plan for Ilam gas refinery and predictable conditions of the process special instructions should be considered at the time of the incident to suffer the least damage on people and environment in the shortest time possible.

  16. Initiating an online asthma management program in urban emergency departments: the recruitment experience.

    Science.gov (United States)

    Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie; Johnson, Dayna A; Duffy, Elizabeth; Demers, Michele; Zhang, Talan; Ownby, Dennis R; Zoratti, Edward; Mahajan, Prashant

    2016-01-01

    The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review.

    Science.gov (United States)

    Gorgon, Edward James R

    2018-06-01

    Caregiver-provided physical therapy home programs (PTHP) play an important role in enhancing motor outcomes in pediatric patient populations. This scoping review systematically mapped clinical trials of caregiver-provided PTHP that were aimed at enhancing motor outcomes in children who have or who are at risk for motor delay, with the purpose of (1) describing trial characteristics; (2) assessing methodologic quality; and (3) examining the reporting of caregiver-related components. Physiotherapy Evidence Database (PEDro), Cochrane CENTRAL, PubMed, Scopus, ScienceDirect, ProQuest Central, CINAHL, LILACS, and OTseeker were searched up to July 31, 2017. Two reviewers independently assessed study eligibility. Randomized or quasi-randomized controlled trials on PTHP administered by parents, other family members, friends, or informal caregivers to children who had or who were at risk for motor delay were included. Two reviewers independently appraised trial quality on the PEDro scale and extracted data. Twenty-four articles representing 17 individual trials were identified. Populations and interventions investigated were heterogeneous. Most of the trials had important research design limitations and methodological issues that could limit usefulness in ascertaining the effectiveness of caregiver-provided PTHP. Few (4 of 17) trials indicated involvement of caregivers in the PTHP planning, assessed how the caregivers learned from the training or instructions provided, or carried out both. Included studies were heterogeneous, and unpublished data were excluded. Although caregiver-provided PTHP are important in addressing motor outcomes in this population, there is a lack of evidence at the level of clinical trials to guide practice. More research is urgently needed to determine the effectiveness of care-giver-provided PTHP. Future studies should address the many important issues identified in this scoping review to improve the usefulness of the trial results.

  18. The livelihoods of Haitian health-care providers after the january 2010 earthquake: a pilot study of the economic and quality-of-life impact of emergency relief.

    Science.gov (United States)

    Haar, Rohini J; Naderi, Sassan; Acerra, John R; Mathias, Maxwell; Alagappan, Kumar

    2012-03-02

    An effective international response to a disaster requires cooperation and coordination with the existing infrastructure. In some cases, however, international relief efforts can compete with the local work force and affect the balance of health-care systems already in place. This study seeks to evaluate the impact of the international humanitarian response to the 12 January 2010 earthquake on Haitian health-care providers (HHP). Fifty-nine HHPs were surveyed in August of 2010 using a modified World Health Organization Quality of Life-Brief questionnaire (WHOQoL-B) that included questions on respondents' workload before the earthquake, immediately after, and presently. The study population consisted of physicians, nurses, and technicians at public hospitals, non-governmental organization (NGO) clinics, and private offices in Port-au-Prince, Haiti. Following the earthquake, public hospital and NGO providers reported a significant increase in their workload (15 of 17 and 22 of 26 respondents, respectively). Conversely, 12 of 16 private providers reported a significant decrease in workload (p working a similar number of hours prior to the earthquake (average 40 h/week), they reported working significantly different amounts following the earthquake. Public hospital and NGO providers averaged more than 50 h/week, and private providers averaged just over 33 h/week of employment (p working at public hospitals and NGOs, however, had significantly lower scores on the WHOQoL-B when answering questions about their environment (p work among HHPs. To create a robust health-care system in the long term while meeting short-term needs, humanitarian responses should seek to better integrate existing systems and involve local providers in the design and implementation of an emergency program.

  19. Implementation of an Emergency Medicine Research Associates Program: Sharing 20 Years of Experience

    Directory of Open Access Journals (Sweden)

    Vincent DeRienzo

    2018-03-01

    Full Text Available Introduction: The use of research associates (RA programs to facilitate study enrollment in the emergency department was initiated during the mid-1990s. The University of Rochester Medical Center (URMC was an early adopting site for this model, which has experienced considerable growth and development over the past 20 years. Methods: Our goal was to detail the Emergency Department Research Associates (EDRA program processes developed at the URMC that has led to our program’s sustainability and productivity. These processes, and the lessons learned during their development, can assist institutions seeking to establish an RA program or refine an existing program. Results: Defined procedures for selecting, training, and monitoring EDRAs have been created and refined with the goal of maximizing study enrollment and minimizing protocol deviations. Our EDRA program functions as a paid service center for investigators, and our EDRAs engage in a variety of study-related activities including screening and enrolling patients, administering surveys, collecting bio-specimens, and making follow-up calls. Over the past two years, our program has averaged 222 enrollments/month (standard deviation = 79.93, gathering roughly 25 participants per study per month. Conclusion: Our EDRA model has consistently resulted in some of the highest number of enrollments across a variety of recently funded, multi-center studies. Maintaining a high-quality EDRA program requires continual investment on the part of the leadership team, though the benefits to investigators within and outside the department outweigh these costs.

  20. Sexual Assault Training in Emergency Medicine Residencies: A Survey of Program Directors

    Directory of Open Access Journals (Sweden)

    Margaret K Sande

    2013-09-01

    Full Text Available Introduction: There is currently no standard forensic medicine training program for emergency medicine residents. In the advent of sexual assault nurse examiner (SANE programs aimed at improving the quality of care for sexual assault victims, it is also unclear how these programs impact emergency medicine (EM resident forensic medicine training. The purpose of this study was togather information on EM residency programs’ training in the care of sexual assault patients and determine what impact SANE programs may have on the experience of EM resident training from the perspective of residency program directors (PDs.Methods: This was a cross-sectional survey. The study cohort was all residency PDs from approved EM residency training programs who completed a closed-response self-administered survey electronically.Results: We sent surveys to 152 PDs, and 71 responded for an overall response rate of 47%. Twenty-two PDs (31% reported that their residency does not require procedural competency for the sexual assault exam, and 29 (41% reported their residents are required only to observe sexual assault exam completion to demonstrate competency. Residency PDs were asked how their programs established resident requirements for sexual assault exams. Thirty-seven PDs (52% did not know how their sexual assault exam requirement was established.Conclusion: More than half of residency PDs did not know how their sexual assault guidelines were established, and few were based upon recommendations from the literature. There is no clear consensus as to how PDs view the effect of SANE programs on resident competency with the sexual assault exam. This study highlights both a need for increased awareness of EM resident sexual assault education nationally and also a possible need for a training curriculum defining guidelines forEM residents performing sexual assault exams. [West J Emerg Med. 2013;14(5:461–466.

  1. Insights into public export promotion programs in an emerging economy: the case of Malaysian SMEs.

    Science.gov (United States)

    Ayob, Abu H; Freixanet, Joan

    2014-10-01

    This study evaluates the impact of public export promotion programs (EPPs) among small and medium-sized enterprises (SMEs) in Malaysia. Three indicators, level of awareness, frequency of use, and perception of usefulness, were examined according to a firm's export status. The global evaluation suggests that exporters are more frequent users of EPPs and perceive them to be more useful than non-exporters. Nonetheless, both groups demonstrate higher levels of awareness, are frequent users, and perceive the programs relating to export info/knowledge are more usefulness than programs relating to financial assistance. Further analysis also reveals that the frequency of use and the perception of usefulness for most programs are positively related to export experience, but not to export turnover. This study offers insights into the effectiveness of export programs for encouraging export initiation and expansion in an emerging economy. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. An evaluation of substance misuse treatment providers used by an employee assistance program.

    Science.gov (United States)

    Miller, N A

    1992-05-01

    Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

  3. Relationship between office-based provider visits and emergency department encounters among publicly-insured adults with epilepsy.

    Science.gov (United States)

    Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

    2018-03-01

    The proportion of adults with epilepsy using the emergency department (ED) is high. Among this patient population, increased frequency of office-based provider visits may be associated with lesser frequency of ED encounters, and key patient features may be linked to more ED encounters. We analyzed the Medical Expenditure Panel Survey Household Component (MEPS-HC) dataset for years 2003-2014, which represents a weighted sample of 842,249 publicly-insured US adults aged ≥18years. The Hurdle Poisson model that accommodates excess zeros was used to estimate the association between office-based and ED visits. Annual mean ED and office-based visits for publicly-insured adults with epilepsy were 0.70 and 10.8 respectively. Probability of at least one ED visit was 0.4% higher for every unit of office-based visit. Individuals in the high income category were less likely to visit the ED at least once while women with epilepsy had a higher likelihood of visiting the ED at least once. Among those who visited the ED at least once, there was a 0.3% higher likelihood of visiting the ED for every unit of office-based visit. Among individuals who visited the ED at least once, being aged 45-64years, residing in the West, and the year 2011/14 were associated with higher ED visits. In this representative sample of publicly-insured adults with epilepsy, higher frequency of office visits was not associated with lower ED utilization, which may be due to underlying greater disease severity or propensity for more treatment complications. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

    Science.gov (United States)

    Varney, Jane; Weiland, Tracey J; Jelinek, George

    2014-06-01

    Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

  5. Hazardous materials emergency response training program at Texas A ampersand M University

    International Nuclear Information System (INIS)

    Stirling, A.G.

    1989-01-01

    The Texas Engineering Extension Service (TEEX) as the engineering vocational training arm of the Texas A ampersand M University system has conducted oil-spill, hazardous-material, and related safety training for industry since 1976 and fire suppression training since 1931. In 1987 TEEX conducted training for some 66,000 persons, of which some 6000 were in hazardous-materials safety training and 22,000 in fire suppression or related fields. Various laws and regulations exist relative to employee training at an industrial facility, such as the Hazard Communication Act, the Resource Conservation and Recovery Act (RCRA), the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA or more commonly Superfund), the Community Right to Know Law, and the Superfund Amendments and Reauthorization Act (SARA), Titles I and III. The TEEX programs developed on the foundation emphasize the hands-on approach (60% field exercises) to provide a comprehensive training curriculum resulting in regulatory compliance, an effective emergency response capability, a prepared community, and a safe work environment

  6. Linear programming: an alternative approach for developing formulations for emergency food products.

    Science.gov (United States)

    Sheibani, Ershad; Dabbagh Moghaddam, Arasb; Sharifan, Anousheh; Afshari, Zahra

    2018-03-01

    To minimize the mortality rates of individuals affected by disasters, providing high-quality food relief during the initial stages of an emergency is crucial. The goal of this study was to develop a formulation for a high-energy, nutrient-dense prototype using linear programming (LP) model as a novel method for developing formulations for food products. The model consisted of the objective function and the decision variables, which were the formulation costs and weights of the selected commodities, respectively. The LP constraints were the Institute of Medicine and the World Health Organization specifications of the content of nutrients in the product. Other constraints related to the product's sensory properties were also introduced to the model. Nonlinear constraints for energy ratios of nutrients were linearized to allow their use in the LP. Three focus group studies were conducted to evaluate the palatability and other aspects of the optimized formulation. New constraints were introduced to the LP model based on the focus group evaluations to improve the formulation. LP is an appropriate tool for designing formulations of food products to meet a set of nutritional requirements. This method is an excellent alternative to the traditional 'trial and error' method in designing formulations. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  7. Impact of a logistics management program on admitted patient boarders within an emergency department.

    Science.gov (United States)

    Healy-Rodriguez, Mary Anne; Freer, Chris; Pontiggia, Laura; Wilson, Rula; Metraux, Steve; Lord, Lyndsey

    2014-03-01

    ED crowding is a public health issue, and hospitals across the country must pursue aggressive strategies to improve patient flow to help solve this growing problem. The logistics management program (LMP) is an expansion of the bed management process to include a systematic approach to patient flow management throughout the facility and a clinical liaison or field agent to drive throughput at all points of care. The purpose of this study was to examine the effects of an LMP on ED length of stay (ED evaluation times and ED placement times), as well as inpatient length of stay (IPLOS). This is a quasi-experimental study of 28,684 ED admissions in a suburban, tertiary medical center before and after implementing an LMP (2008 vs 2009). The median ED evaluation time was 219 minutes (interquartile range [IQR], 178 minutes) in 2008 versus 207 minutes (IQR, 171 minutes) in 2009 (P < .001). The median ED placement time was 219 minutes (IQR, 259 minutes) in 2008 versus 193 minutes (IQR, 158 minutes) in 2009 (P < .001). The median IPLOS was 3.93 days (IQR, 4.9 days) in 2008 versus 3.83 days (IQR, 4.7 days) in 2009 (P < .001), which represents a reduction of 1,483 inpatient days in 2009. The results provide strong evidence to support the impact of an LMP on decreasing ED evaluation times, ED placement times, and IPLOS. Further exploration is needed to examine the program as a best practice, as well as its applicability for other facilities. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  8. One University's Experience Partnering with an Online Program Management (OPM) Provider: A Case Study

    Science.gov (United States)

    Springer, Scott

    2018-01-01

    University and college administrators frequently choose to develop and implement online programs with the help of for-profit companies known as online program management (OPM) providers that specialize in the development and implementation of online programs. This paper reports on the partnership of a private university in the Western United…

  9. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP -- Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: an emergency management plan, with emphasis on the catastrophic earthquake; an Emergency Operations Center Duty Roster Manual; an Integrated Automated Emergency Management Information System (IAEMIS); and a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6, Volume III -- Chapter 7, and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume II, discusses methodology, engineering and environmental analyses, and operational procedures

  10. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc, initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP--Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: (1) an emergency management plan, with emphasis on the catas trophic earthquake, (2) an Emergency Operations Center Duty Roster Manual, (3) an Integrated Automated Emergency Management Information System (IAEMIS), and (4) a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I--Chapters 1--3; Volume II--Chapters 4--6, Volume III--Chapter 7, and Volume IV--23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume IV contains the appendices to this report

  11. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP -- Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: (1) an emergency management plan with emphasis on the catas trophic earthquake; (2) an Emergency Operations Center Duty Roster Manual; (3) an Integrated Automated Emergency Management Information System (IAEMIS); and (4) a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6; Volume III -- Chapter 7; and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is this document numbered as Volume III

  12. Did Focusing on Asia Pacific Emerging Markets Provide Much Benefit to Portfolio Diversification during the Late 2000s Recession?

    Directory of Open Access Journals (Sweden)

    Bambang Hermanto

    2013-01-01

    Full Text Available This research studies the international co-movement among Asia Pacific emerging markets stock price indices during the late 2000s recession by using the monthly observations start from 1st October 2001 until 1st April 2011. The co-integration analysis and parsimonious Vector Error Correction Model employed in this research reveal a long-term relationship and inter-dependencies among seven Asia Pacific emerging market stock price indices. This research finds that the unique co-integration exists on the equations. Specifically, two indices from China and Taiwan having meteor shower potential while the rest indices from Thailand, Malaysia, and Indonesia are known to have heat waves effects or country specific factors on the equation. Finally, all the results are linked to the international diversification strategies. Keywords: Co-movement, co-integration, emerging market, heat waves, meteor shower, Asia Pacific, inter-dependencies, Vector Error Correction Model, international diversification

  13. 25 CFR 36.102 - What student resources must be provided by a homeliving program?

    Science.gov (United States)

    2010-04-01

    ... homeliving program? The following minimum resources must be available at all homeliving programs: (a) Library resources such as access to books and resource materials, including school libraries and public libraries...

  14. 45 CFR 287.125 - What supportive and job retention services may be provided under the NEW Program?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false What supportive and job retention services may be provided under the NEW Program? 287.125 Section 287.125 Public Welfare Regulations Relating to Public... Operations § 287.125 What supportive and job retention services may be provided under the NEW Program? The...

  15. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    International Nuclear Information System (INIS)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S

    2015-01-01

    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  16. SU-E-T-571: Newly Emerging Integrated Transmission Detector Systems Provide Online Quality Assurance of External Beam Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, D; Chung, E; Hess, C; Stern, R; Benedict, S [UC Davis Cancer Center, Sacramento, CA (United States)

    2015-06-15

    Purpose: Two newly emerging transmission detectors positioned upstream from the patient have been evaluated for online quality assurance of external beam radiotherapy. The prototype for the Integral Quality Monitor (IQM), developed by iRT Systems GmbH (Koblenz, Germany) is a large-area ion chamber mounted on the linac accessory tray to monitor photon fluence, energy, beam shape, and gantry position during treatment. The ion chamber utilizes a thickness gradient which records variable response dependent on beam position. The prototype of Delta4 Discover™, developed by ScandiDos (Uppsala, Sweden) is a linac accessory tray mounted 4040 diode array that measures photon fluence during patient treatment. Both systems are employable for patient specific QA prior to treatment delivery. Methods: Our institution evaluated the reproducibility of measurements using various beam types, including VMAT treatment plans with both the IQM ion chamber and the Delta4 Discover diode array. Additionally, the IQM’s effect on photon fluence, dose response, simulated beam error detection, and the accuracy of the integrated barometer, thermometer, and inclinometer were characterized. The evaluated photon beam errors are based on the annual tolerances specified in AAPM TG-142. Results: Repeated VMAT treatments were measured with 0.16% reproducibility by the IQM and 0.55% reproducibility by the Delta4 Discover. The IQM attenuated 6, 10, and 15 MV photon beams by 5.43±0.02%, 4.60±0.02%, and 4.21±0.03% respectively. Photon beam profiles were affected <1.5% in the non-penumbra regions. The IQM’s ion chamber’s dose response was linear and the thermometer, barometer, and inclinometer agreed with other calibrated devices. The device detected variations in monitor units delivered (1%), field position (3mm), single MLC leaf positions (13mm), and photon energy. Conclusion: We have characterized two new transmissions detector systems designed to provide in-vivo like measurements upstream

  17. 77 FR 12697 - VA Homeless Providers Grant and Per Diem Program

    Science.gov (United States)

    2012-03-01

    ... application stage. Proposed paragraph (b) would revise the ``tiebreaker'' provisions in current paragraph (b... ``coordination'' score as the tiebreaker because our experience in managing this program has shown that programs... social services programs, have more successful outcomes. We would similarly include a tiebreaker...

  18. A simulation-based training program improves emergency department staff communication.

    Science.gov (United States)

    Sweeney, Lynn A; Warren, Otis; Gardner, Liz; Rojek, Adam; Lindquist, David G

    2014-01-01

    The objectives of this study were to evaluate the effectiveness of Project CLEAR!, a novel simulation-based training program designed to instill Crew Resource Management (CRM) as the communication standard and to create a service-focused environment in the emergency department (ED) by standardizing the patient encounter. A survey-based study compared physicians' and nurses' perceptions of the quality of communication before and after the training program. Surveys were developed to measure ED staff perceptions of the quality of communication between staff members and with patients. Pretraining and posttraining survey results were compared. After the training program, survey scores improved significantly on questions that asked participants to rate the overall communication between staff members and between staff and patients. A simulation-based training program focusing on CRM and standardizing the patient encounter improves communication in the ED, both between staff members and between staff members and patients.

  19. Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa?

    Science.gov (United States)

    Tambo, Ernest; Madjou, Ghislaine; Khayeka-Wandabwa, Christopher; Tekwu, Emmanuel N; Olalubi, Oluwasogo A; Midzi, Nicolas; Bengyella, Louis; Adedeji, Ahmed A; Ngogang, Jeanne Y

    2016-01-01

    Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA) health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems.  As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs.

  20. A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks.

    Science.gov (United States)

    Reiter, Kristin L; Song, Paula H; Minasian, Lori; Good, Marjorie; Weiner, Bryan J; McAlearney, Ann Scheck

    2012-09-01

    The Community Clinical Oncology Program (CCOP) plays an essential role in the efforts of the National Cancer Institute (NCI) to increase enrollment in clinical trials. Currently, there is little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. In this article, the authors present a conceptual model of the business case for PBRN participation, a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization. A comparative, case-study approach was used to identify key components of the business case for hospitals attempting to support a CCOP research infrastructure. Semistructured interviews were conducted with providers and administrators. Key themes were identified and used to develop the financial analysis tool. Key components of the business case included CCOP start-up costs, direct revenue from the NCI CCOP grant, direct expenses required to maintain the CCOP research infrastructure, and incidental benefits, most notably downstream revenues from CCOP patients. The authors recognized the value of incidental benefits as an important contributor to the business case for CCOP participation; however, currently, this component is not calculated. The current results indicated that providing a method for documenting the business case for CCOP or other PBRN involvement will contribute to the long-term sustainability and expansion of these programs by improving providers' understanding of the financial implications of participation. Copyright © 2011 American Cancer Society.

  1. Sugar daddy. Most Americans know Medicare as the health insurance program for the elderly, but to providers, it's a jobs program, a capital financier and a safety net.

    Science.gov (United States)

    Hallam, K; Gardner, J

    1999-11-08

    Most Americans know Medicare as the health insurance program that covers the elderly. But to providers it's much more that. The program pays for medical education, finances capital projects and subsidizes care for the indigent. Should Medicare continue making those add-on payments? Is that the program's mission? The debate is intensifying.

  2. A Grounded Theory Qualitative Analysis of Interprofessional Providers' Perceptions on Caring for Critically Ill Infants and Children in Pediatric and General Emergency Departments.

    Science.gov (United States)

    Gangadharan, Sandeep; Tiyyagura, Gunjan; Gawel, Marcie; Walsh, Barbara M; Brown, Linda L; Lavoie, Megan; Tay, Khoon-Yen; Auerbach, Marc A

    2016-10-04

    The objective of this study was to explore pediatric emergency department (PED) and general emergency department (GED) providers' perceptions on caring for critically ill infants and children. This study utilized qualitative methods to examine the perceptions of emergency department providers caring for critically ill infants and children. Teams of providers participated in 4 in situ simulation cases followed by facilitated debriefings. Debriefings were recorded and professionally transcribed. The transcripts were reviewed independently and followed by group coding discussions to identify emerging themes. Consistent with grounded theory, the team iteratively revised the debriefing script as new understanding was gained. A total of 188 simulation debriefings were recorded in 24 departments, with 15 teams participating from 8 PEDs and 32 teams from 16 GEDs. Twenty-four debriefings were audiotaped and professionally transcribed verbatim. Thematic saturation was achieved after 20 transcripts. In our iterative qualitative analysis of these transcripts, we observed 4 themes: (1) GED provider comfort with algorithm-based pediatric care and overall comfort with pediatric care in PED, (2) GED provider reliance on cognitive aids versus experience-based recall by PED providers, (3) GED provider discomfort with locating and determining size or dose of pediatric-specific equipment and medications, and (4) PED provider reliance on larger team size and challenges with multitasking during resuscitation. Our qualitative analysis produced several themes that help us to understand providers' perceptions in caring for critically ill children in GEDs and PEDs. These data could guide the development of targeted educational and improvement interventions.

  3. Impact of a computerized provider radiography order entry system without clinical decision support on emergency department medical imaging requests.

    Science.gov (United States)

    Claret, Pierre-Géraud; Bobbia, Xavier; Macri, Francesco; Stowell, Andrew; Motté, Antony; Landais, Paul; Beregi, Jean-Paul; de La Coussaye, Jean-Emmanuel

    2016-06-01

    The adoption of computerized physician order entry is an important cornerstone of using health information technology (HIT) in health care. The transition from paper to computer forms presents a change in physicians' practices. The main objective of this study was to investigate the impact of implementing a computer-based order entry (CPOE) system without clinical decision support on the number of radiographs ordered for patients admitted in the emergency department. This single-center pre-/post-intervention study was conducted in January, 2013 (before CPOE period) and January, 2014 (after CPOE period) at the emergency department at Nîmes University Hospital. All patients admitted in the emergency department who had undergone medical imaging were included in the study. Emergency department admissions have increased since the implementation of CPOE (5388 in the period before CPOE implementation vs. 5808 patients after CPOE implementation, p=.008). In the period before CPOE implementation, 2345 patients (44%) had undergone medical imaging; in the period after CPOE implementation, 2306 patients (40%) had undergone medical imaging (p=.008). In the period before CPOE, 2916 medical imaging procedures were ordered; in the period after CPOE, 2876 medical imaging procedures were ordered (p=.006). In the period before CPOE, 1885 radiographs were ordered; in the period after CPOE, 1776 radiographs were ordered (pmedical imaging did not vary between the two periods. Our results show a decrease in the number of radiograph requests after a CPOE system without clinical decision support was implemented in our emergency department. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The effectiveness of an educational program on preventing and treating compassion fatigue in emergency nurses.

    Science.gov (United States)

    Flarity, Kathleen; Gentry, J Eric; Mesnikoff, Nathan

    2013-01-01

    The purpose of this qualitative study was to examine the treatment effectiveness of a multifaceted education program to decrease compassion fatigue (CF) and burnout (BO) symptoms and increase compassion satisfaction of emergency nurses participating in the training. The goal of the CF multifaceted intervention program was to demonstrate a statistically significant improvement in the 3 CF subscales: an increase on the Compassion Satisfaction (CS) subscale and a decrease on the Secondary Traumatic Stress (STS) and BO subscales in the participants' pretest and posttest scores as measured by The Professional Quality of Life test (B. H. , ). The study sites were 2 emergency departments in Colorado Springs, CO. A convenience sample consisted of emergency nurses who self-selected to participate in the study. Univariate statistics were used, and data were examined for normalcy of distribution. Because these data were not distributed normally, Wilcoxon signed-rank tests were used to evaluate the differences between the baseline and postintervention groups. The multifaceted education program resulted in a statistically significant increase in CS (p = 0.004) and a decrease in BO (p = 0.001 or less) and STS (p = 0.001) symptoms.

  5. Availability of Insurance Linkage Programs in U.S. Emergency Departments

    Directory of Open Access Journals (Sweden)

    Mia Kanak

    2014-07-01

    Full Text Available Introduction: As millions of uninsured citizens who use emergency department (ED services are now eligible for health insurance under the Affordable Care Act, the ED is ideally situated to facilitate linkage to insurance. Forty percent of U.S. EDs report having an insurance linkage program. This is the first national study to examine the characteristics of EDs that offer or do not offer these programs. Methods: This was a secondary analysis of data from the National Survey for Preventive Health Services in U.S. EDs conducted in 2008-09. We compared EDs with and without insurance programs across demographic and operational factors using univariate analysis. We then tested our hypotheses using multivariable logistic regression. We also further examined program capacity and priority among the sub-group of EDs with no insurance linkage program. Results: After adjustment, ED-insurance linkage programs were more likely to be located in the West (RR= 2.06, 95% CI = 1.33 – 2.72. The proportion of uninsured patients in an ED, teaching hospital status, and public ownership status were not associated with insurance linkage availability. EDs with linkage programs also offer more preventive services (RR = 1.87, 95% CI = 1.37–2.35 and have greater social worker availability (RR = 1.71, 95% CI = 1.12–2.33 than those who do not. Four of five EDs with a patient mix of ≥25% uninsured and no insurance linkage program reported that they could not offer a program with existing staff and funding. Conclusion: Availability of insurance linkage programs in the ED is not associated with the proportion of uninsured patients served by an ED. Policy or hospital-based interventions to increase insurance linkage should first target the 27% of EDs with high rates of uninsured patients that lack adequate program capacity. Further research on barriers to implementation and cost effectiveness may help to facilitate increased adoption of insurance linkage programs. [West J

  6. Development of emergency response training program based on human factors; Developpement d'un programme de formation pour la reaction aux situations d'urgences base sur les facteurs humains

    Energy Technology Data Exchange (ETDEWEB)

    Nakata, Y. [Osaka Gas Co., Ltd. (Japan)

    2000-07-01

    A training program has been developed at Osaka Gas Co., Ltd. to improve personal response to emergency situations by enabling plant shift chiefs to understand the unique human behavioral patterns that appear during emergencies. The program provides comprehensive and systematic training consisting of lectures and seminars based on a Human Factor Handbook, simulation training, and feedback training. The program can also be applied to all areas of the process industry. (author)

  7. CoCoRaHS: A Community Science Program Providing Valuable Precipitation Data to Guide Decision Making

    Science.gov (United States)

    Robinson, D. A.; Doesken, N.

    2017-12-01

    CoCoRaHS is an acronym for the Community Collaborative Rain, Hail and Snow Network. It is long-running, community-based network of volunteers working together to measure and map precipitation (rain, hail and snow). Precipitation is an ideal element for public engagement because it affects everyone, it is so variable in time and space and it impacts so many things. By using a standard precipitation gauge, stressing training and education, utilizing an interactive website, and having observations undergo quality assurance, the CoCoRaHS program provides high-quality data for natural resource, education and research applications. The program currently operates in all states, Canada and the Bahamas. It originated with the Colorado Climate Center at Colorado State University in 1998 due in part to the Fort Collins flood a year prior. Upwards of 12,000 observers submit observations each day. Observations meet federal guidelines and are archived at the U.S. National Centers for Environmental Information. Because of excellent spatial coverage, data quality, practical relevance, and accessibility, CoCoRaHS observations are used by a wide variety of organizations and individuals. The U.S. National Weather Service, hydrologists, emergency managers, city utilities (water supply, storm water), insurance adjusters, the U.S. Department of Agriculture, engineers, mosquito control commissions, ranchers and farmers, outdoor and recreation interests, teachers and students are just some examples of those who use CoCoRaHS data in making well-informed, meaningful decisions. Some examples of community applications and the science utility of CoCoRaHS observations include storm warnings, water supply and demand forecasts, disaster declarations (drought, winter storm, etc.), drought and food production assessments, calibration/validation of remote sensing, infrastructure evaluation and potential redesign (ice and snow loading, bridge, storm and sewer design), recreation planning, and

  8. New Policies Allow High School Child Development Programs to Provide CDA Licensure

    Science.gov (United States)

    Langlais, Amanda G.

    2012-01-01

    Recent changes made by the Council for Professional Recognition to the Child Development Associate (CDA) credentialing program create an opportunity to redesign high school child development programs. On April 1, 2011, the Council for Professional Recognition lifted the age restriction in the CDA credentialing requirements, now allowing students…

  9. A Family Agency's Approach to Providing Employee Assistance Programs in Industry.

    Science.gov (United States)

    Keohane, Raymond G.; Newman, Carrie E.

    1984-01-01

    Describes the Employee Services Network (ESN), an employee assistance program developed within the Family and Children's Service of Richmond, Virginia. Demonstrates how a not-for-profit agency can develop, structure, and implement a program of services for the corporate community. (LLL)

  10. Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

    Science.gov (United States)

    Stefos, Kathryn A.; Nable, Jose V.

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

  11. Development of reliability program for emergency diesel generators in domestic nuclear power plants

    International Nuclear Information System (INIS)

    Kim, Young Ho; Jung, Hyun Jong; Choi, Kwang Hee; Hong, Seoung Yeul

    2001-01-01

    Surveillance tests of Emergency Diesel Generators (EDGs) in Nuclear Power Plants (NPPs) have been conducted periodically to verify the reliability and integrity of the EDGs, however, it was found that these surveillance methods were so conservative and severe as to accelerate the degradation of the EDGs. Hence, new regulatory guideline, Reg. Guide 1.9 Rev. 3, was established by the U.S. NRC to resolve these problems. But it requires the additional implementation of reliability program of the EDGs to improve the actual reliability of them. In Korea, the EDGs of Yonggwang nuclear units 3 and 4 were the first plant applying new Reg. guide 1.9 rev.3 and implementing EDG reliability program. Furthermore it is expected that new guideline for the EDGs will be applied to other EDGs of Korean NPPs. In this paper, this reliability program is described, and it can be used as a reference for other EDGs in Korean NPPs

  12. The health worker recruitment and deployment process in Kenya: an emergency hiring program

    Directory of Open Access Journals (Sweden)

    Adano Ummuro

    2008-09-01

    Full Text Available Abstract Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM. Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions

  13. The health worker recruitment and deployment process in Kenya: an emergency hiring program.

    Science.gov (United States)

    Adano, Ummuro

    2008-09-16

    Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART). Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM). Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions and not generalists who are

  14. Three-year emergency medicine training program in The Netherlands: first evaluation from the residents' perspective.

    Science.gov (United States)

    Koning, Salomon Willem; Gaakeer, Menno Iskander; Veugelers, Rebekka

    2013-07-26

    The Netherlands' 3-year training in Emergency Medicine (EM) was formally approved and introduced in November 2008. To identify areas for improvement, we conducted the first evaluation of this curriculum from the residents' perspective. A questionnaire was composed on ten aspects of the curriculum. It contained multiple-choice, open and opinion questions; answers to the latter were classified using the Likert scale. The questionnaires were mailed to all enrolled residents. We mailed questionnaires to all 189 enrolled residents, and 105 responded (55.6%). Although they were satisfied with their training overall, 96.2% thought it was currently too short: 18.3% desired extension to 4 years, 76.0% to 5 and 1.9% to 6 years. Nevertheless, residents expected that they would function effectively as emergency physicians (EPs) after finishing their 3-year training program. Bedside teaching was assessed positively by 35.2%. All rotations were assessed positively, with the general practice rotation seen as contributing the least to the program. According to 43.7%, supervising EPs were available for consultation; 40.7% thought that, in a clinical capacity, the EP was sufficiently present during residents' shifts. When EPs were present, 82.5% found them to be easily accessible, and 66.6% viewed them as role models. In the Emergency Medicine Departments (EDs) with a higher number of EPs employed, residents tended to perceive better supervision and were more likely to see their EPs as role models. While residents were stimulated to do research, actual support and assistance needed to be improved. Although overall, the current training program was evaluated positively, the residents identified four areas for improvement: (1) in training hospitals, trained EPs should be present more continuously for clinical supervision; (2) bedside teaching should be improved, (3) scientific research should be facilitated more and (4) the training program should be extended.

  15. The REDIH experience: an emerging design to develop an effective training program for graduate students in reproductive science

    Directory of Open Access Journals (Sweden)

    MacDonald CJ

    2013-10-01

    Full Text Available Colla J MacDonald,1 Douglas Archibald,2 Jay M Baltz,3 Gerald M Kidder4 1Faculty of Education, 2Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada; 3Ottawa Hospital Research Institute, Ottawa, ON, Canada; 4Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada Background: A training program in Reproduction, Early Development, and the Impact on Health (REDIH was initiated in 2009 by researchers specializing in biomedical, clinical, population health, and ethics research from seven collaborating universities in Quebec and Ontario, and Health Canada. This paper reports the findings from the first three years of the 6-year program. Objectives: The objective of the REDIH program is to provide increased opportunities for excellent training in reproduction and early development for graduate students and fellows, in order to build research, clinical, regulatory, decision-making, and industry capacity in Canada. Methods: A mixed methods approach was used to evaluate the REDIH training program, so as to combine the strengths of both qualitative and quantitative studies. A total of four focus groups (two with mentors and two with trainees were run during the June 2012 REDIH meeting. Surveys were administered directly after each training module. The W(eLearn framework was used as a guide to design and evaluate the program and answer the research questions. Results: The data from the analysis of the focus group interviews, in corroboration with the survey data, suggested trainees enjoyed and benefited from the REDIH experience. Trainees provided several examples of new knowledge and skills they had acquired from REDIH sessions, regarding reproductive and early developmental biology, and health. A few trainees who had been in the program for over a year provided examples of knowledge and skills acquired during the REDIH session that they were using in their place of work. Next steps will include

  16. Reaching new heights: development of the emergency department nurse practitioner fellowship program.

    Science.gov (United States)

    Varghese, Jane R; Silvestri, Antonette; Lopez, Patricia

    2012-01-01

    With nationwide resident shortages and decreasing resident shifts, and legislation decreasing resident work hours, the nurse practitioners (NPs) have been called upon to expand their scope of practice to encompass patients with immediate and critical conditions and to perform quick procedures. Most pediatric NP (PNP) programs do not have formal training for NP students to work in a pediatric emergency department (ED). Senior ED NPs in collaboration with an NP educator developed a comprehensive clinical program to prepare a general PNP student to practice in an ED. The fellowship committee, met with 3 local university PNP program directors. The fellowship program targeted highly motivated individuals with an interest in working in a pediatric ED at the completion of their program as recruits for the position. Based on positive feedback, there has been overwhelming support and acceptance from the ED attending physicians, the NPs in the specialty clinics, as well as the ED staff regarding the new NP fellowship role. The NP fellow experienced less stress transitioning from student to NP. The development of the fellowship program is a step forward in the future training of NPs. The structured fellowship will hopefully facilitate a seamless transition from student to NP.

  17. The Swedish Deep Drilling Program - an emerging scientific drilling program and new infrastructure.

    Science.gov (United States)

    Lorenz, Henning; Juhlin, Christopher

    2010-05-01

    Scientific drilling projects imply numerous aspects that are difficult to handle for individual research groups. Therefore, about three years ago a joint effort was launched in the Swedish geoscientific community to establish a national program for scientific drilling, the Swedish Deep Drilling Program (SDDP). Soon afterwards, several working groups established drilling proposals with Nordic and, also, international participation. With this serious interest in scientific drilling SDDP was able to successfully promote the Swedish membership in ICDP which commenced in 2008. Two SDDP projects achieved workshop grants from the International Continental Scientific Drilling Program (ICDP) in 2009. In the same year the Swedish Research Council decided to support an application for a truck-mounted drill rig - a big success for the SDDP working group. Scientific Drilling infrastructure: SDDP envisages a mobile platform that is capable of core drilling to at least 2500 m depth. The procurement will be made during 2010 and first operations are planned for 2011. This drill rig is primarily intended for use in the SDDP drilling projects, but will be rented out to other scientific drilling projects or even commercial enterprises in the remaining time to cover maintenance and future upgrade costs. SDDP's drill rig will be unique in Europe and complementary to the deep drilling InnovaRig of the GFZ German Research Centre for Geosciences. Until now, drilling to 2000 - 3000 m implied the use of a full-sized drill rig like the InnovaRig or the mobilization of a core drill rig from another continent. This gap will now be filled by Sweden's upcoming scientific drilling infrastructure. Drilling projects and proposals: Presently, SDDP serves six projects: "Collisional Orogeny in the Scandinavian Caledonides" (COSC; ICDP workshop spring 2010), the "Postglacial Fault Drilling Project" (PFDP; ICDP workshop autumn 2010), a "Deep Rock Laboratory" (DRL), "Palaeoproterozoic Mineralized Volcanic

  18. The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions

    Science.gov (United States)

    Bakal, Jeffrey A.; Green, Lee; Bahler, Brad; Lewanczuk, Richard

    2018-01-01

    BACKGROUND: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care. METHODS: We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months. RESULTS: Adults receiving care within a primary care network (n = 1 502 916) were older and had higher comorbidity burdens than those receiving conventional primary care (n = 1 109 941). Patients in a primary care network were less likely to visit the emergency department for an indicator condition (1.4% v. 1.7%, mean 0.031 v. 0.035 per patient, adjusted risk ratio [RR] 0.98, 95% confidence interval [CI] 0.96–0.99) or for any cause (25.5% v. 30.5%, mean 0.55 v. 0.72 per patient, adjusted RR 0.93, 95% CI 0.93–0.94), but were more likely to be admitted to hospital for an indicator condition (0.6% v. 0.6%, mean 0.018 v. 0.017 per patient, adjusted RR 1.07, 95% CI 1.03–1.11) or all-cause (9.3% v. 9.1%, mean 0.25 v. 0.23 per patient, adjusted RR 1.08, 95% CI 1.07–1.09). Patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years. INTERPRETATION: Care within a primary care network was associated with fewer emergency department visits and fewer hospital days. PMID:29530868

  19. 25 CFR 26.30 - Does the Job Training Program provide part-time training or short-term training?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Does the Job Training Program provide part-time training or short-term training? 26.30 Section 26.30 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.30 Does the Job Training...

  20. 75 FR 24437 - Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and...

    Science.gov (United States)

    2010-05-05

    ... including Directors and Board Members of corporations and non-profit organizations and charities. The..., ``Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to...

  1. Electronic Health Record Vendors Reported by Health Care Providers Participating in Federal EHR Incentive Programs

    Data.gov (United States)

    U.S. Department of Health & Human Services — This public use file combines registration data compiled from two federal programs that are on-going since February 2009 – the Centers for Medicare & Medicaid...

  2. Development of a computer program for supporting to the radiological adviser in the management of an emergency situation

    International Nuclear Information System (INIS)

    Loureiro, E.C.M.; Ferreira F, A.L.; Andrade L, F.R. de

    2006-01-01

    One of the more important aspects of the handling of a radiological emergency it is the capacity for, in an immediate and appropriate way, to take the actions to protect the public members and the personnel that intervenes in the emergency. The evaluation of the radiological accident should keep in mind the whole available pertinent information in any moment and it should be an iterative and dynamic process directed to examine the answer in the measure that more complete and detailed information is available. This work presents a program in Delphi, with the tools, generic procedures and the necessary data to support to the radiological advisory in the initial answer to a radiological accident. It is based on the IAEA document, Generic Procedures for the Evaluation and Answer during a radiological emergency, the IAEA-TECDOC-1162. These procedures offer clear, concise and predetermined action criteria, based on the current knowledge and in the accumulated experiences, allowing the immediate decision making. The philosophy is to maintain the simple and quick, but effective process. The objective is to toast, through a laptop, practical and quick orientation for the answer to emergencies that of being implemented, it will provide an estimation or basic evaluation of the situation and it will guarantee the capacity of necessary answer to protect the public and the workers in the event of different types of radiological emergencies. Besides the recommendations of actions of appropriate protection, also it will toast, when it is necessary, orientations on the recovery of sources and initial operations of cleaning. (Author)

  3. Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study

    Directory of Open Access Journals (Sweden)

    Xu Yihua

    2008-10-01

    Full Text Available Abstract Background Since the 9/11 attack and severe acute respiratory syndrome (SARS, the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Methods Forty-one public health leaders (N = 41 from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up. Results The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. Conclusion The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

  4. Development of emergency response training program for on-site commanders (1)

    International Nuclear Information System (INIS)

    Hikono, Masaru; Matsui, Yuko; Kanayama, Masaki

    2017-01-01

    Since the Great East Japan Earthquake of 2011, there have been increasing calls for developing the leadership capabilities of managers who are in charge of command and control of the on-site emergency response center at nuclear power plants. Training programs to improve non-technical skills are being developed and introduced. The authors developed an active learning exercise that can be repeatedly performed on-site, targeting on-site commander teams in charge of the initial response in an emergency situation. The exercise forms the core element of a non-technical skills training curriculum. This paper outlines the developed exercise, evaluates the stress on the participants caused by the exercise, and identifies any issues before actually introducing it to a site. (author)

  5. Applications of the new program system UFOMOD in the field of emergency response planning

    International Nuclear Information System (INIS)

    Burkart, K.; Ehrhardt, J.; Hasemann, I.

    1988-01-01

    In addition to the main purpose of assessing the consequences of nuclear accidents, the new program system UFOMOD is designed to be a very flexible tool for investigation of alternatives in emergency response planning and emergency management, and for studies of the differences in collective exposure due to different response of parts of the population (disregard or misinterpretation of alarms, spontaneous evacuation etc.). After a brief summary of the main features of the countermeasures submodel, scope, flexibility and variety of results are demonstrated by means of calculations with both an early short and a slightly delayed longer lasting release. Risks and benefits of 3 types of evacuation, i.e. prophylactic, during release and after passage of the plume, are discussed by comparing CCFDs of early fatalities. The number of injuries and fatalities as well as areas and numbers of persons affected by countermeasures may depend considerably on the intervention levels applied. Correlations between these quantities obtained within a parameter study are presented

  6. The Impact of Combat Deployment on Health Care Provider Burnout in a Military Emergency Department: A Cross-Sectional Professional Quality of Life Scale V Survey Study.

    Science.gov (United States)

    Cragun, Joshua N; April, Michael D; Thaxton, Robert E

    2016-08-01

    Compassion fatigue is a problem for many health care providers manifesting as physical, mental, and spiritual exhaustion. Our objective was to evaluate the association between prior combat deployment and compassion fatigue among military emergency medicine providers. We conducted a nonexperimental cross-sectional survey of health care providers assigned to the San Antonio Military Medical Center, Department of Emergency Medicine. We used the Professional Quality of Life Scale V survey instrument that evaluates provider burnout, secondary traumatic stress, and compassion satisfaction. Outcomes included burnout, secondary traumatic stress, and compassion satisfaction raw scores. Scores were compared between providers based on previous combat deployments using two-tailed independent sample t tests and multiple regression models. Surveys were completed by 105 respondents: 42 nurses (20 previously deployed), 30 technicians (11 previously deployed), and 33 physicians (16 previously deployed). No statistically significant differences in burnout, secondary traumatic stress, or compassion satisfaction scores were detected between previously deployed providers versus providers not previously deployed. There was no association between previous combat deployment and emergency department provider burnout, secondary traumatic stress, or compassion satisfaction scores. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  7. Structural Aging Program approach to providing an improved basis for aging management of safety-related concrete structures

    International Nuclear Information System (INIS)

    Naus, D.J.; Oland, C.B.; Ellingwood, B.

    1993-01-01

    The Structural Aging (SAG) Program is being conducted at the Oak Ridge National Laboratory (ORNL) for the United States Nuclear Regulatory Commission (USNRC). The SAG Program is addressing the aging management of safety-related concrete structures in nuclear power plants for the purpose of providing improved technical bases for their continued service. The program is organized into four tasks: Program Management, Materials Property Data Base, Structural Component Assessment/Repair Technologies, and Quantitative Methodology for Continued Service Determinations. Objectives and a summary of recent accomplishments under each of these tasks are presented

  8. Genomic analysis of globally diverse Mycobacterium tuberculosis strains provides insights into emergence and spread of multidrug resistance

    Science.gov (United States)

    Manson, Abigail L.; Cohen, Keira A.; Abeel, Thomas; Desjardins, Christopher A.; Armstrong, Derek T.; Barry, Clifton E.; Brand, Jeannette; Chapman, Sinéad B.; Cho, Sang-Nae; Gabrielian, Andrei; Gomez, James; Jodals, Andreea M.; Joloba, Moses; Jureen, Pontus; Lee, Jong Seok; Malinga, Lesibana; Maiga, Mamoudou; Nordenberg, Dale; Noroc, Ecaterina; Romancenco, Elena; Salazar, Alex; Ssengooba, Willy; Velayati, A. A.; Winglee, Kathryn; Zalutskaya, Aksana; Via, Laura E.; Cassell, Gail H.; Dorman, Susan E.; Ellner, Jerrold; Farnia, Parissa; Galagan, James E.; Rosenthal, Alex; Crudu, Valeriu; Homorodean, Daniela; Hsueh, Po-Ren; Narayanan, Sujatha; Pym, Alexander S.; Skrahina, Alena; Swaminathan, Soumya; Van der Walt, Martie; Alland, David; Bishai, William R.; Cohen, Ted; Hoffner, Sven; Birren, Bruce W.; Earl, Ashlee M.

    2017-01-01

    Multidrug-resistant tuberculosis (MDR-TB), caused by drug resistant strains of Mycobacterium tuberculosis, is an increasingly serious problem worldwide. In this study, we examined a dataset of 5,310 M. tuberculosis whole genome sequences from five continents. Despite great diversity with respect to geographic point of isolation, genetic background and drug resistance, patterns of drug resistance emergence were conserved globally. We have identified harbinger mutations that often precede MDR. In particular, the katG S315T mutation, conferring resistance to isoniazid, overwhelmingly arose before rifampicin resistance across all lineages, geographic regions, and time periods. Molecular diagnostics that include markers for rifampicin resistance alone will be insufficient to identify pre-MDR strains. Incorporating knowledge of pre-MDR polymorphisms, particularly katG S315, into molecular diagnostics will enable targeted treatment of patients with pre-MDR-TB to prevent further development of MDR-TB. PMID:28092681

  9. 75 FR 69454 - Emergency Homeowners' Loan Program: Notice of Allocation of Funding for Substantially Similar...

    Science.gov (United States)

    2010-11-12

    ... assistance and provide security for such repayment by recordation of a HUD mortgage as a junior lien on the... current first lien mortgage loan payments for which the homeowner remains responsible. IV. Submission of.... Nondiscrimination and Civil Rights Requirements States operating existing programs that provide substantially...

  10. Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial.

    Science.gov (United States)

    McCarthy, Melissa L; Ding, Ru; Roderer, Nancy K; Steinwachs, Donald M; Ortmann, Melinda J; Pham, Julius Cong; Bessman, Edward S; Kelen, Gabor D; Atha, Walter; Retezar, Rodica; Bessman, Sara C; Zeger, Scott L

    2013-09-01

    We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients. Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge. Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care. Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient

  11. Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs.

    Science.gov (United States)

    Pesko, Michael F; Bains, Jaskaran; Maclean, Johanna Catherine; Cook, Benjamin Lê

    2018-03-01

    The Affordable Care Act (ACA) allowed employer plans in the small-group marketplace to charge tobacco users up to 50 percent more for premiums-known as tobacco surcharges-but only if the employer offered a tobacco cessation program and the employee in question failed to participate in it. Using 2016 survey data collected by the Henry J. Kaiser Family Foundation and Health Research and Educational Trust on 278 employers eligible for Small Business Health Options Program, we examined the prevalence of tobacco surcharges and tobacco cessation programs in the small-group market under this policy and found that 16.2 percent of small employers used tobacco surcharges. Overall, 47 percent of employers used tobacco surcharges but failed to offer tobacco cessation counseling. Wellness program prevalence was lower in states that allowed tobacco surcharges, and 10.8 percent of employers in these states were noncompliant with the ACA by charging tobacco users higher premiums without offering cessation programs. Efforts should be undertaken to improve the monitoring and enforcement of ACA tobacco rating rules.

  12. Emerging Space Powers The New Space Programs of Asia, the Middle East, and South America

    CERN Document Server

    Harvey, Brian; Pirard, Théo

    2010-01-01

    This work introduces the important emerging space powers of the world. Brian Harvey describes the origins of the Japanese space program, from rocket designs based on WW II German U-boats to tiny solid fuel 'pencil' rockets, which led to the launch of the first Japanese satellite in 1970. The next two chapters relate how Japan expanded its space program, developing small satellites into astronomical observatories and sending missions to the Moon, Mars, comet Halley, and asteroids. Chapter 4 describes how India's Vikram Sarabhai developed a sounding rocket program in the 1960s. The following chapter describes the expansion of the Indian space program. Chapter 6 relates how the Indian space program is looking ahead to the success of the moon probe Chandrayan, due to launch in 2008, and its first manned launching in 2014. Chapters 7, 8, and 9 demonstrate how, in Iran, communications and remote sensing drive space technology. Chapter 10 outlines Brazil's road to space, begun in the mid-1960's with the launch of th...

  13. Virtual Property Manager: Providing a Simulated Learning Environment in a New University Program of Study

    Directory of Open Access Journals (Sweden)

    Andrew Carswell

    2007-08-01

    Full Text Available This paper relates the experience that students have while accessing Virtual Property Manager (VPM, a Web-based simulation learning tool designed to introduce students to a new discipline being offered at the university – Residential Property Management. The VPM simulation was designed in part to develop student interest in the new program. Results indicate that this simple simulation device did make a notable impact on student interest. Additionally, student acceptance and self-reported impact differed significantly based upon the delivery context. Adding a competitive reward element to the simulation experience improved student's evaluation of the software and self-reported interest in the field. Results indicate that educational simulation evaluation, acceptance, and performance may often be substantially influenced by the delivery context, rather than simply the program itself. Developers may do well to focus "outside the box" of program content to promote audience-specific delivery environments.

  14. Stressors, supports and the social ecology of displacement: psychosocial dimensions of an emergency education program for Chechen adolescents displaced in Ingushetia, Russia.

    Science.gov (United States)

    Betancourt, Theresa Stichick

    2005-09-01

    This study explored the psychosocial benefits of an emergency education intervention serving adolescents displaced by the war in Chechnya. It set out to describe key stressors and sources of social support available to youth served by the International Rescue Committee's (IRC) emergency education program. Interviews were conducted with 57 Chechen adolescents living in spontaneous settlements in Ingushetia, Russia in the fall of 2000. Of particular interest was the degree to which the education program addressed specified psychosocial goals. Findings indicated that young people and their families faced a number of physical and emotional stressors. The data indicated that the emergency education program provided benefits by enriching sources of social support, providing meaningful activity and a sense of hope for the future, and creating a space for young people to spend time and connect to others. However, the contrast between the desire of adolescents "to live like other kids" and the options available to them presented a dilemma for the emergency education program: adolescents craved normalcy, but for any intervention to be delivered, it had to first begin with creative and adaptive strategies that were by no means a complete replacement for formal, mainstream education. The programmatic and policy implications of these findings are presented here.

  15. Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

    National Research Council Canada - National Science Library

    Tudela, Joseph A

    2004-01-01

    The purpose of this project is to study provider and coder related performance, i.e., provider compliance rate and coder productivity/accuracy rates and average dollar difference between coder and auditor, at Brooke Army Medical Center...

  16. Preparing emergency personnel in dialysis: a just-in-time training program for additional staffing during disasters.

    Science.gov (United States)

    Stoler, Genevieve B; Johnston, James R; Stevenson, Judy A; Suyama, Joe

    2013-06-01

    There are 341 000 patients in the United States who are dependent on routine dialysis for survival. Recent large-scale disasters have emphasized the importance of disaster preparedness, including supporting dialysis units, for people with chronic disease. Contingency plans for staffing are important for providing continuity of care for a technically challenging procedure such as dialysis. PReparing Emergency Personnel in Dialysis (PREP-D) is a just-in-time training program designed to train individuals having minimum familiarity with the basic steps of dialysis to support routine dialysis staff during a disaster. A 5-module educational program was developed through a collaborative, multidisciplinary effort. A pilot study testing the program was performed using 20 nontechnician dialysis facility employees and 20 clinical-year medical students as subjects. When comparing pretest and posttest scores, the entire study population showed a mean improvement of 28.9%, with dialysis facility employees and medical students showing improvements of 21.8% and 36.4%, respectively (P just-in-time training format. The knowledge gained by using the PREP-D program during a staffing shortage may allow for continuity of care for critical services such as dialysis during a disaster.

  17. Community Building Services Training Program: A Model Training Program to Provide Technical Training for Minority Adults in Construction, Building Maintenance,and Property Management. Final Report.

    Science.gov (United States)

    Community Building Maintenance Corp., Chicago, IL.

    A demonstration program, administered by a community based building maintenance, management, and construction corporation, was developed to provide technical training for minority adults in construction, building maintenance, and property management in the Chicago area. The program was concerned with seeking solutions to the lack of housing, job…

  18. Mexican immigrant mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy program.

    Science.gov (United States)

    Kummerer, Sharon E; Lopez-Reyna, Norma A; Hughes, Marie Tejero

    2007-08-01

    This qualitative study explored mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy programs. Participants were 14 Mexican immigrant mothers and their children (age 17-47 months) who were receiving center-based services from an early childhood intervention program, located in a large urban city in the Midwestern United States. Mother interviews composed the primary source of data. A secondary source of data included children's therapy files and log notes. Following the analysis of interviews through the constant comparative method, grounded theory was generated. The majority of mothers perceived their children as exhibiting a communication delay. Causal attributions were diverse and generally medical in nature (i.e., ear infections, seizures) or due to familial factors (i.e., family history and heredity, lack of extended family). Overall, mothers seemed more focused on their children's speech intelligibility and/or expressive language in comparison to emergent literacy abilities. To promote culturally responsive intervention, mothers recommended that professionals speak Spanish, provide information about the therapy process, and use existing techniques with Mexican immigrant families.

  19. How Much of a "Running Start" Do Dual Enrollment Programs Provide Students?

    Science.gov (United States)

    Cowan, James; Goldhaber, Dan

    2015-01-01

    We study a popular dual enrollment program in Washington State, "Running Start" using a new administrative database that links high school and postsecondary data. Conditional on prior high school performance, we find that students participating in Running Start are more likely to attend any college but less likely to attend four-year…

  20. 76 FR 48204 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program

    Science.gov (United States)

    2011-08-08

    ... programs addressing emotional, social, spiritual, and generative needs. Terminally Ill (1) Help... optimize reintegration such as life-skills education, recreational activities, and follow up case..., and medication education. Through this NOFA, VA seeks to renew the FY 2009 previous grant and per diem...

  1. 76 FR 41756 - Notice of Funds Availability Under the Rural Business Enterprise Grant Program To Provide...

    Science.gov (United States)

    2011-07-15

    ... Statement ``The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and... status, familial status, parental status, religion, sexual orientation, genetic information, political... contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination...

  2. Assessing the effects of USDA conservation programs on ecosystem services provided by wetlands

    Science.gov (United States)

    The Conservation Effects Assessment Project (CEAP) is led by the U.S. Department of Agriculture (USDA) in an effort to quantify the environmental effects of conservation programs and practices on privately owned agricultural landscapes across the United States. CEAP’s approach includes application ...

  3. Training of Unskilled Child Care Providers: An In-House Program to Overcome Management's Financial Constraints.

    Science.gov (United States)

    Adams, Brian

    An in-house staff development program was designed and implemented for unskilled child caregivers employed at Tiny Tots Educare Academies, Inc., a privately owned and operated child care center located in Ellenton, Florida. Employees had little knowledge of child development and other topics related to early childhood education and, therefore,…

  4. 77 FR 4986 - Inviting Rural Business Enterprise Grant Program Applications for Grants To Provide Technical...

    Science.gov (United States)

    2012-02-01

    ..., Ineligibility and Voluntary Exclusion;'' AD-1049, ``Certification Regarding Drug-Free Workplace Requirements.... Nondiscrimination Statement The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs... of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant...

  5. Employee Assistance Program Cost Containment through the Utilization of Community-Based, Social Model Treatment Providers.

    Science.gov (United States)

    de Miranda, John; Lampe, Marc

    Statewide efforts by the California Department of Alcohol and Drug Programs to secure third-party payments for nonhospital alcoholism services gradually dissolved due to changes in political administration and overall priorities. San Mateo County, however, served as a demonstration county for the effort and has continued to explore third-party…

  6. Star Power: Providing for the Gifted & Talented. Module 9. Programs for the Gifted/Talented.

    Science.gov (United States)

    Mallis, Jackie; Heinemann, Alison

    The document presents Module 9, programs for the gifted/talented, of the Star Power modules developed for school personnel who have an interest in or a need to explore the area of gifted and talented education. It is explained in an introductory section that the modules can be used for independent study, for small group interaction, or for a large…

  7. American Dreaming: Critical Perspectives on a Media Training Program for Emerging Democracies

    Directory of Open Access Journals (Sweden)

    Miglena Mantcheva Sternadori

    2010-08-01

    Full Text Available Since the end of the Cold War, the International Media Training Center has brought dozens of Eastern European journalists to study in non-degree programs at U.S. universities. This study is a cultural critique of one such program. The analysis is based on in-depth interviews, participant observation, and articles from university newsletters. The trainees reveal that support from mentors is often insufficient, and some participants face significant hostility after returning to their native countries. The fast-paced media environments in those countries have not forgiven their yearlong absence: organizational power has been redistributed, connections have been weakened, and new colleagues have aggressively taken over one's old turf. The findings suggest that training a few journalists from disparate media outlets is unlikely to have much effect on media professionalism in emerging democracies, unless the trainees are guaranteed an opportunity to become trainers. URN: urn:nbn:de:0114-fqs100376

  8. Cost of Services Provided by the National Breast and Cervical Cancer Early Detection Program

    Science.gov (United States)

    Ekwueme, Donatus U.; Subramanian, Sujha; Trogdon, Justin G.; Miller, Jacqueline W.; Royalty, Janet E.; Li, Chunyu; Guy, Gery P.; Crouse, Wesley; Thompson, Hope; Gardner, James G.

    2015-01-01

    BACKGROUND The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. METHODS We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. RESULTS We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. CONCLUSIONS These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program. PMID:25099904

  9. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    OpenAIRE

    Huded, Jill M.; Dresden, Scott M.; Gravenor, Stephanie J.; Rowe, Theresa; Lindquist, Lee A.

    2015-01-01

    Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Methods: P...

  10. Development of graphic display program of reactor operating parameters for emergency exercise at nuclear power plants

    International Nuclear Information System (INIS)

    Okuda, Yasunori; Yoshida, Yoshitaka; Gotou, Kazuko

    2001-01-01

    A scenario of nuclear emergency exercise based on the result of accident progress analysis is expected to ensure effective training. Thereupon a new graphic display program for reactor operating parameters has been developed to present real-time of plant process values (parameters), released radioactivities from the plant, and dose rate data around the site calculated by using the accident analysis code MAAP4 and other codes. This system has a trend graph screen displaying reactor operating parameters, an environmental dose rate summary screen indicating dose rate distribution around the site on the map, and a plant parameters summary screen showing important plant parameters on a simplified plant system diagram. One screen can be switched to another any time. It also has a jump-function easily accessing any stage during the exercise scenario in accordance with progress of the exercise. As a result of the application of this system to a real nuclear emergency exercise, it has been verified that this system is quite useful for confirming the parameters when the nuclear emergency exercise starts and the licensee reports the plant conditions to related bodied. (author)

  11. Development of graphic display program of reactor operating parameters for emergency exercise at nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Okuda, Yasunori; Yoshida, Yoshitaka [Institute of Nuclear Safety System Inc., Mihama, Fukui (Japan); Gotou, Kazuko [Kansai Electric Power Co., Inc., Osaka (Japan)

    2001-09-01

    A scenario of nuclear emergency exercise based on the result of accident progress analysis is expected to ensure effective training. Thereupon a new graphic display program for reactor operating parameters has been developed to present real-time of plant process values (parameters), released radioactivities from the plant, and dose rate data around the site calculated by using the accident analysis code MAAP4 and other codes. This system has a trend graph screen displaying reactor operating parameters, an environmental dose rate summary screen indicating dose rate distribution around the site on the map, and a plant parameters summary screen showing important plant parameters on a simplified plant system diagram. One screen can be switched to another any time. It also has a jump-function easily accessing any stage during the exercise scenario in accordance with progress of the exercise. As a result of the application of this system to a real nuclear emergency exercise, it has been verified that this system is quite useful for confirming the parameters when the nuclear emergency exercise starts and the licensee reports the plant conditions to related bodied. (author)

  12. Our leadership in science and technology as provided by the national space program

    Science.gov (United States)

    Kock, W. E.

    1972-01-01

    The contributions of science and technology to the success of the United States as a world leader are discussed. Specific instances of the manner in which science advances and new technologies resulting from space research have contributed to a higher standard of living are presented. It is concluded that the benefits of the space program are not reflected only in the material advancements, but that intangible results have also been achieved in greater incentives to improve the present culture.

  13. The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs.

    Science.gov (United States)

    McGuire, Alan B; White, Dominique A; Bartholomew, Tom; Flanagan, Mindy E; McGrew, John H; Rollins, Angela L; Mueser, Kim T; Salyers, Michelle P

    2017-01-01

    Provider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.

  14. The WIPP research and development program: providing the technical basis for defense waste disposal

    International Nuclear Information System (INIS)

    Hunter, Th.O.

    1983-01-01

    The Waste Isolation Pilot Plant (WIPP), located in southeastern New Mexico, is being developed by the US Department of Energy as a research and development facility to demonstrate the safe disposal of radioactive wastes from the defense programs of the United States. Underground workings are at a depth of 660 in a bedded-salt formation. Site investigations began in the early 1970s and are culminating with the completion of the Site and Preliminary Design Validation (SPDV) program in 1983 in which two shafts and several thousand feet of underground drifts are being constructed. The underground facility will be used for in situ tests and demonstrations that address technical issues associated with the disposal of transuranic and defense high-level wastes (DHLW) in bedded salt. These tests are based on several years of laboratory tests, field tests in mines, and analytical modeling studies. They primarily address repository development in bedded salt, including thermal-structural interactions plugging and sealing, and facility operations; and waste package interactions, including the effects of the waste on local rock salt and the evaluation of waste package materials. In situ testing began in the WIPP with the initiation of the SPDV program in 1981. In 1983, a major series of tests will begin to investigate the response of the rock salt without the use of any radioactivity

  15. New program for identification of child maltreatment in emergency department: preliminary data.

    Science.gov (United States)

    Milani, Gregorio P; Vianello, Federica A; Cantoni, Barbara; Agostoni, Carlo; Fossali, Emilio F

    2016-07-13

    Early detection of child maltreatment in pediatric emergency department is one of the most important challenges for the Italian and European medical care system. Several interventions have been proposed, but results are often unquantifiable or inadequate to face this problem. We promoted an educational program and built up an interdisciplinary team to improve the identification and management of maltreated children. Aim of this study is to report preliminary results of these interventions. Meetings structured with lecture-based teaching and case-based lessons were focused on identification and management of maltreatment cases. An interdisciplinary team with forensic physicians, dermatologists, orthopedics, radiologists, gynecologists, oculists, psychologists and psychiatrics, was created to manage children with suspected diagnosis of maltreatment. We analysed the characteristics of subjects diagnosed after these interventions and their number was compared with the one in the two previous years. An increased rate of diagnoses of 16.9 % was found. Results of the reported program are encouraging, but many efforts are still mandatory to improve the child maltreatment identification in emergency departments.

  16. HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

    Science.gov (United States)

    Cuffe, Kendra M; Esie, Precious; Leichliter, Jami S; Gift, Thomas L

    2017-04-07

    The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD

  17. Establishing an autologous versus allogeneic hematopoietic cell transplant program in nations with emerging economies.

    Science.gov (United States)

    Chaudhri, Naeem A; Aljurf, Mahmoud; Almohareb, Fahad I; Alzahrani, Hazzaa A; Bashir, Qaiser; Savani, Bipin; Gupta, Vikas; Hashmi, Shahrukh K

    2017-12-01

    More than 70,000 hematopoietic cell transplants are currently performed each year, and these continue to increase every year. However, there is a significant variation in the number of absolute transplants and transplant rates between centers, countries, and global regions. The prospect for emerging countries to develop a hematopoietic cell transplantation (HCT) program, as well as to decide on whether autologous HCT (auto-HCT) or allogeneic HCT (allo-HCT) should be established to start with, relies heavily on factors that can explain differences between these two procedures. Major factors that will influence a decision about establishing the type of HCT program are macroeconomic factors such as organization of the healthcare network, available resources and infrastructure. Prevalence of specific diseases in the region as well genetic background of donors and recipients will also influence the mandate or priority of the HCT in the national healthcare plan to explain some of the country-specific differences. Furthermore, microeconomic factors play a role, such as center-specific experience in treating various disorders requiring hematopoietic stem cell transplantation, along with accreditation status and patient volume. The objective of the transplant procedure was to improve the survival and quality of life of patients. The regional difference that one notices in emerging countries about the higher number of allo-HCT compared with auto-HCT procedures performed is primarily based on suboptimal healthcare network in treating various malignant disorders that are the primary indication for auto-stem cell transplantation. In this context, nonmalignant disorders such as bone marrow failure syndromes, inherited genetic disorders and hemoglobinopathies have become the major indication for stem cell transplantation. Better understanding of these factors will assist in establishing new transplant centers in the emerging countries to achieve their specific objectives and

  18. Garrison Institute on Aging – Lubbock Retired and Senior Volunteer Program (RSVP Provides Services to South Plains, Texas

    Directory of Open Access Journals (Sweden)

    Joan eBlackmon

    2015-12-01

    Full Text Available The Texas Tech University Health Sciences (TTUHSC Garrison Institute on Aging (GIA was established to promote healthy aging through cutting edge research on Alzheimer ’s disease (AD and other diseases of aging, through innovative educational and community outreach opportunities for students, clinicians, researchers, health care providers, and the public. The GIA sponsors the Lubbock Retired and Senior Volunteer Program (RSVP. According to RSVP Operates Handbook, RSVP is one of the largest volunteer efforts in the nation. Through this program, volunteer skills and talents can be matched to assist with community needs. It is a federally funded program under the guidance of the Corporation for National and Community Service (CNCS and Senior Corps (SC. Volunteers that participate in RSVP provide service in the following areas: food security, environmental awareness building and education, community need-based volunteer programs, and veteran services.

  19. Bibliotherapy-based Wellness Program for Healthcare Providers: Using Books and Reading to Create a Healthy Workplace

    Directory of Open Access Journals (Sweden)

    Natalia Tukhareli

    2017-08-01

    Full Text Available Within the context of benefits of a healthy workplace, bibliotherapy is seen as an effective way of promoting health and wellness to hospital employees. The paper will present a detailed description of an innovative informational and recreational bibliotherapy-based reading program for healthcare providers developed and implemented by a Health Sciences library, in collaboration with the Occupational Health department. The methodology involved an extensive review of the bibliotherapy research and best practices in the UK and North America. The mechanics, benefits, and challenges of the program will be discussed. The program evaluation included an internal survey to the hospital employees. The evaluation results show that the bibliotherapy program has provided a new venue to address work-related stress and promote health, well-being, and resilience within the organization. Moreover, it helped to expand opportunities for collaborative projects and partnerships for the library as well as increase visibility of the library within the organization.

  20. 77 FR 31618 - Medicaid Program; Announcement of Requirements and Registration for CMS Provider Screening...

    Science.gov (United States)

    2012-05-29

    ... submissions with subjectively evaluated components (for example, graphical design, workflow, GUI layout, etc... flagged as higher risk (that is, Report Card Methodology). 2. Capability to Build Provider Profiles. a...

  1. Association Between Home Visit Programs and Emergency Preparedness Among Elderly Vulnerable People in New South Wales, Australia

    Directory of Open Access Journals (Sweden)

    W. Kathy Tannous PhD

    2017-03-01

    Full Text Available Objective: The purpose of this study is to examine the association between home visit programs and emergency preparedness among elderly vulnerable people in New South Wales, Australia. Method: The study used data acquired from an intervention program run by emergency agencies and consisted of 370 older people. Seven emergency outcome measures were examined by adjusting for key demographic factors, using a generalized estimating equation model, to examine the association between home visit programs and emergency preparedness. Results: The study revealed that knowledge demonstrated by participants during visits and post home visits showed significant improvements in the seven emergency outcome measures. The odds of finding out what emergencies might affect one’s area were significantly lower among older participants who were born outside Australia and those who were women. Discussion: The findings suggest that the intervention via home visits and periodic reminders post these visits may be a useful intervention in improving emergency preparedness among older people, especially among men and those who were born outside of Australia. In addition, other reminders such as safety messaging via mobile or landline telephone calls may also be a supplementary and useful intervention to improve emergency preparedness among older people.

  2. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  3. “Let Me Tell You About My…” Provider Self-Disclosure in the Emergency Department Builds Patient Rapport

    Directory of Open Access Journals (Sweden)

    Zink, Korie

    2017-01-01

    Full Text Available As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED provider self-disclosure on patients’ rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers’ communication skills. We compared patients’ ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p<0.05, more positive ratings of provider rapport (p<0.05 and higher satisfaction with provider communication (p<0.05. Patients who noted SD scored their providers’ communication skills as “excellent” (63.4% compared to patients without selfdisclosure (47.1%. Patients reported that they would like to hear about their providers’ experiences with a similar chief complaint (64.4% of patients, their providers’ education (49%, family (33%, personal life (21% or an injury/ailment unlike their own (18%. Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction. [West J Emerg Med. 2017;18(143-49.

  4. Summer school on radio monitoring as a part of radioecological education and emergency preparedness program

    Energy Technology Data Exchange (ETDEWEB)

    Poyarkov, V.; Kadenko, I.; Jordynsky, D.; Nazarov, A.; Dubchak, S. [Ministry of Emergemcies, Kiev (Ukraine). Ukrainian Radiation Trainig Center

    1997-12-31

    The International Summer School is organized by the Ukrainian Radiation Training Centre of the Ministry of Ukraine of Emergencies and Affairs of Population Protection from the Consequences of Chernobyl Catastrophe to provide training and experience in the techniques of environmental radiation monitoring and emergency preparedness training of students and to enhance knowledge`s of specialists in different fields of radioecology as well. It includes classroom instructions and training in areas affected by the Chernobyl accident. Within selected areas dose rates and gamma flux measurements have been conducted at two different heights. Ten measurements for dose rate and for gamma flux were done at each selected point of sites. The main results of summer school activities are briefly presented 4 refs., 1 fig., 8 tab.

  5. Summer school on radio monitoring as a part of radioecological education and emergency preparedness program

    International Nuclear Information System (INIS)

    Poyarkov, V.; Kadenko, I.; Jordynsky, D.; Nazarov, A.; Dubchak, S.

    1997-01-01

    The International Summer School is organized by the Ukrainian Radiation Training Centre of the Ministry of Ukraine of Emergencies and Affairs of Population Protection from the Consequences of Chernobyl Catastrophe to provide training and experience in the techniques of environmental radiation monitoring and emergency preparedness training of students and to enhance knowledge's of specialists in different fields of radioecology as well. It includes classroom instructions and training in areas affected by the Chernobyl accident. Within selected areas dose rates and gamma flux measurements have been conducted at two different heights. Ten measurements for dose rate and for gamma flux were done at each selected point of sites. The main results of summer school activities are briefly presented

  6. Rapid emergence of free-riding behavior in new pediatric immunization programs.

    Directory of Open Access Journals (Sweden)

    Chris T Bauch

    Full Text Available BACKGROUND: Mathematical models have formalized how free-rider effects can threaten the stability of high vaccine coverage levels under established voluntary vaccination programs. However, little research has addressed the question of when free-riding begins to develop when a new vaccine is first introduced in a population. METHODOLOGY/PRINCIPAL FINDINGS: Here, we combine a game theoretical model of vaccinating behavior with an age-structured compartmental model to analyze rational vaccinating behavior in the first years of a universal immunization program, where a new vaccine is free to all children of a specified age. The model captures how successive birth cohorts face different epidemiological landscapes that have been shaped by the vaccinating decisions of previous birth cohorts, resulting in a strategic interaction between individuals in different birth cohorts. The model predicts a Nash equilibrium coverage level of for the first few birth cohorts under the new program. However, free-riding behavior emerges very quickly, with the Nash equilibrium vaccine coverage dropping significantly within 2-5 years after program initiation. Subsequently, a rich set of coupled dynamics between infection prevalence and vaccinating behaviors is possible, ranging from relatively stable (but reduced coverage in later birth cohorts to wide fluctuations in vaccine coverage from one birth cohort to the next. Individual tolerance for vaccine risk also starts out at relatively high levels before dropping significantly within a few years. CONCLUSIONS/SIGNIFICANCE: These results suggest that even relatively new immunization programs can be vulnerable to drops in vaccine coverage caused by vaccine scares and exacerbated by herd immunity effects, necessitating vigilance from the start.

  7. VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.

    Science.gov (United States)

    Ellerbe, Laura S; Manfredi, Luisa; Gupta, Shalini; Phelps, Tyler E; Bowe, Thomas R; Rubinsky, Anna D; Burden, Jennifer L; Harris, Alex H S

    2017-04-04

    these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.

  8. Development of emergency response training program for on-site commanders (2). Extraction of non-technical skills

    International Nuclear Information System (INIS)

    Matsui, Yuko; Hikono, Masaru; Iwasaki, Mari; Morita, Miduho

    2017-01-01

    This study aimed at characterizing a non-technical skill exercise for on-site managers in charge of initial response at an emergency response center by extracting and clarifying the behavior examples of non-technical skills shown in the exercise scenario. From video observations, the non-technical skill examples were identified from seven of the eight non-technical skill categories which had been defined when the training program was developed. At the same time, the limitation when extracting the cases by observations was identified. The extracted non-technical skill cases are expected to be used for characterizing exercise scenarios, as well as provide knowledge to raise the awareness of exercise participants. (author)

  9. Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

    decline and handicap levels, and improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical specialists. Discussion: Reviewing the body of research reveals the importance of both designing programs with an eye to local context, and building in flexibility allowing the program to be adapted to changing circumstances.  Creating partnerships between policy designers, project implementers, and academic teams is an important element in achieving these goals. Partnerships are also valuable for achieving effective monitoring and evaluation, and support to "evidence-based" policy-making processes. Despite a shared electronic health record being a key component of the service model, there was an under-investigation of the impact this technology on facilitating and enabling integration and the outcomes achieved. Conclusions: PRISMA provides evidence of the benefits that can arise from integrating care for older persons, particularly in terms of increased feelings of personal empowerment, and improved client satisfaction with the care provided. Taken alongside other integrated care experiments, PRISMA provides further evidentiary support to policy makers pursuing integrated care programs. The scale and scope of the research body highlights the long-term and complex nature of program evaluations, but underscores the benefits of evaluation, review and subsequent adaptation of programs. The role of information technology in supporting integration of services is likely to substantially expand in the future and the potential this technology offers should be investigated and harnessed. Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including

  10. Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

    Directory of Open Access Journals (Sweden)

    Michael J. Stewart

    2013-02-01

    decline and handicap levels, and improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical specialists.Discussion: Reviewing the body of research reveals the importance of both designing programs with an eye to local context, and building in flexibility allowing the program to be adapted to changing circumstances.  Creating partnerships between policy designers, project implementers, and academic teams is an important element in achieving these goals. Partnerships are also valuable for achieving effective monitoring and evaluation, and support to "evidence-based" policy-making processes. Despite a shared electronic health record being a key component of the service model, there was an under-investigation of the impact this technology on facilitating and enabling integration and the outcomes achieved.Conclusions: PRISMA provides evidence of the benefits that can arise from integrating care for older persons, particularly in terms of increased feelings of personal empowerment, and improved client satisfaction with the care provided. Taken alongside other integrated care experiments, PRISMA provides further evidentiary support to policy makers pursuing integrated care programs. The scale and scope of the research body highlights the long-term and complex nature of program evaluations, but underscores the benefits of evaluation, review and subsequent adaptation of programs. The role of information technology in supporting integration of services is likely to substantially expand in the future and the potential this technology offers should be investigated and harnessed. Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including

  11. Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study.

    Science.gov (United States)

    Allen, Jennifer D; Torres, Maria Idali; Tom, Laura S; Rustan, Sarah; Leyva, Bryan; Negron, Rosalyn; Linnan, Laura A; Jandorf, Lina; Ospino, Hosffman

    2015-04-09

    Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings. We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, "fit" between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training. Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program

  12. 78 FR 12600 - VA Homeless Providers Grant and Per Diem Program

    Science.gov (United States)

    2013-02-25

    ... ``medical respite'' in the definition of supportive housing in Sec. 61.1 to avoid confusion between what the commenter referred to as ``caregiver respite'' and ``medical respite.'' In addition, the commenter... respite care provided to veterans with caregivers. We make no changes based on this comment because there...

  13. Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey.

    Science.gov (United States)

    Michaud, S; Dasgupta, K; Bell, L; Yale, J-F; Anjachak, N; Wafa, S; Nakhla, M

    2018-03-25

    To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting. © 2018 Diabetes UK.

  14. Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

    Science.gov (United States)

    Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U

    2017-03-01

    As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  15. Programmed Cell-to-Cell Variability in Ras Activity Triggers Emergent Behaviors during Mammary Epithelial Morphogenesis

    Directory of Open Access Journals (Sweden)

    Jennifer S. Liu

    2012-11-01

    Full Text Available Variability in signaling pathway activation between neighboring epithelial cells can arise from local differences in the microenvironment, noisy gene expression, or acquired genetic changes. To investigate the consequences of this cell-to-cell variability in signaling pathway activation on coordinated multicellular processes such as morphogenesis, we use DNA-programmed assembly to construct three-dimensional MCF10A microtissues that are mosaic for low-level expression of activated H-Ras. We find two emergent behaviors in mosaic microtissues: cells with activated H-Ras are basally extruded or lead motile multicellular protrusions that direct the collective motility of their wild-type neighbors. Remarkably, these behaviors are not observed in homogeneous microtissues in which all cells express the activated Ras protein, indicating that heterogeneity in Ras activity, rather than the total amount of Ras activity, is critical for these processes. Our results directly demonstrate that cell-to-cell variability in pathway activation within local populations of epithelial cells can drive emergent behaviors during epithelial morphogenesis.

  16. A Pilot Study Exploring After-School Care Providers' Response to the Incredible Years Classroom Management Program

    Science.gov (United States)

    Hicks-Hoste, Taylor B.; Carlson, John S.; Tiret, Holly B.

    2015-01-01

    The need for and importance of bringing evidence-based interventions into school settings has been firmly established. Adapting and adjusting intervention programs to meet the unique needs of a school district requires personnel to use a data-based approach to implementation. This pilot study is the first to report on after-school care providers'…

  17. 20 CFR 669.680 - What activities and services may be provided under the MSFW youth program?

    Science.gov (United States)

    2010-04-01

    ... under the MSFW youth program? 669.680 Section 669.680 Employees' Benefits EMPLOYMENT AND TRAINING... provide activities and services to MSFW youth that include: (1) Intensive services and training services... interpersonal skills development; (3) Community service projects; (4) Small business development technical...

  18. 75 FR 44971 - Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children

    Science.gov (United States)

    2010-07-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with Comments. SUMMARY: This notice...

  19. 20 CFR 402.175 - Fees for providing information and related services for non-program purposes.

    Science.gov (United States)

    2010-04-01

    ... rendered. (d) Fee for copies of printed materials. When extra copies of printed material are available, the... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Fees for providing information and related services for non-program purposes. 402.175 Section 402.175 Employees' Benefits SOCIAL SECURITY...

  20. An Educational Training on Cervical Cancer Screening Program for Rural Healthcare Providers in India

    Directory of Open Access Journals (Sweden)

    Rita Caroline Isaac

    2014-03-01

    Full Text Available Conventional, cytology based Cervical cancer screening programmes used in the developed world is often not practical in developing countries. Training of health care work force on a feasible, low-tech, screening methods is urgently needed in low resource settings. Twenty providers including doctors and nurses participated in a 2-days training workshop organized by a Community Health Center in rural South India. The pre-post-training assessment showed significant improvement in knowledge about cervical cancer, ‘low tech’ screening, treatment options and counseling among the participants.  Twenty volunteers screened at the workshop, 2 women (10% tested positive and one had CINIII lesion and the other had cervical cancer stage IIIB. After the training, the participants felt confident about their ability to counsel and screen women for cervical cancer.

  1. Providing Feedback, Orientation and Opportunities for Reflection as Key Elements for Successful Mentoring Programs: Reviewing a Program for Future Business Education Teachers

    Directory of Open Access Journals (Sweden)

    Elisabeth Riebenbauer

    2017-12-01

    Full Text Available The introduction to teaching is critical for novice teachers. Near the end of their master’s program, students of Business Education and Development in Austria spend one semester at an assigned school. They are introduced to teaching, while being assisted by peer students, mentoring teachers, and a companion course. Mentors receive special training and preparation in advance, thus contributing to a high quality mentoring program. The program is organized threefold: (1 providing feedback, (2 opportunities for reflection and (3 career orientation. The purpose of this paper is to assess key elements of successful mentoring programs and to question which competences of mentors contribute most to the success of those programs. Between 2012 and 2015, 188 persons (student teachers and their mentors responded to an online survey at the end of their mentoring program. Additionally, data from a study (1,245 questionnaires regarding the student teachers’ perception of their own competence was utilized, allowing for a comparison of student teacher confidence in their abilities before and after the mentoring program. The present results provide insight into the key elements of successful mentoring programs; both from a student teacher’s and mentor’s perspective. During the semester, students showed an increase regarding their self-perception of their professional competences. It was found that students and mentoring teachers valued feedback after each lesson more than feedback in regular meetings. Opportunities for reflection (e.g. exchange with peer students, learning diaries were considered helpful. The mentoring program helped students to decide whether to become a teacher or not.

  2. Emergency Food Assistance in Northern Syria: An Evaluation of Transfer Programs in Idleb Governorate.

    Science.gov (United States)

    Doocy, Shannon; Tappis, Hannah; Lyles, Emily; Witiw, Joseph; Aken, Vicki

    2017-06-01

    The war in Syria has left millions struggling to survive amidst violent conflict, pervasive unemployment, and food insecurity. Although international assistance funding is also at an all-time high, it is insufficient to meet the needs of conflict-affected populations, and there is increasing pressure on humanitarian stakeholders to find more efficient, effective ways to provide assistance. To evaluate 3 different assistance programs (in-kind food commodities, food vouchers, and unrestricted vouchers) in Idleb Governorate of Syria from December 2014 and March 2015. The evaluation used repeated survey data from beneficiary households to determine whether assistance was successful in maintaining food security at the household level. Shopkeeper surveys and program monitoring data were used to assess the impact on markets at the district/governorate levels and compare the cost-efficiency and cost-effectiveness of transfer modalities. Both in-kind food assistance and voucher programs showed positive effects on household food security and economic measures in Idleb; however, no intervention was successful in improving all outcomes measured. Food transfers were more likely to improve food access and food security than vouchers and unrestricted vouchers. Voucher programs were found to be more cost-efficient than in-kind food assistance, and more cost-effective for increasing household food consumption. Continuation of multiple types of transfer programs, including both in-kind assistance and vouchers, will allow humanitarian actors to remain responsive to evolving access and security considerations, local needs, and market dynamics.

  3. Experience and policy implications of children presenting with dental emergencies to US pediatric dentistry training programs.

    Science.gov (United States)

    Edelstein, Burton; Vargas, Clemencia M; Candelaria, Devanie; Vemuri, Maryen

    2006-01-01

    The purpose of this study was to describe and substantiate the experience of children, their families, and their caregivers with children's dental pain and to explore implications of these experiences for public policy. Data for 301 children presenting to 35 pediatric dentistry training programs during a 1-week period in 2000 for pain relief were collected with a questionnaire asking for: (1) sociodemographic characteristics; (2) oral health status; (3) dental care history; (4) presenting problem; (5) clinical findings; and (6) clinical disposition. Descriptive statistics are presented. Among children presenting to training programs with oral pain, 28% were under age 6, 57% were on Medicaid, and 38% were regarded by their dentists to have "likely or obvious" functional impairment-with 22% reporting the highest pain level. Parents reported that 59% had "poor or fair oral health" and 29% had a prior dental emergency in the previous year. Pain, experienced for several days by 73% of children, was associated with difficulty: (1) eating; (2) sleeping; (3) attending school; and (4) playing. Parent-reported barriers to seeking dental care included: (1) missed work (24%); (2) transportation costs (12%); and (3) arranging child care (10%). In this study of children with dental pain, many suffered significant pain: (1) duration; (2) intensity; (3) recurrence; and (4) consequences. This study demonstrates the ongoing need for public policies that assure timely, comprehensive, and affordable dental care for vulnerable children.

  4. Caregiver and adolescent mental health in Ethiopian Kunama refugees participating in an emergency education program.

    Science.gov (United States)

    Betancourt, Theresa S; Yudron, Monica; Wheaton, Wendy; Smith-Fawzi, Mary C

    2012-10-01

    To examine the role of caregiver mental health and risk and protective factors in influencing levels of internalizing and externalizing emotional and behavioral symptoms over time among a sample of refugee adolescents. Prospective study of 153 Kunama refugee adolescents receiving an emergency education intervention while living in a camp in Ethiopia. Surveys were collected in 2001 (T1) and 2002 (T2). Adolescent and caregiver mental health were assessed using a Kunamenga adaptation of the Youth Self Report; caregiver mental health was assessed using the Hopkins Symptom Checklist-25. Attitudes toward education, satisfaction with education programming, socioeconomic status, and perceptions of access to services were also explored as variables potentially influencing adolescent mental health at follow-up. Caregiver distress was significantly associated with youth externalizing behavior symptoms (β = 8.34, p effect on externalizing behaviors (β = -7.54, p effect on internalizing symptoms. In terms of modifying effects, among youth with distressed caregivers, those who were satisfied with the International Rescue Committee education intervention had a lower internalizing score (β = -6.34, p refugee displacement. Results suggest that programs targeting mental health in refugee children should consider children within the larger family system, including caregiver influence on child and adolescent mental health adjustment over time. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  5. Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review

    Science.gov (United States)

    Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

    2018-01-01

    Introduction The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. PMID:29662521

  6. Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

    Science.gov (United States)

    Gotovac, Sandra; Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

    2018-04-01

    The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

  7. Feasibility of a computer-delivered driver safety behavior screening and intervention program initiated during an emergency department visit.

    Science.gov (United States)

    Murphy, Mary; Smith, Lucia; Palma, Anton; Lounsbury, David; Bijur, Polly; Chambers, Paul; Gallagher, E John

    2013-01-01

    Injuries from motor vehicle crashes are a significant public health problem. The emergency department (ED) provides a setting that may be used to screen for behaviors that increase risk for motor vehicle crashes and provide brief interventions to people who might otherwise not have access to screening and intervention. The purpose of the present study was to (1) assess the feasibility of using a computer-assisted screening program to educate ED patients about risky driving behaviors, (2) evaluate patient acceptance of the computer-based traffic safety educational intervention during an ED visit, and (3) assess postintervention changes in risky driving behaviors. Pre/posteducational intervention involving medically stable adult ED patients in a large urban academic ED serving over 100,000 patients annually. Patients completed a self-administered, computer-based program that queried patients on risky driving behaviors (texting, talking, and other forms of distracted driving) and alcohol use. The computer provided patients with educational information on the dangers of these behaviors and data were collected on patient satisfaction with the program. Staff called patients 1 month post-ED visit for a repeat query. One hundred forty-nine patients participated, and 111 completed 1-month follow up (75%); the mean age was 39 (range: 21-70), 59 percent were Hispanic, and 52 percent were male. Ninety-seven percent of patients reported that the program was easy to use and that they were comfortable receiving this education via computer during their ED visit. All driving behaviors significantly decreased in comparison to baseline with the following reductions reported: talking on the phone, 30 percent; aggressive driving, 30 percent; texting while driving, 19 percent; drowsy driving, 16 percent; driving while multitasking, 12 percent; and drinking and driving, 9 percent. Overall, patients were very satisfied receiving educational information about these behaviors via computer

  8. Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program.

    Science.gov (United States)

    Shaw-Battista, Jenna; Belew, Cynthia; Anderson, Deborah; van Schaik, Sandrijn

    2015-01-01

    This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice

  9. CF3DODA-Me induces apoptosis, degrades Sp1, and blocks the transformation phase of the blebbishield emergency program.

    Science.gov (United States)

    Taoka, Rikiya; Jinesh, Goodwin G; Xue, Wenrui; Safe, Stephen; Kamat, Ashish M

    2017-05-01

    Cancer stem cells are capable of undergoing cellular transformation after commencement of apoptosis through the blebbishield emergency program in a VEGF-VEGFR2-dependent manner. Development of therapeutics targeting the blebbishield emergency program would thus be important in cancer therapy. Specificity protein 1 (Sp1) orchestrates the transcription of both VEGF and VEGFR2; hence, Sp1 could act as a therapeutic target. Here, we demonstrate that CF 3 DODA-Me induced apoptosis, degraded Sp1, inhibited the expression of multiple drivers of the blebbishield emergency program such as VEGFR2, p70S6K, and N-Myc through activation of caspase-3, inhibited reactive oxygen species; and inhibited K-Ras activation to abolish transformation from blebbishields as well as transformation in soft agar. These findings confirm CF 3 DODA-Me as a potential therapeutic candidate that can induce apoptosis and block transformation from blebbishields.

  10. Succession planning for the future through an academic-practice partnership: a nursing administration master's program for emerging nurse leaders.

    Science.gov (United States)

    Sherman, Rose; Dyess, Susan; Hannah, Ed; Prestia, Angela

    2013-01-01

    A global nursing leadership shortage is projected by the end of this decade. There is an urgent need to begin developing emerging nurse leaders now. This article describes the work of an academic-practice partnership collaborative of nurse leaders. The goal of the partnership is to develop and promote an innovative enhanced nursing administration master's program targeted to young emerging nurse leaders, who have not yet moved into formal leadership roles. An action research design is being used in program development and evaluation. Qualities needed by emerging leaders identified through research included a need to be politically astute, competency with business skills required of nurse leaders today, comfort with ambiguity, use of a caring approach, and leadership from a posture of innovation. The current curriculum was revised to include clinical immersion with a nurse leader from the first semester in the program, a change from all online to online/hybrid courses, innovative assignments, and a strong mentorship component. Eighteen young emerging nurse leaders began the program in January 2012. Early outcomes are positive. The emerging nurse leaders may be uniquely positioned, given the right skills sets, to be nurse leaders in the new age.

  11. International cooperation during radiological emergencies. NRC program guidance for the provision of technical advice to foreign counterpart organizations

    International Nuclear Information System (INIS)

    Senseney, R.

    1986-04-01

    This report defines the scope, application, and limits of the technical cooperation the Nuclear Regulatory Commission (NRC) would provide, upon request, to a foreign regulatory agency in a nuclear emergency. It outlines the basis for such cooperation, offers a model written agreement, and describes recent cases of NRC assistance. It also identifies non-NRC sources of emergency advisory assistance available to foreign organizations

  12. [The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses' Resilience, Violence Coping, Nursing Competency and Burnout].

    Science.gov (United States)

    Lee, Seung Min; Sung, Kyung Mi

    2017-06-01

    The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms. A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks. Levels of resilience, F=59.41, pnursing competency, F=59.41 pburnout, F=52.74, pburnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms. © 2017 Korean Society of Nursing Science

  13. Incentive-based demand response programs designed by asset-light retail electricity providers for the day-ahead market

    International Nuclear Information System (INIS)

    Fotouhi Ghazvini, Mohammad Ali; Faria, Pedro; Ramos, Sergio; Morais, Hugo; Vale, Zita

    2015-01-01

    Following the deregulation experience of retail electricity markets in most countries, the majority of the new entrants of the liberalized retail market were pure REP (retail electricity providers). These entities were subject to financial risks because of the unexpected price variations, price spikes, volatile loads and the potential for market power exertion by GENCO (generation companies). A REP can manage the market risks by employing the DR (demand response) programs and using its' generation and storage assets at the distribution network to serve the customers. The proposed model suggests how a REP with light physical assets, such as DG (distributed generation) units and ESS (energy storage systems), can survive in a competitive retail market. The paper discusses the effective risk management strategies for the REPs to deal with the uncertainties of the DAM (day-ahead market) and how to hedge the financial losses in the market. A two-stage stochastic programming problem is formulated. It aims to establish the financial incentive-based DR programs and the optimal dispatch of the DG units and ESSs. The uncertainty of the forecasted day-ahead load demand and electricity price is also taken into account with a scenario-based approach. The principal advantage of this model for REPs is reducing the risk of financial losses in DAMs, and the main benefit for the whole system is market power mitigation by virtually increasing the price elasticity of demand and reducing the peak demand. - Highlights: • Asset-light electricity retail providers subject to financial risks. • Incentive-based demand response program to manage the financial risks. • Maximizing the payoff of electricity retail providers in day-ahead market. • Mixed integer nonlinear programming to manage the risks

  14. Benefits of a Pharmacology Antimalarial Reference Standard and Proficiency Testing Program Provided by the Worldwide Antimalarial Resistance Network (WWARN)

    Science.gov (United States)

    Lourens, Chris; Lindegardh, Niklas; Barnes, Karen I.; Guerin, Philippe J.; Sibley, Carol H.; White, Nicholas J.

    2014-01-01

    Comprehensive assessment of antimalarial drug resistance should include measurements of antimalarial blood or plasma concentrations in clinical trials and in individual assessments of treatment failure so that true resistance can be differentiated from inadequate drug exposure. Pharmacometric modeling is necessary to assess pharmacokinetic-pharmacodynamic relationships in different populations to optimize dosing. To accomplish both effectively and to allow comparison of data from different laboratories, it is essential that drug concentration measurement is accurate. Proficiency testing (PT) of laboratory procedures is necessary for verification of assay results. Within the Worldwide Antimalarial Resistance Network (WWARN), the goal of the quality assurance/quality control (QA/QC) program is to facilitate and sustain high-quality antimalarial assays. The QA/QC program consists of an international PT program for pharmacology laboratories and a reference material (RM) program for the provision of antimalarial drug standards, metabolites, and internal standards for laboratory use. The RM program currently distributes accurately weighed quantities of antimalarial drug standards, metabolites, and internal standards to 44 pharmacology, in vitro, and drug quality testing laboratories. The pharmacology PT program has sent samples to eight laboratories in four rounds of testing. WWARN technical experts have provided advice for correcting identified problems to improve performance of subsequent analysis and ultimately improved the quality of data. Many participants have demonstrated substantial improvements over subsequent rounds of PT. The WWARN QA/QC program has improved the quality and value of antimalarial drug measurement in laboratories globally. It is a model that has potential to be applied to strengthening laboratories more widely and improving the therapeutics of other infectious diseases. PMID:24777099

  15. Development and Operation of the nuclear technology program for improving the public acceptance by providing the right information

    International Nuclear Information System (INIS)

    Lee, Juwoon; Kang, Mincheol; Min, Sangky; Yi, Jongmin; Yi, Yunyoung

    2013-11-01

    This detailed assignment conducted to improve the communication efficiency through the operation of differentiated programs to accomplish 'Establishment of knowledge diffusion system for improvement of Nuclear understanding', which is the purpose of the general assignment. We developed the programs on each social opinion leader groups by providing the right information on nuclear(radiation) technology, and had a forum for providing the right information on each social groups. Also, Consisted the consultant group, which participates humanities and social sciences, civic group, science teachers, the press, national assembly workers. Technology PR was performed 4 times, which is 1 time more than the original plan of 4 times. In the theme of affection of radiation, we broadened the vision of various fields which enabled to approach in general for the PR program. We Induced a positive reaction from the participants in political areas which coexistent of uncertain expectation and difficult vision of nuclear and radiation, by sharing the development possibility in relation with potential values of radiation industry and other industries and delivering accurate information, not a fragmentary knowledge, but in general. We hope that this results will contribute to establishing the effective nuclear knowledge diffusion program system

  16. Development and Operation of the nuclear technology program for improving the public acceptance by providing the right information

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Juwoon; Kang, Mincheol; Min, Sangky; Yi, Jongmin; Yi, Yunyoung

    2013-11-15

    This detailed assignment conducted to improve the communication efficiency through the operation of differentiated programs to accomplish 'Establishment of knowledge diffusion system for improvement of Nuclear understanding', which is the purpose of the general assignment. We developed the programs on each social opinion leader groups by providing the right information on nuclear(radiation) technology, and had a forum for providing the right information on each social groups. Also, Consisted the consultant group, which participates humanities and social sciences, civic group, science teachers, the press, national assembly workers. Technology PR was performed 4 times, which is 1 time more than the original plan of 4 times. In the theme of affection of radiation, we broadened the vision of various fields which enabled to approach in general for the PR program. We Induced a positive reaction from the participants in political areas which coexistent of uncertain expectation and difficult vision of nuclear and radiation, by sharing the development possibility in relation with potential values of radiation industry and other industries and delivering accurate information, not a fragmentary knowledge, but in general. We hope that this results will contribute to establishing the effective nuclear knowledge diffusion program system.

  17. The Volunteering-in-Place (VIP) Program: Providing meaningful volunteer activity to residents in assisted living with mild cognitive impairment.

    Science.gov (United States)

    Klinedinst, N Jennifer; Resnick, Barbara

    2016-01-01

    The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults with MCI in assisted living. The purposes of this single-site pre-test/post-test pilot study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months. Ten residents participated. The majority was white, female and educated, and on average 88 years old. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity. The results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.

    Science.gov (United States)

    Dombrowski, Julia C; Carey, James W; Pitts, Nicole; Craw, Jason; Freeman, Arin; Golden, Matthew R; Bertolli, Jeanne

    2016-06-10

    U.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing "Data to Care" programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program. Disease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009-2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015. PLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV

  19. Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers

    Directory of Open Access Journals (Sweden)

    Rannou François

    2011-07-01

    Full Text Available Abstract Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women and 14 care providers (6 women: 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.

  20. Communicating with the workforce during emergencies: developing an employee text messaging program in a local public health setting.

    Science.gov (United States)

    Karasz, Hilary N; Bogan, Sharon; Bosslet, Lindsay

    2014-01-01

    Short message service (SMS) text messaging can be useful for communicating information to public health employees and improving workforce situational awareness during emergencies. We sought to understand how the 1,500 employees at Public Health--Seattle & King County, Washington, perceived barriers to and benefits of participation in a voluntary, employer-based SMS program. Based on employee feedback, we developed the system, marketed it, and invited employees to opt in. The system was tested during an ice storm in January 2012. Employee concerns about opting into an SMS program included possible work encroachment during non-work time and receiving excessive irrelevant messages. Employees who received messages during the weather event reported high levels of satisfaction and perceived utility from the program. We conclude that text messaging is a feasible form of communication with employees during emergencies. Care should be taken to design and deploy a program that maximizes employee satisfaction.

  1. [Emergence of novel psychoactive substances among clients of a needle exchange program in Budapest, Hungary].

    Science.gov (United States)

    Rácz, József; Csák, Róbert

    2014-08-31

    In this paper the authors summarize experience of a drug service provider with the injecting use of novel psychoactive substances. Among clients of the needle exchange programme of Blue Point Drug Counselling and Outpatient Centre, the authors observed the spread of the novel substances since 2009. The extensive spread of the novel substances caused substantial change in injecting use patterns, thus in the usage of the needle exchange programme. The novel psychoactive substances appeared consecutively, so that this setting gave a unique opportunity to observe and track the emergence of these substances. The authors summarize the characteristics which are important for medical practice (risks, frequent use, severe psychopathological conditions) as well as special risks associated with these substances (substances with unknown composition and effect). They highlight the importance and role of the early warning system, monitoring the online sources of information and testing of samples containing novel psychoactive substances.

  2. Effectiveness of a caregiver education program on providing oral care to individuals with intellectual and developmental disabilities.

    Science.gov (United States)

    Fickert, Nancy A; Ross, Diana

    2012-06-01

    Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to determine the effectiveness of a caregiver educational program. This study used a quasi-experimental one-group pretest/posttest design with repeated measures to describe the outcomes of an educational program. Program participants demonstrated oral hygiene skills on each other while being scored by a trained observer, after which they completed an oral hygiene compliance survey. After three months, a follow-up included the same posttest, demonstration of oral hygiene skills, and repeat of the compliance survey. Paired-sample t-tests of oral hygiene knowledge showed a statistically significant improvement from pretest to posttest and from pretest to three-month posttest. Oral hygiene skills and compliance improved. Results demonstrate evidence that caregiver education improves knowledge, skill, and compliance in oral hygiene. Further studies are required to demonstrate the value of providing oral hygiene education and training for caregivers of individuals with intellectual and developmental disabilities.

  3. Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers.

    Science.gov (United States)

    Porter, Laura S; Pollak, Kathryn I; Farrell, David; Cooper, Meredith; Arnold, Robert M; Jeffreys, Amy S; Tulsky, James A

    2015-10-01

    Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers. The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study. The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %. This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.

  4. Use of the Emergency First Response Program as a Tool for Teaching English as a Foreign Language: A Discussion

    Science.gov (United States)

    Cordice, Kurt

    2009-01-01

    This paper discussed both the theoretical and practical implications of using a first aid training course, specifically the Emergency First Response (EFR) program, as a tool for the teaching and practice of English as a Foreign Language (EFL). The conceptual origins of the idea are discusses through comparisons with theories of learning found in…

  5. Korean round-robin result for new international program to assess the reliability of emerging nondestructive techniques

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Cho; Kim, Jin Gyum; Kang, Sung Sik; Jhung, Myung Jo [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2017-04-15

    The Korea Institute of Nuclear Safety, as a representative organization of Korea, in February 2012 participated in an international Program to Assess the Reliability of Emerging Nondestructive Techniques initiated by the U.S. Nuclear Regulatory Commission. The goal of the Program to Assess the Reliability of Emerging Nondestructive Techniques is to investigate the performance of emerging and prospective novel nondestructive techniques to find flaws in nickel-alloy welds and base materials. In this article, Korean round-robin test results were evaluated with respect to the test blocks and various nondestructive examination techniques. The test blocks were prepared to simulate large-bore dissimilar metal welds, small-bore dissimilar metal welds, and bottom-mounted instrumentation penetration welds in nuclear power plants. Also, lessons learned from the Korean round-robin test were summarized and discussed.

  6. Expanding The INSPIRED COPD Outreach ProgramTM to the emergency department: a feasibility assessment

    Directory of Open Access Journals (Sweden)

    Gillis D

    2017-05-01

    Full Text Available Darcy Gillis,1 Jillian Demmons,1 Graeme Rocker1,2 1Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada; 2Division of Respirology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80% reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD who avoid hospital admission.Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.Results: Referral rates were 0.5/week. Among eligible patients (n=174 33 (19% were referred of whom 15 (M=4, F=11 enrolled in INSPIRED-ED. Mean (SD age was 68 (7 years, post-bronchdilator FEV1 44.2 (15.5 % predicted, and Medical Research Council (MRC dyspnea score 3.8 (0.41. We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD Care Transition Measure (CTM-3 improved from 8.6 (2.0 to 11.3 (1.3, P=0.0004, and of 14 patients responding 12 (86% found the program very helpful. An additional 34

  7. Evaluation of primary health workers training program to provide psychoeducation to family caregivers of persons with psychotic disorder

    Directory of Open Access Journals (Sweden)

    Carla Raymondalexas Marchira

    2016-02-01

    Full Text Available ABTRACT Many persons suffering psychotic illnesses, such as schizophrenia, are largely untreated in low income countries. In these settings, most persons with severe mental illness live with their families. Thus, families play a particular critical role in determining whether a person with a psychotic illness will receive treatment and what the quality of treatment. Psychoeducation has proven to be extremely effective in helping families develop the knowledge and skills which is necessary to help their family members. Indonesia has a national policy to integrate the management of mental health problems into the primary health care system. However, in practice, such care does not implemented effectively. A preliminary study in primary health centers in two districts of Bantul and Gunung Kidul regency, Yogyakarta province, showed that there was very little or there is not any training for health care workers on diagnosis and treatment of psychotic disorder. This study was conducted to evaluate the effectiveness of the training program for health workers in three primary health centers in Yogyakarta, Indonesia, to provide psychoeducation to family caregivers for persons with psychotic disorder. A quasi-experimental study with the approach of one group pre and posttest design was performed in this study. Fortythree health workers in 3 primary health centers in Bantul and Gunung Kidul, Yogyakarta were trained every week for a month to provide psychoeducation to family caregivers who live with psychotic disorder patient. Result showed that the baseline score of knowledge of schizophrenia among health workers in 3 primary health centers in Bantul and Gunung Kidul before training were not significantly different (p=0.162. After the psychoeducation training program there were significantly different (p=0.003 of the score of knowledge of schizophrenia among health workers in 3 primary health care centers compared with before training. For conclusion, the

  8. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  9. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis.

    Science.gov (United States)

    Ouma, Paul O; Maina, Joseph; Thuranira, Pamela N; Macharia, Peter M; Alegana, Victor A; English, Mike; Okiro, Emelda A; Snow, Robert W

    2018-03-01

    %) women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital. Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa. Wellcome Trust and the UK Department for International Development. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  10. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis

    Directory of Open Access Journals (Sweden)

    Paul O Ouma, MSc

    2018-03-01

     282 013 (29·0% people and 64 495 526 (28·2% women of child bearing age are located more than 2-h travel time from the nearest hospital. Marked differences were observed within and between countries, ranging from less than 25% of the population within 2-h travel time of a public hospital in South Sudan to more than 90% in Nigeria, Kenya, Cape Verde, Swaziland, South Africa, Burundi, Comoros, São Tomé and Príncipe, and Zanzibar. Only 16 countries reached the international benchmark of more than 80% of their populations living within a 2-h travel time of the nearest hospital. Interpretation: Physical access to emergency hospital care provided by the public sector in Africa remains poor and varies substantially within and between countries. Innovative targeting of emergency care services is necessary to reduce these inequities. This study provides the first spatial census of public hospital services in Africa. Funding: Wellcome Trust and the UK Department for International Development.

  11. National audit of the quality of pain relief provided in emergency departments in Aotearoa, New Zealand: The PRiZED 1 Study.

    Science.gov (United States)

    2017-04-01

    Pain is a common feature of ED presentations and the timely provision of adequate analgesia is important for patient care. However, there is currently no New Zealand data with respect to this indicator of care quality. The present study aimed to provide a baseline for the quality of care with respect to the provision of timely and adequate analgesia in New Zealand EDs. The present study is a secondary analysis of data initially collected for the Shorter Stays in Emergency Department Study, using a retrospective chart review of 1685 randomly selected ED presentations (2006-2012) from 26 New Zealand public hospital EDs. Of the 1685 charts randomly selected, 1547 (91%) were reviewed from 21 EDs. There were 866 ED presentations with painful conditions, of whom 132 (15%) did not have pain recorded, 205 (24%) did not receive pain relief and 19 (2%) did not have time of analgesia documented leaving 510 (59%) for the analysis of time to analgesia. Four hundred and fifty-seven (53%) did not have pain well documented sufficiently to assess adequacy, leaving 277 (32%) for the analysis of adequacy of analgesia. The median (interquartile range) time to analgesia was 62 (30-134) min and the provision of adequate analgesia was 141/277 (51%, 95% CI: 45-57%); however, there was some variation between hospitals for both outcomes. Although these outcomes are on a par with other countries, this baseline audit has shown both poor documentation and variation in the provision of timely and adequate pain relief in New Zealand EDs, with room for improvement with respect to this quality indicator. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies.

    Science.gov (United States)

    Waterbrook, Anna L; Spear Ellinwood, Karen C; Pritchard, T Gail; Bertels, Karen; Johnson, Ariel C; Min, Alice; Stoneking, Lisa R

    2018-01-01

    Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.

  13. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2018-05-01

    Full Text Available Anna L Waterbrook,1 Karen C Spear Ellinwood,2 T Gail Pritchard,3 Karen Bertels,1 Ariel C Johnson,4 Alice Min,1 Lisa R Stoneking1 1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA; 4College of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management are challenging for a supervising emergency medicine (EM physician to evaluate in real-time on shift while also managing a busy emergency department (ED. This study examines residents’ perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills.Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones.Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2. Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received

  14. Emerging technologies for biotherapeutic bioanalysis from a high-throughput and multiplexing perspective: insights from an AAPS emerging technology action program committee.

    Science.gov (United States)

    Purushothama, Shobha; Dysinger, Mark; Chen, Yao; Österlund, Karolina; Mora, Johanna; Chunyk, Allison Given; Peloquin, Russ

    2018-02-01

    This manuscript aims to provide insights and updates on emerging technologies from a throughput and multiplexing perspective and to update readers on changes in previously reported technologies. The technologies discussed range from nascent (ultrasensitive Cira, Intellicyt ® , Dynaxi and Captsure™) to the more established (Ella and SQIDlite™). For the nascent technologies, there was an emphasis on user interviews and reviews, where available, to help provide an unbiased view to our readers. For the Ella, a review of published user data as well as author and other user experiences are summarized. Due to their emergent nature, all the technologies described are applicable in the early drug development stage, may require an upfront investment of capital and may not perform as expected.

  15. HIV and cancer in Africa: mutual collaboration between HIV and cancer programs may provide timely research and public health data

    Directory of Open Access Journals (Sweden)

    Mbulaiteye Sam M

    2011-10-01

    Full Text Available Abstract The eruption of Kaposi sarcoma (KS and aggressive non-Hodgkin lymphoma (NHL in young homosexual men in 1981 in the West heralded the onset of the human immunodeficiency virus (HIV infection epidemic, which remains one of the biggest challenges to global public health and science ever. Because KS and NHL were increased >10,000 and 50-600 times, respectively, with HIV, they were designated AIDS defining cancers (ADC. Cervical cancer (CC, increased 5-10 times was also designated as an ADC. A few other cancers are elevated with HIV, including Hodgkin lymphoma (10 times, anal cancer (15-30 times, and lung cancer (4 times are designated as non-AIDS defining cancers (NADCs. Since 1996 when combination antiretroviral therapy (cART became widely available in the West, dramatic decreases in HIV mortality have been observed and substantial decrease in the incidence of ADCs. Coincidentally, the burden of NADCs has increased as people with HIV age with chronic HIV infection. The impact of HIV infection on cancer in sub-Saharan Africa, where two thirds of the epidemic is concentrated, remains poorly understood. The few studies conducted indicate that risks for ADCs are also increased, but quantitatively less so than in the West. The risks for many cancers with established viral associations, including liver and nasopharynx, which are found in Africa, do not appear to be increased. These data are limited because of competing mortality, and cancer is under diagnosed, pathological confirmation is rare, and cancer registration not widely practiced. The expansion of access to life-extending cART in sub-Saharan Africa, through programs such as the Global Fund for AIDS, Malaria, and Tuberculosis and the US President's Emergency Program for AIDS Relief (PEPFAR, is leading to dramatic lengthening of life of HIV patients, which will likely influence the spectrum and burden of cancer in patients with HIV. In this paper, we review current literature and explore

  16. Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

    Directory of Open Access Journals (Sweden)

    Scott D. Casey

    2017-04-01

    Full Text Available Introduction: Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED pain management of geriatric fragility hip fractures. Methods: We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation. Results: We studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001 and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001 in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04 and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001 than patients in the pre-GFP period. Conclusion: Implementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.

  17. Lay First Responder Training in Eastern Uganda: Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency Care Training Program.

    Science.gov (United States)

    Delaney, Peter G; Bamuleke, Richard; Lee, Yang Jae

    2018-01-18

    Though road traffic injuries (RTIs) are a major cause of mortality in East Africa, few countries have emergency medical services. The aim was to create a sustainable and efficient prehospital lay first responder program, creating a system with lay first responders spread through the 53 motorcycle taxi stages of Iganga Municipality. One hundred and fifty-four motorcycle taxi riders were taught a first aid curriculum in partnership with a local Red Cross first aid trainer and provided with a first aid kit following WHO guidelines for basic first aid. Pre- and post-survey tests measured first aid knowledge improvement over the course. Post-implementation incident report forms were collected from lay first responders after each patient encounter over 6 months. Follow-up interviews were conducted with 110 of 154 trainees, 9 months post-training. Improvement was measured across all five major first aid categories: bleeding control (56.9 vs. 79.7%), scene management (37.6 vs. 59.5%), airway and breathing (43.4 vs. 51.6%), recovery position (13.1 vs. 43.4%), and victim transport (88.2 vs. 94.3%). From the incident report findings, first responders treated 250 victims (82.8% RTI related) and encountered 24 deaths (9.6% of victims). Of the first aid skills, bleeding control and bandaging was used most often (55.2% of encounters). Lay first responders provided transport in 48.3% of encounters. Of 110 lay first responders surveyed, 70 of 76 who had used at least one skill felt "confident" in the care they provided. A prehospital care system composed of lay first responders can be developed leveraging existing transport organizations, offering a scalable alternative for LMICs, demonstrating usefulness in practice and measurable educational improvements in trauma skills for non-clinical lay responders.

  18. The Emergence of Hospital Accreditation Programs in East Africa: Lessons from Uganda, Kenya, and Tanzania

    Directory of Open Access Journals (Sweden)

    Jeffrey Lane

    2014-01-01

    Full Text Available The objective of this manuscript was to examine existing hospital accreditation systems in three East African countries (Uganda, Kenya and Tanzania, assess attitudes and opinions of key stakeholders regarding hospital accreditation systems in the region, and identify lessons regarding sustainable and effective implementation of hospital accreditation systems in resource-limited countries. National hospital accreditation systems were found in Kenya and Tanzania. Uganda’s accreditation system, known as Yellow Star, had been suspended. Attitudes and opinions of key stakeholders almost unanimously supported the idea of establishing new national hospital accreditation programs, but opinions differed regarding whether that system should be operated by the government or a private independent organization. Our analysis supports the following lessons regarding accreditation systems in the region: (1 self-funding mechanisms are critical to long-term success; (2 external assessments occurred more frequently in our focus countries than accreditation systems in developed countries; (3 Kenya has established framework for providing financial incentives to highly performing hospitals, but these links need to be strengthened; and (4 automatic accreditation of governmental health facilities in Kenya and Tanzania illustrate the potential hazard of public authorities overseeing accreditation programs.

  19. The Emergence of Hospital Accreditation Programs in East Africa: Lessons from Uganda, Kenya, and Tanzania

    Directory of Open Access Journals (Sweden)

    Jeffrey Lane

    2014-03-01

    Full Text Available The objective of this manuscript was to examine existing hospital accreditation systems in three East African countries (Uganda, Kenya and Tanzania, assess attitudes and opinions of key stakeholders regarding hospital accreditation systems in the region, and identify lessons regarding sustainable and effective implementation of hospital accreditation systems in resource-limited countries. National hospital accreditation systems were found in Kenya and Tanzania. Uganda’s accreditation system, known as Yellow Star, had been suspended. Attitudes and opinions of key stakeholders almost unanimously supported the idea of establishing new national hospital accreditation programs, but opinions differed regarding whether that system should be operated by the government or a private independent organization. Our analysis supports the following lessons regarding accreditation systems in the region: (1 self--‐funding mechanisms are critical to long-term success; (2 external assessments occurred more frequently in our focus countries than accreditation systems in developed countries; (3 Kenya has established framework for providing financial incentives to highly performing hospitals, but these links need to be strengthened; and (4 automatic accreditation of governmental health facilities in Kenya and Tanzania illustrate the potential hazard of public authorities overseeing accreditation programs.

  20. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program.

    Science.gov (United States)

    Huded, Jill M; Dresden, Scott M; Gravenor, Stephanie J; Rowe, Theresa; Lindquist, Lee A

    2015-12-01

    Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL. Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%). The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  1. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    Directory of Open Access Journals (Sweden)

    Jill M. Huded

    2015-12-01

    Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  2. An Anaylsis of Pretest and Post Test Scores of Head Start African American, Hispanic American and European American Students Engaged in an Intensive Emergent Literacy Program.

    Science.gov (United States)

    Baumgarten, Thomas L.; Minix, Quinella

    The Texas Education Agency awarded twenty competitive grants to Head Start programs in the state. The focus of the grants was on emergent literacy and pre-reading skills. Teachers, mentors, and administrators underwent intensive training. To investigate whether children emerged from the grant programs ready to enter school reading, an outside…

  3. A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

    Science.gov (United States)

    Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

    2012-06-01

    releases, and correspondence. Interviews will be conducted in person with senior administrative leaders, government officials, screening experts, and high-level cancer system stakeholders. The proposed study comprises the third and final phase of an Emerging Team grant to address the challenges of health-policy decision making and colorectal cancer screening decisions in Canada. This study will contribute a unique prospective look at how policy makers address new, emerging scientific evidence in several different policy environments and at different stages of program planning and implementation. Findings will provide important insight into the various approaches that are or should be used to monitor emerging evidence, the relative importance of scientific versus contextual evidence for decision making, and the tools and processes that may be important to support challenging health-policy decisions.

  4. Health care Providers Needs About Malaria Control Program in Puskesmas Kisam Tinggi, South Ogan Komering Ulu District

    Directory of Open Access Journals (Sweden)

    Maya Arisanti

    2015-11-01

    Full Text Available Background: Malaria is an infectious disease that is still a health problem in Indonesia, which can cause death, especially in high-risk groups such as infants, toddlers, pregnant women and can directly lead to anemia and decreased work productivity. South Ogan Komering Ulu District was one of the endemic areas in South Sumatera Province. In a previous study in the District South Ogan Komering Ulu County Superior Data AMI found that high and low knowledge society related to malaria and most of respondents have not received counseling. Objective:The purpose of this study was to determine the needs of health care providers in malaria control programs. Methods:Data collected through in-depth interviews. Informant interviews are two people responsible for malaria at the health department, the head of health centers and two people responsible for malaria in health centers. Results: The results showed that the needs required by the health care providers to improve health care services, especially malaria is a need for laboratory equipment (microscope, reagents, and rapid diagnostic test, the need for microscopic power, the need for malaria drugs that are still effective, procurement of mosquito nets, education malaria to the community, and training needs for existing microscopic officer. Conclusion: The need of health care providers is the fulfillment of the malaria supplies equipment, laboratory personnel and training that support the ability of health care providers. With the fulfillment of the provider of health services to the community are expected to be performing well. Recommendation:Budget is needed to support supplier equipment & training.

  5. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.

    Science.gov (United States)

    Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena

    2014-01-01

    Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. Creation and implementation of an emergency medicine education and training program in Turkey: an effective educational intervention to address the practitioner gap

    OpenAIRE

    Bellows, Jennifer Whitfield; Douglass, Katherine; Atilla, Ridvan; Smith, Jeffrey; Kapur, G Bobby

    2013-01-01

    Background The specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills. Methods To address this ?practitioner gap,? the authors developed a four-phase comprehensive emergency medicine education and training program for gen...

  7. Emergency Shelter Grantee (ESG) Areas

    Data.gov (United States)

    Department of Housing and Urban Development — The Emergency Shelter Grants (ESG) program is designed to identify sheltered and unsheltered homeless persons, as well as those at risk of homelessness, and provide...

  8. Experiences of health care providers managing sexual assault victims in the emergency unit Part 2: Discussion of results and literature control

    Directory of Open Access Journals (Sweden)

    Rebecca M. Skhosana

    2009-09-01

    Full Text Available The objective of this study was to explore and describe the experiences of health care providers managing sexual assault victims in the emergency unit of a community hospital in the Nkangala district in the Mpumalanga Province. A qualitative, phenomenological design was applied. Purposeful sampling was used to select participants from health care providers who were working in the emergency unit and had managed more than four sexual assault victims. Data were collected by means of individual interviews and analysed according to the Tesch method of data analysis by the researcher and the independent co-coder. Main categories, subcategories and themes were identified. Participants expressed their emotions, challenges and police attitudes and behaviours, as well as inconsistencies in guidelines and needs identification. It was recommended that members of the multidisciplinary team engage in community activities and that the community participate in matters pertaining to sexual assault. Government should develop clear guidelines that are applicable to rural and urban South Africa. Health care sciences should aim to train more forensic nurses. All relevant departments should work together to alleviate the complications caused by sexual assault incidents. Opsomming Die doel van hierdie studie was om die ervaringe van gesondheidsorgverskaffers wat slagoffers van seksuele aanranding in die ongevalle-eenheid van 'n gemeenskapshospitaal in die Nkangala-distrik in die provinsie van Mpumalanga hanteer, te ontgin en te beskryf. ’n Kwalitatiewe fenomenologiese ontwerp is toegepas. Doelbewuste steekproefneming is gebruik om deelnemers te selekteer uit die groep gesondheidsorgverskaffers wat in die ongevalle-eenheid werksaam was en meer as vier slagoffers van seksuele aanranding hanteer het. Data is by wyse van individuele onderhoude ingesamel en volgens die Tesch-metode van data-analise deur die navorser en die onafhanklike medekodeerder geanaliseer

  9. Exploring of Wireless Technology to Provide Information Sharing Among Military, United Nations and Civilian Organizations During Complex Humanitarian Emergencies and Peacekeeping Operations

    National Research Council Canada - National Science Library

    Bridges, Douglas

    2003-01-01

    ...) and peacekeeping operations. Humanitarian emergencies and peacekeeping operations are a complex mix of related activities that require the combined efforts of the UN, military, International Organizations (IOs...

  10. 78 FR 3848 - Fisheries Off West Coast States; Pacific Coast Groundfish Fishery; Trawl Rationalization Program...

    Science.gov (United States)

    2013-01-17

    ... Rationalization Program; Emergency Rule Extension AGENCY: National Marine Fisheries Service (NMFS), National... Coast Groundfish Fishery Trawl Rationalization Program (program) regulations. This emergency rule... trawl rationalization program. Background on this rule was provided in the proposed rule, published on...

  11. Tree Mortality Undercuts Ability of Tree-Planting Programs to Provide Benefits: Results of a Three-City Study

    Directory of Open Access Journals (Sweden)

    Sarah Widney

    2016-03-01

    Full Text Available Trees provide numerous benefits for urban residents, including reduced energy usage, improved air quality, stormwater management, carbon sequestration, and increased property values. Quantifying these benefits can help justify the costs of planting trees. In this paper, we use i-Tree Streets to quantify the benefits of street trees planted by nonprofits in three U.S. cities (Detroit, Michigan; Indianapolis, Indiana, and Philadelphia, Pennsylvania from 2009 to 2011. We also use both measured and modeled survival and growth rates to “grow” the tree populations 5 and 10 years into the future to project the future benefits of the trees under different survival and growth scenarios. The 4059 re-inventoried trees (2864 of which are living currently provide almost $40,000 (USD in estimated annual benefits ($9–$20/tree depending on the city, the majority (75% of which are increased property values. The trees can be expected to provide increasing annual benefits during the 10 years after planting if the annual survival rate is higher than the 93% annual survival measured during the establishment period. However, our projections show that with continued 93% or lower annual survival, the increase in annual benefits from tree growth will not be able to make up for the loss of benefits as trees die. This means that estimated total annual benefits from a cohort of planted trees will decrease between the 5-year projection and the 10-year projection. The results of this study indicate that without early intervention to ensure survival of planted street trees, tree mortality may be significantly undercutting the ability of tree-planting programs to provide benefits to neighborhood residents.

  12. The IRIS Education and Outreach Program: Providing access to data and equipment for educational and public use

    Science.gov (United States)

    Taber, J.; Toigo, M.; Bravo, T. K.; Hubenthal, M.; McQuillan, P. J.; Welti, R.

    2009-12-01

    The IRIS Education and Outreach Program has been an integral part of IRIS for the past 10 years and during that time has worked to advance awareness and understanding of seismology and earth science while inspiring careers in geophysics. The focus on seismology and the use of seismic data has allowed the IRIS E&O program to develop and disseminate a unique suite of products and services for a wide range of audiences. One result of that effort has been increased access to the IRIS Data Management System by non-specialist audiences and simplified use of location and waveform data. The Seismic Monitor was one of the first Web-based tools for observing near-real-time seismicity. It continues to be the most popular IRIS web page, and thus it presents aspects of seismology to a very wide audience. For individuals interested in more detailed ground motion information, waveforms can be easily viewed using the Rapid Earthquake Viewer, developed by the University of South Carolina in collaboration with IRIS E&O. The Seismographs in Schools program gives schools the opportunity to apply for a low-cost educational seismograph and to receive training for its use in the classroom. To provide better service to the community, a new Seismographs in Schools website was developed in the past year with enhanced functions to help teachers improve their teaching of seismology. The site encourages schools to make use of seismic data and communicate with other educational seismology users throughout the world. Users can view near-real-time displays of other participating schools, upload and download data, and use the “find a teacher” tool to contact nearby schools that also may be operating seismographs. In order to promote and maintain program participation and communication, the site features a discussion forum to encourage and support the growing global community of educational seismograph users. Any data that is submitted to the Seismographs in Schools Website is also accessible

  13. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K

    2015-08-01

    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

  14. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance.

    Science.gov (United States)

    Blick, Kenneth E

    2013-08-01

    To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.

  15. An analysis of program planning in schools with emerging excellence in science instructional design

    Science.gov (United States)

    Carroll, Karen Marie

    Science educators agree on many of the program elements that characterize exemplary science instructional programs, but it has not been clear how the processes of planning and implementation lead to excellence in program design. This study focuses on two K--12 school clusters located in unified school districts and one K--12 school cluster spanning two non-unified districts that are in the midst of building new science programs. The clusters were selected for support by an organization of educators, scientists, and businesspersons because they were recognized as likely to produce good programs. The investigation centers on three research questions: (1) To what extent have schools engaged in science education reform achieved excellence? (2) How did schools engaged in science program improvement go about achieving their goals, and (3) What contextual factors are most closely related to the realization of quality program elements? The degree to which each program studied met indicators of quality suggested by the National Science Education Standards (NSES) are described according to an Innovation Configuration (IC) Chart. Using a Stream Diagnostic method of analysis, levels of practice were associated with contextual factors categorized as Social, Organizing, and Resource. Findings reveal the importance of a balanced and synchronized function of all components, including administrative commitment, teacher participation, and favorable logistical aspects. Individual reform projects were more likely to be successful if they included exemplary program elements and mechanisms for program managers to access district personnel and procedures needed to implement programs. A review of the cluster case histories also revealed the positive impact of cooperation between the funding organization and the project, the degree to which professional development is directly related to the new program, and the availability of resources and support for each exemplary program element.

  16. An Examination of the Relationship between Professional Development Providers' Epistemological and Nature of Science Beliefs and Their Professional Development Programs

    Science.gov (United States)

    Garcia Arriola, Alfonso

    In the last twenty years in US science education, professional development has emphasized the need to change science instruction from a direct instruction model to a more participatory and constructivist learning model. The result of these reform efforts has seen an increase in science education professional development that is focused on providing teaching strategies that promote inquiry learning to learn science content. Given these reform efforts and teacher responses to professional development, research seems to indicate that whether teachers actually change their practice may depend on the teachers' basic epistemological beliefs about the nature of science. The person who builds the bridge between teacher beliefs and teacher practice is the designer and facilitator of science teacher professional development. Even though these designers and facilitators of professional development are critical to science teacher change, few have studied how these professionals approach their work and what influence their beliefs have on their professional development activities. Eight developers and designers of science education professional development participated in this study through interviews and the completion of an online questionnaire. To examine the relationship between professional development providers' science beliefs and their design, development, and implementation of professional development experiences for science teachers, this study used the Views on Science Education Questionnaire (VOSE), and interview transcripts as well as analysis of the documents from teacher professional development experiences. Through a basic interpretive qualitative analysis, the predominant themes that emerged from this study suggest that the nature of science is often equated with the practice of science, personal beliefs about the nature of science have a minimal impact on the design of professional development experiences, current reform efforts in science education have a

  17. Development of a hospital reiki training program: training volunteers to provide reiki to patients, families, and staff in the acute care setting.

    Science.gov (United States)

    Hahn, Julie; Reilly, Patricia M; Buchanan, Teresa M

    2014-01-01

    Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

  18. Technology for the oil spills clean-up which provides preliminary accumulation of sorbents into the area of emergence and localization oil spills

    Directory of Open Access Journals (Sweden)

    M.L.Soroka

    2012-12-01

    Full Text Available Introduction: The implementation of measures for the prevention and spill of dangerous goods is an important aspect of sustainable development of railway transport. oil spills accident are the most dangerous. They are accompanied by significant pollution of all environmental objects. Studying and development of oil localization and clean-up technologies of such accidents is an important problem of environmental protection to modern conditions of railway transport development. The purpose: to improve the effectiveness of traditional methods of oil spill elimination and the development of new clean-up technologies adapted to the real conditions of the railway transport of Ukraine. Methods: To achieve the research purposes was used analysis of material flows, typical for places emergence and localization of the oil spill on the railways. Results: Analysis of standard technological scheme for the oil spills eliminations has shown that the most difficult task of effective clean-up surfaces is the timely delivery of oil sorbents and special equipment to the area spill containment. The general effectiveness of the elimination activities specifies the time from the beginning contact of dangerous goods with environmental objects to the absorption it into the structure of sorbent . Us was developed the technological scheme of oil spill elimination. This scheme provide a permanent and fast access to the sorbents into the oil spill localization area. It was proposed to device that allows you to transport the sorbent into sorption booms directly on the tank for transportation of petroleum products. Conclusions: Preventative accumulation of sorbents to the oil spill elimination into the localization area provides the organizational and operational simplicity of all stages of clean-up technology. Technical and economic assessment shows that the proposed technology is effective, technologically feasible and economically competitive.

  19. Brief mental health interventions in conflict and emergency settings: an overview of four Médecins Sans Frontières - France programs.

    Science.gov (United States)

    Coldiron, Matthew E; Llosa, Augusto E; Roederer, Thomas; Casas, German; Moro, Marie-Rose

    2013-11-01

    Mental health problems, particularly anxiety and mood disorders, are prevalent in the setting of humanitarian emergencies, both natural and man-made disasters. Evidence regarding best strategies for therapeutic interventions is sparse. Médecins Sans Frontières has been providing mental health services during emergencies for over two decades, and here we compare data from four programs. In China, 564 patients were followed for an average of 7 sessions after a major earthquake. The most common diagnoses were PTSD and other anxiety disorders. Between program entry and exit, the median global assessment of functioning increased from 65 to 80. At program entry, 58% were considered moderately, markedly or severely ill; a proportion which fell to 14% at program exit. In Colombia in the setting of chronic violence, 2411 patients were followed for a median of two sessions. Anxiety disorders and major depression were the most common diagnoses, and 76% of patients were moderately or severely ill at program entry. 91% had symptomatic improvement at program exit. In Gaza, 1357 patients were followed for a median of 9 sessions; a majority was under age 15. PTSD and other anxiety disorders were the most common diagnoses, and 91% were moderately or severely ill at entry. 89% had improved symptoms at program exit. In the West Bank, the 1478 patients had similar characteristics to those enrolled in Gaza. 88% were moderately or severely ill at entry; 88% had improved at exit. It was feasible to implement brief yet effective mental health interventions in a wide variety of humanitarian contexts - post-natural disaster, during acute violent conflict and during chronic violent conflict. The most common diagnoses were PTSD, other anxiety disorders and mood disorders. The use of local specially-trained counselors who were focused on coping skills and improving functionality over a brief time period, likely contributed to the symptomatic improvement seen in a large majority of patients

  20. Learning About Love: A Meta-Analytic Study of Individually-Oriented Relationship Education Programs for Adolescents and Emerging Adults.

    Science.gov (United States)

    Simpson, David M; Leonhardt, Nathan D; Hawkins, Alan J

    2018-03-01

    Despite recent policy initiatives and substantial federal funding of individually oriented relationship education programs for youth, there have been no meta-analytic reviews of this growing field. This meta-analytic study draws on 17 control-group studies and 13 one-group/pre-post studies to evaluate the effectiveness of relationship education programs on adolescents' and emerging adults' relationship knowledge, attitudes, and skills. Overall, control-group studies produced a medium effect (d = .36); one-group/pre-post studies also produced a medium effect (d = .47). However, the lack of studies with long-term follow-ups of relationship behaviors in the young adult years is a serious weakness in the field, limiting what we can say about the value of these programs for helping youth achieve their aspirations for healthy romantic relationships and stable marriages.

  1. Emerging Youth Leaders in an After-School Civic Leadership Program

    Science.gov (United States)

    Monkman, Karen; Proweller, Amira

    2016-01-01

    This qualitative study examines the notion of youth leadership in an after-school program focused on teaching leadership skills and instilling habits of civic engagement within a long-term support program that prioritizes college readiness for low-income minority students. Through activities designed to help youth discover their passions, envision…

  2. Developing Training Programs to Save Lives: Serving Students with Complex or Emergency Healthcare Needs

    Science.gov (United States)

    Urso, Annmarie; Rozalski, Michael

    2014-01-01

    The number of students with special health care needs (SHCN; McPherson, Arango & Fox, 1998) and the frequency of life-threatening health emergencies in schools (e.g., asthma, diabetes, severe allergic reactions, cardiac arrest, seizure disorders), continues to increase. It has become increasingly important for teachers to be trained in…

  3. Strategies for Integrating Emerging Technologies: Case Study of an Online Educational Technology Master's Program

    Science.gov (United States)

    Czerkawski, Betul C.

    2013-01-01

    Emerging technologies do not necessarily facilitate or advance learning processes; teaching strategies that are used in the learning process, integration and incorporation methods do. In online instruction, research shows that "effective distance education depends on the provision of pedagogical excellence" (Bernard et al., 2004, p.413).…

  4. 77 FR 34149 - Heavy-Duty Highway Program: Revisions for Emergency Vehicles and SCR Maintenance

    Science.gov (United States)

    2012-06-08

    ... selective catalytic reduction technologies. Third, EPA is proposing to offer short-term relief for nonroad..., Attention Docket No. EPA-HQ-OAR-2011-1032. Such deliveries are only accepted during the Docket's normal..., especially given some emergency vehicles' extreme duty cycles. By this action, EPA intends to help our nation...

  5. Canadian Physicians' Use of Antiobesity Drugs and Their Referral Patterns to Weight Management Programs or Providers: The SOCCER Study

    Directory of Open Access Journals (Sweden)

    R. S. Padwal

    2011-01-01

    Full Text Available Antiobesity pharmacotherapy and programs/providers that possess weight management expertise are not commonly used by physicians. The underlying reasons for this are not known. We performed a cross-sectional study in 33 Canadian medical practices (36 physicians examining 1788 overweight/obese adult patients. The frequency of pharmacotherapy use and referral for further diet, exercise, behavioral management and/or bariatric surgery was documented. If drug treatment or referral was not made, reasons were documented by choosing amongst preselected categories. Logistic regression models were used to identify predictors of antiobesity drug use. No single antiobesity management strategy was recommended by physicians in more than 50% of patients. Referral was most common for exercise (49% of cases followed by dietary advice (46%, and only 5% of eligible patients were referred for bariatric surgery. Significant predictors of initiating/continuing pharmacotherapy were male sex (OR 0.70; 95% CI 0.52–0.94, increasing BMI (1.02; 95% CI 1.01–1.03, and private drug coverage (1.78; 95% CI 1.39–2.29. “Not considered” and “patient refusal” were the main reasons for not initiating further weight management. We conclude that both physician and patient factors act as barriers to the use of weight management strategies and both need to be addressed to increase uptake of these interventions.

  6. Electronic medication complete communication strategy for opioid prescriptions in the emergency department: Rationale and design for a three-arm provider randomized trial.

    Science.gov (United States)

    McCarthy, Danielle M; Courtney, D Mark; Lank, Patrick M; Cameron, Kenzie A; Russell, Andrea M; Curtis, Laura M; Kim, Kwang-Youn A; Walton, Surrey M; Montague, Enid; Lyden, Abbie L; Gravenor, Stephanie J; Wolf, Michael S

    2017-08-01

    Thousands of people die annually from prescription opioid overdoses; however there are few strategies to ensure patients receive medication risk information at the time of prescribing. To compare the effectiveness of the Emergency Department (ED) Electronic Medication Complete Communication (EMC 2 ) Opioid Strategy (with and without text messaging) to promote safe medication use and improved patient knowledge as compared to usual care. The ED EMC 2 Opioid Strategy consists of 5 automated components to promote safe medication use: 1) physician reminder to counsel, 2) inbox message sent on to the patient's primary care physician, 3) pharmacist message on the prescription to counsel, 4) MedSheet supporting prescription information, and 5) patient-centered Take-Wait-Stop wording of prescription instructions. This strategy will be assessed both with and without the addition of text messages via a three-arm randomized trial. The study will take place at an urban academic ED (annual volume>85,000) in Chicago, IL. Patients being discharged with a new prescription for hydrocodone-acetaminophen will be enrolled and randomized (based on their prescribing physician). The primary outcome of the study is medication safe use as measured by a demonstrated dosing task. Additionally actual safe use, patient knowledge and provider counseling will be measured. Implementation fidelity as well as costs will be reported. The ED EMC 2 Opioid Strategy embeds a risk communication strategy into the electronic health record and promotes medication counseling with minimal workflow disruption. This trial will evaluate the strategy's effectiveness and implementation fidelity as compared to usual care. This trial is registered on clinicaltrials.gov with identifier NCT02431793. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Specific features of using programmed hardware in emergency protection systems of NPP

    International Nuclear Information System (INIS)

    Konoplev, N.P.; Pogorelov, I.V.; Kirsanov, A.V.

    2005-01-01

    The specific features of using the microprocessor-based technical means and programmed logic integrated circuits (PLIC) in WWER reactor protection systems are considered. The basic causes of occurring the failures in programmed technical means are analyzed. The features of using PLIC in reactor protection systems are discussed. The methods permitting to decrease the probability occurring the common mode failure of programmed technical means are proposed. It is concluded that at creating of reactor protection systems with the use of microprocessors and PLIC it is necessary to apply the principle of the functional diversity [ru

  8. Competency, Programming, and Emerging Innovation in Graduate Education within Schools of Pharmacy: The Report of the 2016-2017 Research and Graduate Affairs Committee.

    Science.gov (United States)

    Poloyac, Samuel M; Block, Kirsten F; Cavanaugh, Jane E; Dwoskin, Linda P; Melchert, Russell B; Nemire, Ruth E; O'Donnell, James M; Priefer, Ronny; Touchette, Daniel R

    2017-10-01

    Graduate education in the pharmaceutical sciences is a cornerstone of research within pharmacy schools. Pharmaceutical scientists are critical contributors to addressing the challenges of new drug discovery, delivery, and optimal care in order to ensure improved therapeutic outcomes in populations of patients. The American Association of Colleges of Pharmacy (AACP) charged the 2016-2017 Research and Graduate Affairs Committee (RGAC) to define the competencies necessary for graduate education in the pharmaceutical sciences (Charge 1), recommend collaborative curricular development across schools of pharmacy (Charge 2), recommend AACP programing for graduate education (Charge 3), and provide guidance on emerging areas for innovation in graduate education (Charge 4). With respect to Charges 1 and 2, the RGAC committee developed six domains of core competencies for graduate education in the pharmaceutical sciences as well as recommendations for shared programming. For Charge 3, the committee made 3 specific programming recommendations that include AACP sponsored regional research symposia, a professional development forum at the AACP INterim Meeting, and the addition of a graduate research and education poster session at the AACP Annual Meeting. For Charge 4, the committee recommended that AACP develop a standing committee of graduate program deans and directors to provide guidance to member schools in support of graduate program representation at AACP meetings, develop skills for interprofessional teamwork and augment research through integration of Pharm.D., Ph.D., postdoctoral associates, resident, and fellow experiences. Two proposed policy statements by the committee are that AACP believes core competencies are essential components of graduate education and AACP supports the inclusion of research and graduate education focuses in its portfolio of meetings and programs.

  9. Surveillance programs for detection and characterization of emergent pathogens and antimicrobial resistance: results from the Division of Infectious Diseases, UNIFESP.

    Science.gov (United States)

    Colombo, Arnaldo L; Janini, Mario; Salomão, Reinaldo; Medeiros, Eduardo A S; Wey, Sergio B; Pignatari, Antonio C C

    2009-09-01

    Several epidemiological changes have occurred in the pattern of nosocomial and community acquired infectious diseases during the past 25 years. Social and demographic changes possibly related to this phenomenon include a rapid population growth, the increase in urban migration and movement across international borders by tourists and immigrants, alterations in the habitats of animals and arthropods that transmit disease, as well as the raise of patients with impaired host defense abilities. Continuous surveillance programs of emergent pathogens and antimicrobial resistance are warranted for detecting in real time new pathogens, as well as to characterize molecular mechanisms of resistance. In order to become more effective, surveillance programs of emergent pathogens should be organized as a multicenter laboratory network connected to the main public and private infection control centers. Microbiological data should be integrated to guide therapy, adapting therapy to local ecology and resistance patterns. This paper presents an overview of data generated by the Division of Infectious Diseases, Federal University of São Paulo, along with its participation in different surveillance programs of nosocomial and community acquired infectious diseases.

  10. Emergency airway management in critically injured patients: a survey of U.S. aero-medical transport programs.

    Science.gov (United States)

    James, Dorsha N; Voskresensky, Igor V; Jack, Meg; Cotton, Bryan A

    2009-06-01

    Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs. The Association of Air Medical Services (AAMS) Resource Guide from 2005 to 2006 was utilized to identify the e-mail addresses of all directors of U.S. aero-medical transport programs. Program directors from 182 U.S. aero-medical programs were asked to participate in an anonymous, web-based survey of emergency airway management protocols and practices. Non-responders to the initial request were contacted a second time by e-mail. 89 programs responded. 98.9% have rapid sequence intubation (RSI) protocols. 90% use succinylcholine, 70% use long-acting neuromuscular blockers (NMB) within their RSI protocol. 77% have protocols for mandatory in-flight sedation but only 13% have similar protocols for maintenance paralytics. 60% administer long-acting NMB immediately after RSI, 13% after confirmation of neurological activity. Given clinical scenarios, however, 97% administer long-acting NMB to patients with scene and in-flight Glasgow Coma Scale (GCS) of 3, even for brief transport times. The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.

  11. Using tracking infrastructure to support public health programs, policies, and emergency response in New York City.

    Science.gov (United States)

    Jeffery, Nancy Loder; McKelvey, Wendy; Matte, Thomas

    2015-01-01

    To describe how the New York City (NYC) Tracking Program has used nationally mandated Secure Portal infrastructure and staff analytical expertise to support programs and inform policy. The NYC Health Department assesses, investigates, and acts on a wide range of environmental concerns to protect the health of New Yorkers. Specific examples of highly effective policies or initiatives that relied on the NYC Tracking Program are described, including restaurant sanitary grade posting, rat indexing, converting boilers to cleaner-burning fuels, reducing exposure to mercury from fish and contaminated products, and responding to Superstorm Sandy. The NYC Tracking Program supports the Health Department in using inspectional, administrative, and health data to guide operations. Tracking has also allowed internal and external partners to use these data to guide policy development.

  12. Emerging Technologies Program Integration Report. Volume 2. Background, Delphi and Workshop Data. Appendices

    Science.gov (United States)

    1987-05-04

    Celanese Research Co.) Dr. William Koros (U. Texas/Austin) Dr. Raphael Ottenbrite (Virginia Commonwealth U.) Dr. Elsa Reichmanis (AT&T Bell Labs.) Dr. John...processing elements in a single chip focal plane array 1621 1 71 4 23 5. Synchrotron radiation source X-ray lithography 5 1 2 1316 2 1 7 8 6. Growth... SYNCHROTRON RADIATION SOURCE X-RAY LITHOGRAPHY A. Specific milestones/research developments that must occur for AVAILABILITY: this emerging technology

  13. Should CAM and CAM Training Programs Be Included in the Curriculum of Schools That Provide Health Education?

    Directory of Open Access Journals (Sweden)

    2016-12-01

    Full Text Available Objectives: This study aimed to determine the knowledge levels and attitudes of School of Health and Vocational School of Health students toward complementary and alternative medicine (CAM. Methods: Three hundred thirty-three (333 students studying at the Mehmet Akif Ersoy University School of Health and the Golhisar Vocational School of Health in Burdur, Turkey, were included in the study. Research data were collected by using a survey method based on the expressed opinions of the participants. Results: Of the participants, 69.7% were female and 97% were single (unmarried. Of cigarette users and those with chronic illnesses, 46.8% and 47.8%, respectively, used CAM. Those using CAM were statistically more likely to be female (P < 0.021, to have higher grades (P < 0.007, to be single (P < 0.005, to be vocational school of health graduates (P < 0.008, and to have fathers at work (P < 0.021. While 9.6% of the students thought CAM to be nonsense, 10.8% thought that the methods of CAM should be tried before consulting a doctor. Conclusion: A majority of the students in the study population were found to use complementary and alternative medicine, but that they lacked information about its methods. As a way to address this, CAM should be included in the curriculum of schools that provide health education, and CAM training programs should be given to healthcare professionals to improve their knowledge of CAM. In Turkey, many more studies should be performed to determine nurses’ and doctors’ knowledge of and attitudes about CAM methods so that they can give correct guidance to society and take more active responsibility in improving patient safety.

  14. Use of Pneumococcal Disease Epidemiology to Set Policy and Prevent Disease during 20 Years of the Emerging Infections Program.

    Science.gov (United States)

    Moore, Matthew R; Whitney, Cynthia G

    2015-09-01

    Two decades ago, the Emerging Infections Program of the US Centers for Disease Control and Prevention implemented what seemed like a simple yet novel idea: a population- and laboratory-based surveillance system designed to identify and characterize invasive bacterial infections, including those caused by Streptococcus pneumoniae. This system, known as Active Bacterial Core surveillance, has since served as a flexible platform for following trends in invasive pneumococcal disease and studying vaccination as the most effective method for prevention. We report the contributions of Active Bacterial Core surveillance to every pneumococcal vaccine policy decision in the United States during the past 20 years.

  15. A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective.

    Science.gov (United States)

    Beasley, Lana O; Ridings, Leigh E; Smith, Tyler J; Shields, Jennifer D; Silovsky, Jane F; Beasley, William; Bard, David

    2018-05-01

    Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.

  16. 41 CFR 102-75.760 - Who must the Office of Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who must the Office of Justice Programs (OJP) and the Federal Emergency Management Agency (FEMA) notify that surplus real property is available for correctional facility, law enforcement, or emergency management response purposes? 102-75.760 Section 102-75.760 Public...

  17. Healthy Families America state systems development: an emerging practice to ensure program growth and sustainability.

    Science.gov (United States)

    Friedman, Lori; Schreiber, Lisa

    2007-01-01

    In an era of fiscal constraints and increased accountability for social service programs, having a centralized and efficient infrastructure is critical. A well-functioning infrastructure helps a state reduce duplication of services, creates economies of scale, coordinates resources, supports high-quality site development and promotes the self-sufficiency and growth of community-based programs. Throughout the Healthy Families America home visitation network, both program growth and contraction have been managed by in-state collaborations, referred to as "state systems." This article explores the research base that supports the rationale for implementing state systems, describes the evolution of state systems for Healthy Families America, and discusses the benefits, challenges and lessons learned of utilizing a systems approach.

  18. The Wright Institute Sanctuary Project: Development and Proposed Evaluation of a Graduate Training Program Providing Clinical Services to Asylum Seekers in the Bay Area

    Science.gov (United States)

    Padilla, Brenda Lisa

    2012-01-01

    This study highlights the development of a graduate training program at The Wright Institute in Berkeley, CA, which provides assessment services for undocumented immigrants seeking asylum. This program focuses on the needs of a general asylum seeking population, with a specific relevance to some of the populations that may be served in the…

  19. The Turn the Tables Technique (T[cube]): A Program Activity to Provide Group Facilitators Insight into Teen Sexual Behaviors and Beliefs

    Science.gov (United States)

    Sclafane, Jamie Heather; Merves, Marni Loiacono; Rivera, Angelic; Long, Laura; Wilson, Ken; Bauman, Laurie J.

    2012-01-01

    The Turn the Tables Technique (T[cube]) is an activity designed to provide group facilitators who lead HIV/STI prevention and sexual health promotion programs with detailed and current information on teenagers' sexual behaviors and beliefs. This information can be used throughout a program to tailor content. Included is a detailed lesson plan of…

  20. Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States.

    Science.gov (United States)

    Sarin, Ritu R; Cattamanchi, Srihari; Alqahtani, Abdulrahman; Aljohani, Majed; Keim, Mark; Ciottone, Gregory R

    2017-08-01

    The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals. Hypothesis This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place. The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training. Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars. There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.

  1. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences

    Directory of Open Access Journals (Sweden)

    Emily A. Hurley

    2017-12-01

    Full Text Available Effective patient-provider communication (PPC promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART, yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power, and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp. Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2% compared to a biomedical style (22.5% (p<0.001. Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2% compared to a provider-dominated style (35.8%. In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4% and/or “tough” style (40.6%, but significantly fewer preferred the “sharp” style (14.5% (p<0.001. Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately

  2. Improvement of the preventive maintenance program of an emergency diesel generator set

    International Nuclear Information System (INIS)

    Jacquot, J.P.; Meuwisse, C.; Cailleaux, J.P.

    1995-01-01

    An exhaustive Reliability Centered Maintenance (RCM) analysis was performed of the emergency diesel generator sets in Electricite de France 900-MW nuclear power plants. The first part of this paper describes the Reliability Centered Maintenance approach, including the functional breakdown, complete analysis of operation feedback and safety assessment of the risk induced by functional diesel failures. The second part shows how this kind of RCM analysis can be used to improve the efficiency of periodic tests of the machine, and more generally, the efficiency of condition-directed maintenance tasks. The underlying objective is to minimize risk and aging of the machine

  3. State-Funded "Eminent Scholars" Programs: University Faculty Recruitment as an Emerging Policy Instrument

    Science.gov (United States)

    Hearn, James C.; McLendon, Michael K.; Lacy, T. Austin

    2013-01-01

    Over the past two decades, state governments have increasingly invested in programs to recruit accomplished scientists from elsewhere to university positions. This event history analysis suggests that an intriguing mix of comparative state disadvantage and leveragable existing research resources is associated with the likelihood of states adopting…

  4. Evaluation of the certificate in emerging infectious disease research and the certificate in one health training programs, University of Florida

    Directory of Open Access Journals (Sweden)

    Marissa A. Valentine

    2015-03-01

    Full Text Available In developing countries, public health professionals and scientists need targeted training and practical skills to respond to global emerging infectious disease threats. The Certificate in Emerging Infectious Disease Research was developed in 2008 to aid such professionals to respond to complex emerging disease problems. The short-course was modified slightly in 2013 and renamed the Certificate in One Health. To evaluate the immediate impact of the short-course, an online survey of 176 past participants from both the courses was conducted. The survey tool assessed the program’s process, impact, and outcome measures respectively via assessing the courses’ perceived strengths and weaknesses, perceived skills gained, and the participants’ current position, publication status, funding status, and educational attainment; 85 (48.3% participants completed the survey. Reported program strengths included the curriculum, expertise of lecturers, and diversity of the training cohort. The principal reported weakness was the compressed academic schedule. The most frequently reported benefits included: epidemiological and biostatistical skills, followed by One-Health knowledge, and research skills. Twenty-eight percent of the survey respondents reported publishing one or more manuscripts since completing the course and 21% reported receiving research funding. The course appears to have had a positive, immediate impact on the students’ self-perceived knowledge and capabilities.

  5. A Comparative Study of Compression Methods and the Development of CODEC Program of Biological Signal for Emergency Telemedicine Service

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, T.S.; Kim, J.S. [Changwon National University, Changwon (Korea); Lim, Y.H. [Visionite Co., Ltd., Seoul (Korea); Yoo, S.K. [Yonsei University, Seoul (Korea)

    2003-05-01

    In an emergency telemedicine system such as the High-quality Multimedia based Real-time Emergency Telemedicine(HMRET) service, it is very important to examine the status of the patient continuously using the multimedia data including the biological signals(ECG, BP, Respiration, S{sub p}O{sub 2}) of the patient. In order to transmit these data real time through the communication means which have the limited transmission capacity, it is also necessary to compress the biological data besides other multimedia data. For this purpose, we investigate and compare the ECG compression techniques in the time domain and in the wavelet transform domain, and present an effective lossless compression method of the biological signals using JPEG Huffman table for an emergency telemedicine system. And, for the HMRET service, we developed the lossless compression and reconstruction program of the biological signals in MSVC++ 6.0 using DPCM method and JPEG Huffman table, and tested in an internet environment. (author). 15 refs., 17 figs., 7 tabs.

  6. Designing monitoring programs for chemicals of emerging concern in potable reuse ⋯ What to include and what not to include?

    KAUST Repository

    Drewes, Jorg; Anderson, Paul D.; Denslow, Nancy D.; Olivieri, Adam W.; Schlenk, Daniel K.; Snyder, Shane A.; Maruya, Keith

    2012-01-01

    This study discussed a proposed process to prioritize chemicals for reclaimed water monitoring programs, selection of analytical methods required for their quantification, toxicological relevance of chemicals of emerging concern regarding human health, and related issues. Given that thousands of chemicals are potentially present in reclaimed water and that information about those chemicals is rapidly evolving, a transparent, science-based framework was developed to guide prioritization of which compounds of emerging concern (CECs) should be included in reclaimed water monitoring programs. The recommended framework includes four steps: (1) compile environmental concentrations (e.g., measured environmental concentration or MEC) of CECs in the source water for reuse projects; (2) develop a monitoring trigger level (MTL) for each of these compounds (or groups thereof) based on toxicological relevance; (3) compare the environmental concentration (e.g., MEC) to the MTL; CECs with a MEC/MTL ratio greater than 1 should be prioritized for monitoring, compounds with a ratio less than '1' should only be considered if they represent viable treatment process performance indicators; and (4) screen the priority list to ensure that a commercially available robust analytical method is available for that compound. © IWA Publishing 2013.

  7. Designing monitoring programs for chemicals of emerging concern in potable reuse--what to include and what not to include?

    Science.gov (United States)

    Drewes, J E; Anderson, P; Denslow, N; Olivieri, A; Schlenk, D; Snyder, S A; Maruya, K A

    2013-01-01

    This study discussed a proposed process to prioritize chemicals for reclaimed water monitoring programs, selection of analytical methods required for their quantification, toxicological relevance of chemicals of emerging concern regarding human health, and related issues. Given that thousands of chemicals are potentially present in reclaimed water and that information about those chemicals is rapidly evolving, a transparent, science-based framework was developed to guide prioritization of which compounds of emerging concern (CECs) should be included in reclaimed water monitoring programs. The recommended framework includes four steps: (1) compile environmental concentrations (e.g., measured environmental concentration or MEC) of CECs in the source water for reuse projects; (2) develop a monitoring trigger level (MTL) for each of these compounds (or groups thereof) based on toxicological relevance; (3) compare the environmental concentration (e.g., MEC) to the MTL; CECs with a MEC/MTL ratio greater than 1 should be prioritized for monitoring, compounds with a ratio less than '1' should only be considered if they represent viable treatment process performance indicators; and (4) screen the priority list to ensure that a commercially available robust analytical method is available for that compound.

  8. Designing monitoring programs for chemicals of emerging concern in potable reuse ⋯ What to include and what not to include?

    KAUST Repository

    Drewes, Jorg

    2012-11-01

    This study discussed a proposed process to prioritize chemicals for reclaimed water monitoring programs, selection of analytical methods required for their quantification, toxicological relevance of chemicals of emerging concern regarding human health, and related issues. Given that thousands of chemicals are potentially present in reclaimed water and that information about those chemicals is rapidly evolving, a transparent, science-based framework was developed to guide prioritization of which compounds of emerging concern (CECs) should be included in reclaimed water monitoring programs. The recommended framework includes four steps: (1) compile environmental concentrations (e.g., measured environmental concentration or MEC) of CECs in the source water for reuse projects; (2) develop a monitoring trigger level (MTL) for each of these compounds (or groups thereof) based on toxicological relevance; (3) compare the environmental concentration (e.g., MEC) to the MTL; CECs with a MEC/MTL ratio greater than 1 should be prioritized for monitoring, compounds with a ratio less than \\'1\\' should only be considered if they represent viable treatment process performance indicators; and (4) screen the priority list to ensure that a commercially available robust analytical method is available for that compound. © IWA Publishing 2013.

  9. Emergency Immigration Education Act Programs: Summer E.S.L. Welcome Plus Program for Students of Limited English Proficiency (LEP), Summer Bilingual Program, and Project Omega. OREA Report.

    Science.gov (United States)

    Duque, Diana L.

    This report presents findings of the evaluation by the New York City public school system's Office of Research, Evaluation, and Assessment of three programs (Summer E.S.L. Welcome Plus, Summer Bilingual, and Project Omega) for immigrant students. The Summer E.S.L. (English as a Second Language) Welcome Plus program operated at 19 sites in New York…

  10. Short-term moderate intensive high volume training program provides aerobic endurance benefit in wheelchair basketball players.

    Science.gov (United States)

    Skucas, Kestutis; Pokvytyte, Vaida

    2017-04-01

    The aim of this paper was to investigate the effect of short-term period, moderate intensity and high volume endurance training on physiological variables in elite wheelchair basketball players. Eight wheelchair basketball players were examined. The subjects participated in a two-week intervention program of mainly two training types: wheelchair basketball and wheelchair driving endurance training. The subjects performed the continuously increasing cycling exercise (CCE) at the constant 60 rpm arm cranking speed at the beginning of the program and after two weeks of the program. The initial workload was 20 W, then the workload was increased by 2 W every 5 seconds until fatigue. The post training of the wheelchair basketball group in the study showed a significant improvement in the peak oxygen uptake (VO2peak) and the peak power output (POpeak). VO2peak increased by 9% from 2.32±0.16 L/min to 2.53±0.2 L/min (Pbasketball squad had relatively high levels of aerobic fitness prior to participating in the endurance training program. Nevertheless, the high-volume, moderate-intensity, short-term training program, which evolved over the two-weeks period, resulted in the improvement of the athlete's aerobic endurance. The ventilatory threshold (VT) and the second ventilatory threshold (VT2) are good markers for aerobic capacity of wheelchair athletes.

  11. CANADA’S MOTHER-CHILD PROGRAM: EXAMINING ITS EMERGENCE, USAGE, AND CURRENT STATE

    Directory of Open Access Journals (Sweden)

    Sarah Brennan

    2014-04-01

    Full Text Available One of many issues a mother must face while incarcerated is separation from her child(ren for an extended period of time. Empirical findings have consistently highlighted various negative effects for both mothers and their children as a result of this separation. To curb some of the negative effects, Correctional Service Canada’s Mother-Child Program offers full- and part-time visitation between children and their incarcerated mothers at various women’s federal correctional facilities in Canada. The current study involves an in-depth critical analysis of Canada’s MCP by asking three related questions. First, to what extent has the MCP been used since its full implementation in 2001? Second, to what extent is the MCP used today? Third, do any barriers exist currently that are inhibiting the success of the MCP and, if so, how can these be addressed? The results of the study reveal that, since the full implementation of the program in 2001, the participation rate declined from an already low starting point and has remained relatively low since. Further, three main factors were suggested as potential barriers impeding the success of the MCP: correctional overcrowding, a more punitive institutional culture, and a series of changes to the program’s eligibility criteria. Recommendations on ways to increase the usage of the program are offered and suggestions for future research are made.

  12. How Much of a "Running Start" Do Dual Enrollment Programs Provide Students? CEDR Working Paper. WP #2014-­7

    Science.gov (United States)

    Cowan, James; Goldhaber, Dan

    2014-01-01

    We study a popular dual enrollment program in Washington State, "Running Start" using a new administrative database that links high school and postsecondary data. Conditional on prior high school performance, we find that students participating in Running Start are more likely to attend any college but less likely to attend four-year…

  13. Effectiveness of a Caregiver Education Program on Providing Oral Care to Individuals with Intellectual and Developmental Disabilities

    Science.gov (United States)

    Fickert, Nancy A.; Ross, Diana

    2012-01-01

    Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to…

  14. Providing Support for Rural Teachers of Students with Low Incidence Disabilities Who Are Completing the Kentucky Teacher Internship Program

    Science.gov (United States)

    Abell, Michael; Collins, Belva C.; Kleinert, Harold; Pennington, Robert

    2014-01-01

    The Education and Professional Standards Board (EPSB) is the governing organization for teacher certification in Kentucky. According to the EPSB (2013a), only three institutions of higher education in the state (i.e., Morehead State University, University of Kentucky, University of Louisville) offer an approved alternate certificate program in…

  15. Clinical, Bacteriologic, and Geographic Stratification of Melioidosis Emerges from the Sri Lankan National Surveillance Program.

    Science.gov (United States)

    Sathkumara, Harindra D; Merritt, Adam J; Corea, Enoka M; Krishnananthasivam, Shivankari; Natesan, Mohan; Inglis, Timothy J J; De Silva, Aruna Dharshan

    2018-02-01

    Melioidosis, a potentially fatal tropical infection, is said to be underdiagnosed in low-income countries. An increase in melioidosis cases in Sri Lanka allowed us to analyze the relationship among clinical outcome, bacteriology, epidemiology, and geography in the first 108 laboratory-confirmed cases of melioidosis from a nationwide surveillance program. The additional 76 cases of laboratory-confirmed melioidosis confirmed further associations between Burkholderia pseudomallei multilocus sequence typing (MLST) and infection phenotype; ST1137/unifocal bacteremic infection (χ 2 = 3.86, P national genotyping-supported melioidosis registry will improve melioidosis diagnosis, treatment, and prevention where underdiagnosis and mortality rates remain high.

  16. Improvement of the reliability of the emergency diesel generators and their protections as a part of the modernization program for units 5 and 6 of the Kozloduy NPP

    International Nuclear Information System (INIS)

    Bogdanov, D.

    2003-01-01

    The measure 'Improvement of the reliability of the emergency diesel generators and their protections' 28411 is part of the modernization program for Units 5 and 6 of Kozloduy NPP. The scope of the measure includes complete change of the I and C system, the local control panels, the technological and electrical protections of the DG set, the excitation system and some of the power distribution switchboards. The new I and C system will be Teleperm XS type, produced by Framatome ANP, the power distribution switchboards type Sivacon, the excitation system Thyripart, and the electrical protection and synchronization system will be provided by Siemens. The purpose of the measure is to increase the availability, maintainability and to improve the reliability of the DG sets

  17. Management of the Commander's Emergency Response Program in Iraq for Fiscal Year 2006

    National Research Council Canada - National Science Library

    2007-01-01

    ... in their areas of responsibility. This may include making condolence payments after combat operations, providing funds for repairs, purchasing critical infrastructure equipment, or conducting large-scale civic cleanups that employ...

  18. Stockpile strategy for China's emergency oil reserve: A dynamic programming approach

    International Nuclear Information System (INIS)

    Bai, Y.; Dahl, C.A.; Zhou, D.Q.; Zhou, P.

    2014-01-01

    China is currently accelerating construction of its strategic petroleum reserves. How should China fill the SPR in a cost-effective manner in the short-run? How might this affect world oil prices? Using a dynamic programming model to answer these questions, the objective of this paper is to minimize the stockpiling costs, including consumer surplus as well as crude acquisition and holding costs. The crude oil acquisition price in the model is determined by global equilibrium between supply and demand. Demand, in turn, depends on world market conditions including China's stockpile filling rate. Our empirical study under different market conditions shows that China's optimal stockpile acquisition rate varies from 9 to 19 million barrels per month, and the optimal stockpiling drives up the world oil price by 3–7%. The endogenous price increase accounts for 52% of total stockpiling costs in the base case. When the market is tighter or the demand function is more inelastic, the stockpiling affects the market more significantly and pushes prices even higher. Alternatively, in a disruption, drawdown from the stockpile can effectively dampen soaring prices, though the shortage is likely to leave the price higher than before the disruption. - Highlights: • China's SPR policies are examined by dynamic programming. • The optimal stockpile acquisition rate varies from 9 to 19 million barrels per month. • The optimal stockpiling drives up world oil price by 3–7%

  19. Utilization of a state run public private emergency transportation service exclusively for childbirth: the Janani (maternal) Express program in Madhya Pradesh, India.

    Science.gov (United States)

    Sidney, Kristi; Ryan, Kayleigh; Diwan, Vishal; De Costa, Ayesha

    2014-01-01

    In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.

  20. Incentive-based demand response programs designed by asset-light retail electricity providers for the day-ahead market

    DEFF Research Database (Denmark)

    Fotouhi Ghazvini, Mohammad Ali; Faria, Pedro; Ramos, Sergio

    2015-01-01

    how a REP with light physical assets, such as DG (distributed generation) units and ESS (energy storage systems), can survive in a competitive retail market. The paper discusses the effective risk management strategies for the REPs to deal with the uncertainties of the DAM (day-ahead market) and how...... to hedge the financial losses in the market. A two-stage stochastic programming problem is formulated. It aims to establish the financial incentive-based DR programs and the optimal dispatch of the DG units and ESSs. The uncertainty of the forecasted day-ahead load demand and electricity price is also...... taken into account with a scenario-based approach. The principal advantage of this model for REPs is reducing the risk of financial losses in DAMs, and the main benefit for the whole system is market power mitigation by virtually increasing the price elasticity of demand and reducing the peak demand....

  1. Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil

    Directory of Open Access Journals (Sweden)

    Luciana C. Silva

    2017-12-01

    Full Text Available Objective: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência – CAPSi in São Paulo, Brazil. Methods: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1 pre-intervention observation; 2 meeting with staff to assess the main needs of the training program; 3 developing materials for training and evaluation; 4 meetings to discuss program implementation; 5 a final meeting for case discussion and evaluation; and 6 distance supervision. Three measures were used to evaluate the training program: i the Knowledge, Attitudes, and Practices (KAP questionnaire; ii videos containing questions designed to assess program comprehension; and iii a satisfaction survey. Results: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. Conclusion: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

  2. Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil.

    Science.gov (United States)

    Silva, Luciana C; Teixeira, Maria C T V; Ribeiro, Edith L; Paula, Cristiane S

    2017-12-18

    To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

  3. 78 FR 31769 - Accessible Emergency Information; Apparatus Requirements for Emergency Information and Video...

    Science.gov (United States)

    2013-05-24

    ... and equipment and better access video programming.'' \\7\\ \\7\\ H.R. Rep. No. 111-563, 111th Cong., 2d... Video Accessibility Act of 2010 (``CVAA''), the Commission adopts rules requiring video programming distributors and video programming providers (including program owners) to make televised emergency information...

  4. Interview Day Environment May Influence Applicant Selection of Emergency Medicine Residency Programs

    Directory of Open Access Journals (Sweden)

    Lewis, Jason

    2017-01-01

    Full Text Available The structure of the interview day affects applicant interactions with faculty and residents, which can influence the applicant’s rank list decision. We aimed to determine if there was a difference in matched residents between those interviewing on a day on which didactics were held and had increased resident and faculty presence (didactic day versus an interview day with less availability for applicant interactions with residents and faculty (non-didactic day. This was a retrospective study reviewing interview dates of matched residents from 2009-2015. Forty-two (61.8% matched residents interviewed on a didactic day with increased faculty and resident presence versus 26 (38.2% on a non-didactic interview day with less availability for applicant interactions (p = 0.04. There is an association between interviewing on a didactic day with increased faculty and resident presence and matching in our program.

  5. Multiple Problem-Solving Strategies Provide Insight into Students' Understanding of Open-Ended Linear Programming Problems

    Science.gov (United States)

    Sole, Marla A.

    2016-01-01

    Open-ended questions that can be solved using different strategies help students learn and integrate content, and provide teachers with greater insights into students' unique capabilities and levels of understanding. This article provides a problem that was modified to allow for multiple approaches. Students tended to employ high-powered, complex,…

  6. 77 FR 45421 - Homeless Emergency Assistance and Rapid Transition to Housing: Continuum of Care Program

    Science.gov (United States)

    2012-07-31

    ... which service providers are familiar. The following highlights key definitions used in the Continuum of... Continuum of Care in 1995. Local grantees and stakeholders are familiar with the Continuum of Care as the... violence, dating violence, sexual assault, and stalking. In developing the baseline requirements for a...

  7. Pedagogical perspectives and implicit theories of teaching: First year science teachers emerging from a constructivist science education program

    Science.gov (United States)

    Dias, Michael James

    Traditional, teacher-centered pedagogies dominate current teaching practice in science education despite numerous research-based assertions that promote more progressive, student-centered teaching methods. Best-practice research emerging from science education reform efforts promotes experiential, collaborative learning environments in line with the constructivist referent. Thus there is a need to identify specific teacher education program designs that will promote the utilization of constructivist theory among new teachers. This study explored the learning-to-teach process of four first-year high school teachers, all graduates of a constructivist-based science education program known as Teacher Education Environments in Mathematics and Science (TEEMS). Pedagogical perspectives and implicit theories were explored to identify common themes and their relation to the pre-service program and the teaching context. Qualitative methods were employed to gather and analyze the data. In depth, semi-structured interviews (Seidman, 1998) formed the primary data for probing the context and details of the teachers' experience as well as the personal meaning derived from first year practice. Teacher journals and teaching artifacts were utilized to validate and challenge the primary data. Through an open-coding technique (Strauss & Corbin, 1990) codes, and themes were generated from which assertions were made. The pedagogical perspectives apparent among the participants in this study emerged as six patterns in teaching method: (1) utilization of grouping strategies, (2) utilization of techniques that allow the students to help teach, (3) similar format of daily instructional strategy, (4) utilization of techniques intended to promote engagement, (5) utilization of review strategies, (6) assessment by daily monitoring and traditional tests, (7) restructuring content knowledge. Assertions from implicit theory data include: (1) Time constraints and lack of teaching experience made

  8. Project quality assurance plan for research and development services provided by Oak Ridge National Laboratory in support of the Hanford Grout Disposal Program

    International Nuclear Information System (INIS)

    Spence, R.D.; Gilliam, T.M.

    1991-11-01

    This Project Quality Assurance Plan (PQAP) is being published to provide the sponsor with referenceable documentation for work conducted in support of the Hanford WHC Grout Disposal Program. This plan, which meets NQA-1 requirements, is being applied to work performed at Oak Ridge National Laboratory (ORNL) during FY 1991 in support of this program. It should also be noted that with minor revisions, this plan should be applicable to other projects involving research and development that must comply with NQA-1 requirements

  9. Project quality assurance plan for research and development services provided by Oak Ridge National Laboratory in support of the Hanford Grout Disposal Program

    Energy Technology Data Exchange (ETDEWEB)

    Spence, R.D.; Gilliam, T.M.

    1991-11-01

    This Project Quality Assurance Plan (PQAP) is being published to provide the sponsor with referenceable documentation for work conducted in support of the Hanford WHC Grout Disposal Program. This plan, which meets NQA-1 requirements, is being applied to work performed at Oak Ridge National Laboratory (ORNL) during FY 1991 in support of this program. It should also be noted that with minor revisions, this plan should be applicable to other projects involving research and development that must comply with NQA-1 requirements.

  10. Should providers encourage realistic weight expectations and satisfaction with lost weight in commercial weight loss programs? a preliminary study.

    Science.gov (United States)

    Ames, Gretchen E; Thomas, Colleen S; Patel, Roshni H; McMullen, Jillian S; Lutes, Lesley D

    2014-01-01

    Attrition is a problem among patients who participate in commercial weight loss programs. One possible explanation is that if patients are unable to reach a weight that they expect to achieve, they may be more likely to drop out of treatment. This study investigated variables associated with attrition among 30 obese patients who completed a liquid meal replacement program (LMR) and enrolled in a 52-week Small Changes Maintenance intervention (SCM). Patients lost a median 18% of body weight during LMR and completed assessments about weight expectations and weight satisfaction pre- and post-SCM. Of the 30 patients who started SCM, 8 (27%) were lost to attrition. Odds of SCM attrition were higher in patients who lost ≤ 18.2% of pre-LMR weight (OR: 12.25, P = 0.035), had lower satisfaction (≤7) pre-SCM (OR: 10.11,