75 FR 26160 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

Science.gov (United States)

2010-05-11

... ward areas where patients may be encountered; (ii) Clinic examination rooms; (iii) Nurses stations; (iv... access to VA medical facilities by sales representatives (including account managers and clinical... would require the Chief of Pharmacy or other official responsible for such decisions to approve...

Medical cyclotron facilities

International Nuclear Information System (INIS)

1984-09-01

This report examines the separate proposals from the Austin Hospital and the Australian Atomic Energy Commission for a medical cyclotron facility. The proponents have argued that a cyclotron facility would benefit Australia in areas of patient care, availability and export of radioisotopes, and medical research. Positron emission tomography (PET) and neutron beam therapy are also examined

A systematic exploration of differences in contextual factors related to implementing the MOVE! weight management program in VA: A mixed methods study

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Fletcher Carol E

2011-09-01

Full Text Available Abstract Background In January 2006, Veterans Affairs (VA disseminated the MOVE!® Weight Management Program to VA medical centers to address the high prevalence of overweight/obesity. In its second year, MOVE! implementation varied widely across facilities. The objective of this study was to understand contextual factors that facilitated or impeded implementation of MOVE! in VA medical centers in the second year after its dissemination. Methods We used an embedded mixed methods cross-sectional study design. Qualitative and quantitative data were collected simultaneously with the primary purpose to explore contextual factors most likely to influence MOVE! implementation effectiveness at five purposively selected facilities. Facilities were selected to maximize variation with respect to participation in MOVE! by candidate Veterans. Semi-structured phone interviews were conducted with 24 staff across the five facilities. Quantitative responses were elicited followed by open-ended questions. The quantitative measures were adapted from a published implementation model. Qualitative analysis was conducted using rigorous content analysis methods. Results Qualitative and quantitative data converged to strengthen findings that point to several recommendations. Management support can help increase visibility of the program, commit needed resources, and communicate the importance of implementation efforts. Establishing a receptive implementation climate can be accomplished by emphasizing the important role that weight management may have in reducing incidence and severity of obesity-related chronic conditions. Coalescing highly functioning multi-disciplinary teams was an essential step for more effective implementation of MOVE!. In some situations, local champions can overcome challenging barriers in facilities that lack sufficient management support. Conclusions Key organizational factors at local VA medical centers were strongly associated with MOVE

Comparing Catheter-associated Urinary Tract Infection Prevention Programs Between VA and Non-VA Nursing Homes

Science.gov (United States)

Mody, Lona; Greene, M. Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W.; Wald, Heidi L.; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E.; King, Beth J.; Hogikyan, Robert; Edson, Barbara; Krein, Sarah L.

2018-01-01

OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that U.S. Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the “AHRQ Safety Program for Long-term Care” collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention. RESULTS A total of 353 (71%; 47 VA, 306 non-VA) of 494 nursing homes from 41 states responded. VA nursing homes reported more hours/week devoted to infection prevention-related activities (31 vs. 12 hours, P<.001), and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs. 66%, P<.001), sharing CAUTI data with leadership (94% vs. 70%, P=.014) and nursing personnel (85% vs. 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs. 81%, P=.004) and catheter insertion (83% vs. 94%, P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. PMID:27917728

Facilities & Leadership

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Department of Veterans Affairs — The facilities web service provides VA facility information. The VA facilities locator is a feature that is available across the enterprise, on any webpage, for the...

Has the VA Become a White Elephant?

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Robbins RA

2016-11-01

Full Text Available No abstract available. Article truncated at 150 words. As I write this Dennis Wagner is publishing a series of articles in the Arizona Republic describing his quest to find out if care at VA hospitals have improved over the last 2 years (1. To begin the article Wagner describes the fable of the King of Siam who presented albino pachyderms to his enemies knowing they would be bankrupted because the cost of food and care outweighed all usefulness. A modern expression derives from this parable: the white elephant. The Department of Veterans Affairs (VA has prided itself on being a leader in healthcare. It is the largest healthcare system in the US, implemented the first electronic medical record, and more than 70 percent of all US doctors have received training in the VA healthcare system (2. This year the VA is celebrating the 70th anniversary of its partnership with US medical schools. Beginning in 1946, the VA partnered ...

Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center.

Science.gov (United States)

Cosio, David; Lin, Erica H

2015-06-01

Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

Medical Total Force Management

Science.gov (United States)

2014-05-01

Facilities (MTFs). For specialties that are common in civilian labor markets , civilian providers generally cost less than military providers. While the...produced in Military Treatment Facilities (MTFs). For specialties that are common in civilian labor markets , civilian providers generally cost less...Attracting Fully Trained Medical Personnel,” CRM D0013237.A2 (Alexandria, VA: CNA Corporation, 2006). 66

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.

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Erin K Nichols

2018-01-01

Full Text Available Verbal autopsy (VA is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

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Rachel Peterson

Full Text Available Researchers at the U.S. Department of Veterans Affairs (VA have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012 of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services, plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%. Adding allied V60 codes increased that to 31,260 (rate 3.3%. While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

Science.gov (United States)

Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

Building a medical system for nuclear facilities

International Nuclear Information System (INIS)

Maeda, Mitsuya

2016-01-01

To build a medical system for nuclear facilities, I explained what kinds of actions were performed with the TEPCO Fukushima Daiichi Nuclear Power Plant Accident and what kinds of actions are going to be performed in the future. We examined the health and medical care of the emergency workers in nuclear facilities including TEPCO Fukushima Daiichi Nuclear Power Plant from 2014 to 2015 in the Ministry of Health, Labour and Welfare (MHLW). We carried out a detailed hearing from stakeholders of electric companies and medical institutions about the medical system in nuclear facilities carrying out urgent activities. It has been said that the electric company is responsible to maintain the medical system for affected workers in nuclear facilities. However, TEPCO could not find the medical staff, such as doctors, by their own effort at the TEPCO Fukushima Daiichi Nuclear Power Plant Accident. The network of doctors familiar with emergency medical care support dispatched the medical staff after July of 2011. The stakeholders indicated that the following six tasks must be resolved: (1) the fact that no electric company performs the action of bringing up medical staff who can be dispatched into nuclear facilities in emergencies in 2015; (2) bringing up personnel in charge of radiation management and logistics other than the medical staff, such as doctors; (3) cooperation with the community medicine system given the light and shade by nuclear facilities; (4) performing training for the many concurrent wounded based on the scenario of a severe accident; (5) indicating both the condition of the contract and the guarantee of status that is appropriate for dispatched medical staffs; and (6) clarifying the organization of the network of stakeholders. The stakeholders showed the future directionality as follows: (1) To recruit the medical staff expected to be dispatched into nuclear facilities, (2) to carry out the discussion and conveyance training to strengthen cooperation with

Whistle-blower accuses VA inspector general of a "whitewash"

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Robbins RA

2014-09-01

Full Text Available No abstract available. Article truncated after 150 words. Yesterday, Dr. Sam Foote, the initial whistle-blower at the Phoenix VA, criticized the Department of Veterans Affairs inspector general's (VAOIG report on delays in healthcare at the Phoenix VA at a hearing before the House Committee of Veterans Affairs (1,2. Foote accused the VAOIG of minimizing bad patient outcomes and deliberately confusing readers, downplaying the impact of delayed health care at Phoenix VA facilities. "At its best, this report is a whitewash. At its worst, it is a feeble attempt at a cover-up," said Foote. Foote earlier this year revealed that as many as 40 Phoenix patients died while awaiting care and that the Phoenix VA maintained secret waiting lists while under-reporting patient wait times for appointments. His disclosures triggered the national VA scandal. Richard Griffin, the acting VAOIG, said that nearly 300 patients died while on backlogged wait lists in the Phoenix VA Health Care System, a much higher ...

VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

Science.gov (United States)

Shireman, Paula K; Rasmussen, Todd E; Jaramillo, Carlos A; Pugh, Mary Jo

2015-02-03

Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities

OpenAIRE

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed u...

LIFE JOURNEY: MEDICAL AND SCIENTIFIC WORK OF PROFESSOR V.A. SOKOLOV

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P. A. Ivanov

2017-01-01

Full Text Available The article is dedicated to doctor of medicine, professor V.A. Sokolov. In 2017 he celebrates his eightieth birthday. Professor V.A. .Sokolov is one of the founders of polytrauma treatment in USSR and Russia. For a long time he had been heading polytrauma department at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Due to his work, algorithms of life sustaining and recovery of serious patients were developed. Professor V.A. Sokolov is the author of 6 monographies and about 300 periodical papers. Besides, he is the holder of 32 patents. Some of his inventions were popularized and manufactured. He had been leading active scientific work, which resulted in 6 doctoral dissertations and 15 candidate theses. The staff of N.V. Sklifosovsky Research Institute for Emergency Medicine congratulates on the anniversary.

Mental Health Disorders, Suicide Risk, and Treatment seeking among Formerly Deployed National Guardand Reserve Service Member seen in Non VA Facilities

Science.gov (United States)

2016-10-01

through the Affordable Healthcare Act ( ACA ) and other sources. Most veterans are not seen in VA facilities. The Geisinger Clinic, the community partner...group practice, ten hospital campuses, a 467,000-member health plan, and is one of the largest employers in the state. The knowledge gained from...Complete Analyses for Study Aim 3 ( Effectiveness ) and for Aim 4 (Genetics), Prepare Final Manuscripts for Review and Submission, Convene Final Conferences

AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs. James J. Peters VA Medical Center, Bronx, NY

Energy Technology Data Exchange (ETDEWEB)

Schey, Stephen [Intertek Testing Services, North America, Phoenix, AZ (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2014-10-01

This report focuses on the Department of Veterans Affairs, James J. Peters VA Medical Center (VA - Bronx) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

In aftermath of financial investigation Phoenix VA employee demoted after her testimony

Directory of Open Access Journals (Sweden)

Robbins RA

2013-03-01

Full Text Available No abstract available. Article truncated after 150 words. A previous Southwest Journal of Pulmonary and Critical Care Journal editorial commented on fiscal mismanagement at the Department of Veterans Affairs (VA Medical Center in Phoenix (1. Now Paula Pedene, the former Phoenix VA public affairs officer, claims she was demoted for testimony she gave to the VA Inspector General’s Office (OIG regarding that investigation (2. In 2011, the OIG investigated the Phoenix VA for excess spending on private care of patients (3. The report blamed systemic failures for controls so weak that $56 million in medical fees were paid during 2010 without adequate review. The report particularly focused on one clinician assigned by the Chief of Staff to review hundreds of requests per week and the intensive care unit physicians for transferring patients to chronic ventilator units (1,3. After the investigation, the director and one of the associate directors left the VA and the chief of staff was promoted …

VA Health Care: VA Spends Millions on Post-Traumatic Stress Disorder Research and Incorporates Research Outcomes into Guidelines and Policy for Post-Traumatic Stress Disorder Services

Science.gov (United States)

2011-01-01

post - traumatic stress disorder ( PTSD ) and...Veterans Affairs (VA) Intramural Post - Traumatic Stress Disorder ( PTSD ) Research Funding and VA’s Medical and Prosthetic Research Appropriation...Table 6: Department of Veterans Affairs (VA) Research Centers and Programs That Conduct or Support Post - Traumatic Stress Disorder ( PTSD ) Research

Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

Science.gov (United States)

Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

2017-04-01

Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

Medical facility statistics in Japan.

Science.gov (United States)

Hamajima, Nobuyuki; Sugimoto, Takuya; Hasebe, Ryo; Myat Cho, Su; Khaing, Moe; Kariya, Tetsuyoshi; Mon Saw, Yu; Yamamoto, Eiko

2017-11-01

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

Ecotoxicity of Wastewater from Medical Facilities: A Review

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Cidlinová A.

2018-03-01

Full Text Available Wastewater from medical facilities contains a wide range of chemicals (in particular pharmaceuticals, disinfectants, heavy metals, contrast media, and radionuclides and pathogens, therefore it constitutes a risk to the environment and human health. Many micropollutants are not efficiently eliminated during wastewater treatment and contaminate both surface water and groundwater. As we lack information about the long-term effects of low concentrations of micropollutants in the aquatic environment, it is not possible to rule out their adverse effects on aquatic organisms and human health. It is, therefore, necessary to focus on the evaluation of chronic toxicity in particular when assessing the environmental and health risks and to develop standards for the regulation of hazardous substances in wastewater from medical facilities on the basis of collected data. Wastewater from medical facilities is a complex mixture of many compounds that may have synergetic, antagonistic or additive effects on organisms. To evaluate the influence of a wide range of pollutants contained in the effluents from medical facilities on aquatic ecosystems, it is necessary to determine their ecotoxicity.

The impact of the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 on VA physicians' salaries and retention.

Science.gov (United States)

Weeks, William B; Wallace, Tanner A; Wallace, Amy E

2009-01-01

To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.

Radiation safety and regulatory aspects in Medical Facilities

International Nuclear Information System (INIS)

Banerjee, Sharmila

2017-01-01

Radiation safety and regulatory aspect of medical facilities are relevant in the context where radiation is used in providing healthcare to human patients. These include facilities, which carry out radiological procedures in diagnostic radiology, including dentistry, image-guided interventional procedures, nuclear medicine, and radiation therapy. The safety regulations provide recommendations and guidance on meeting the requirements for the safe use of radiation in medicine. The different safety aspects which come under its purview are the personnel involved in medical facilities where radiological procedures are performed which include the medical practitioners, radiation technologists, medical physicists, radiopharmacists, radiation protection and over and above all the patients. Regulatory aspects cover the guidelines provided by ethics committees, which regulate the administration of radioactive formulation in human patients. Nuclear medicine is a modality that utilizes radiopharmaceuticals either for diagnosis of physiological disorders related to anatomy, physiology and patho-physiology and for diagnosis and treatment of cancer

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers.

Science.gov (United States)

Wang, Virginia; Maciejewski, Matthew L; Patel, Uptal D; Stechuchak, Karen M; Hynes, Denise M; Weinberger, Morris

2013-01-18

Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both ("dual") settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans' baseline dialysis date. Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. VA expenditures for "buying" outsourced dialysis are high and increasing relative to "making" dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans' access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

Use of information technology for medication management in residential care facilities: correlates of facility characteristics.

Science.gov (United States)

Bhuyan, Soumitra S; Chandak, Aastha; Powell, M Paige; Kim, Jungyoon; Shiyanbola, Olayinka; Zhu, He; Shiyanbola, Oyewale

2015-06-01

The effectiveness of information technology in resolving medication problems has been well documented. Long-term care settings such as residential care facilities (RCFs) may see the benefits of using such technologies in addressing the problem of medication errors among their resident population, who are usually older and have numerous chronic conditions. The aim of this study was two-fold: to examine the extent of use of Electronic Medication Management (EMM) in RCFs and to analyze the organizational factors associated with the use of EMM functionalities in RCFs. Data on RCFs were obtained from the 2010 National Survey of Residential Care Facilities. The association between facility, director and staff, and resident characteristics of RCFs and adoption of four EMM functionalities was assessed through multivariate logistic regression. The four EMM functionalities included were maintaining lists of medications, ordering for prescriptions, maintaining active medication allergy lists, and warning of drug interactions or contraindications. About 12% of the RCFs adopted all four EMM functionalities. Additionally, maintaining lists of medications had the highest adoption rate (34.5%), followed by maintaining active medication allergy lists (31.6%), ordering for prescriptions (19.7%), and warning of drug interactions or contraindications (17.9%). Facility size and ownership status were significantly associated with adoption of all four EMM functionalities. Medicaid certification status, facility director's age, education and license status, and the use of personal care aides in the RCF were significantly associated with the adoption of some of the EMM functionalities. EMM is expected to improve the quality of care and patient safety in long-term care facilities including RCFs. The extent of adoption of the four EMM functionalities is relatively low in RCFs. Some RCFs may strategize to use these functionalities to cater to the increasing demands from the market and also to

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

Directory of Open Access Journals (Sweden)

Wang Virginia

2013-01-01

Full Text Available Abstract Background Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA, requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. Methods We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1 VA, (2 VA-outsourced settings, or (3 both (“dual” settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date. Results Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48% were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. Conclusions VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

Wireless local network architecture for Naval medical treatment facilities

OpenAIRE

Deason, Russell C.

2004-01-01

Approved for public release; distribution is unlimited In today's Navy Medicine, an approach towards wireless networks is coming into view. The idea of developing and deploying workable Wireless Local Area Networks (WLAN) throughout Naval hospitals is but just a few years down the road. Currently Naval Medical Treatment Facilities (MTF) are using wired Local Area Networks (LANs) throughout the infrastructure of each facility. Civilian hospitals and other medical treatment facilities have b...

KENO-VA-PVM KENO-VA-SM, KENO5A for Parallel Processors

International Nuclear Information System (INIS)

Ramon, Javier; Pena, Jorge

2002-01-01

1 - Description of program or function: This package contains versions KENO-Va-SM (Shared Memory version) and KENO-Va-PVM (Parallel Virtual Machine version) based on SCALE-4.1. KENO-Va three-dimensional Boltzmann transport equation for neutron multiplying systems. The primary purpose of KENO-Va is to determine k-effective. Other calculated quantities include lifetime and generation time, energy-dependent leakages, energy- and region-dependent absorptions, fissions, fluxes, and fission densities. 2 - Method of solution: KENO-Va employs the Monte Carlo technique

Instrumentation of the ESRF medical imaging facility

CERN Document Server

Elleaume, H; Berkvens, P; Berruyer, G; Brochard, T; Dabin, Y; Domínguez, M C; Draperi, A; Fiedler, S; Goujon, G; Le Duc, G; Mattenet, M; Nemoz, C; Pérez, M; Renier, M; Schulze, C; Spanne, P; Suortti, P; Thomlinson, W; Estève, F; Bertrand, B; Le Bas, J F

1999-01-01

At the European Synchrotron Radiation Facility (ESRF) a beamport has been instrumented for medical research programs. Two facilities have been constructed for alternative operation. The first one is devoted to medical imaging and is focused on intravenous coronary angiography and computed tomography (CT). The second facility is dedicated to pre-clinical microbeam radiotherapy (MRT). This paper describes the instrumentation for the imaging facility. Two monochromators have been designed, both are based on bent silicon crystals in the Laue geometry. A versatile scanning device has been built for pre-alignment and scanning of the patient through the X-ray beam in radiography or CT modes. An intrinsic germanium detector is used together with large dynamic range electronics (16 bits) to acquire the data. The beamline is now at the end of its commissioning phase; intravenous coronary angiography is intended to start in 1999 with patients and the CT pre-clinical program is underway on small animals. The first in viv...

A medical facility proposal to use the SSC linac

International Nuclear Information System (INIS)

Funk, L.W.

1994-01-01

A consortium organized by the Texas National Research Laboratory Commission under a Department of Energy grant proposes to build and operate a Regional Medical Technology Center to function as a combined medical radioisotope production complex and proton cancer therapy facility using the Linear Accelerator (Linac) assets of the Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications for linear accelerator technology

Communications and Collaboration Keep San Francisco VA Medical Center Project on Track

International Nuclear Information System (INIS)

Federal Energy Management Program

2001-01-01

This case study about energy saving performance contacts (ESPCs) presents an overview of how the Veterans Affairs Medical Center in San Francisco established an ESPC contract and the benefits derived from it. The Federal Energy Management Program instituted these special contracts to help federal agencies finance energy-saving projects at their facilities

Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees.

Science.gov (United States)

Helfrich, Christian D; Dolan, Emily D; Simonetti, Joseph; Reid, Robert J; Joos, Sandra; Wakefield, Bonnie J; Schectman, Gordon; Stark, Richard; Fihn, Stephan D; Harvey, Henry B; Nelson, Karin

2014-07-01

A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed. To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT). Web-based, cross-sectional survey and administrative data from May 2012. A total of 4,539 VA primary care personnel from 588 VA primary care clinics. The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity. Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout. Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.

VA Library Service--Today's look at Tomorrow's Library.

Science.gov (United States)

Veterans Administration, Washington, DC.

The Conference Poceedings are divided into three broad topics: systems planning, audiovisuals in biomedical communication, and automation and networking. Speakers from within the Veterans Administration (VA), from the National Medical Audiovisual Center, and the Lister Hill National Center for Biomedical Communications, National Library of…

Správa nemovitosti versus facility management

OpenAIRE

Rázga, Štěpán

2008-01-01

Problematiku facility managementu a správy nemovitostí práce uceleně shrnuje a porovnává teoretické předpoklady a metodické postupy plynoucí z výuky facility managementu na VŠE v Praze s výkonem daných činností v praxi.

A medical facility proposal to use the SSC linac

International Nuclear Information System (INIS)

Funk, L.W.

1995-01-01

A consortium organized by the Texas National Research Laboratory Commission (TNRLC) under a Department of Energy (DOE) grant proposes to build and operate a Regional Medical Technology Center (RMTC) to function as a combined medical radioisotope production complex and proton cancer therapy facility using the linear accelerator (linac) assets of the cancelled Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications of linear accelerator technology. (orig.)

A medical facility proposal to use the SSC linac

Science.gov (United States)

Warren Funk, L.

1995-05-01

A consortium organized by the Texas National Research Laboratory Commission (TNRLC) under a Department of Energy (DOE) grant proposes to build and operate a Regional Medical Technology Center (RMTC) to function as a combined medical radioisotope production complex and proton cancer therapy facility using the linear accelerator (linac) assets of the cancelled Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications of linear accelerator technology.

Facilities for Research and Development of Medical Radioisotopes

International Nuclear Information System (INIS)

Shin, Byung Chul; Choung, Won Myung; Park, Jin Ho

2003-03-01

This study is carried out by KAERI(Korea Atomic Energy Research Institute) to construct the basic facilities for development and production of medical radioisotope. For the characteristics of radiopharmaceuticals, the facilities should be complied with the radiation shield and GMP(Good Manufacturing Practice) guideline. The KAERI, which has carried out the research and development of the radiopharmaceuticals, made a design of these facilities and built them in the HANARO Center and opened the technique and facilities to the public to give a foundation for research and development of the radiopharmaceuticals. In the facilities, radiation shielding utilities and GMP instruments were set up and their operating manuals were documented. Every utilities and instruments were performed the test to confirm their efficiency and the approval for use of the facilities will be achieved from MOST(Ministry of Science and Technology). It is expected to be applied in development of therapeutic radioisotope such as Re-188 generator and Ho-166, as well as Tc-99m generator and Sr-89 chloride for medical use. And it also looks forward to the contribution to the related industry through the development of product in high demand and value

Medical Isotope Production Analyses In KIPT Neutron Source Facility

International Nuclear Information System (INIS)

Talamo, Alberto; Gohar, Yousry

2016-01-01

Medical isotope production analyses in Kharkov Institute of Physics and Technology (KIPT) neutron source facility were performed to include the details of the irradiation cassette and the self-shielding effect. An updated detailed model of the facility was used for the analyses. The facility consists of an accelerator-driven system (ADS), which has a subcritical assembly using low-enriched uranium fuel elements with a beryllium-graphite reflector. The beryllium assemblies of the reflector have the same outer geometry as the fuel elements, which permits loading the subcritical assembly with different number of fuel elements without impacting the reflector performance. The subcritical assembly is driven by an external neutron source generated from the interaction of 100-kW electron beam with a tungsten target. The facility construction was completed at the end of 2015, and it is planned to start the operation during the year of 2016. It is the first ADS in the world, which has a coolant system for removing the generated fission power. Argonne National Laboratory has developed the design concept and performed extensive design analyses for the facility including its utilization for the production of different radioactive medical isotopes. 99 Mo is the parent isotope of 99m Tc, which is the most commonly used medical radioactive isotope. Detailed analyses were performed to define the optimal sample irradiation location and the generated activity, for several radioactive medical isotopes, as a function of the irradiation time.

Medical Isotope Production Analyses In KIPT Neutron Source Facility

Energy Technology Data Exchange (ETDEWEB)

Talamo, Alberto [Argonne National Lab. (ANL), Argonne, IL (United States); Gohar, Yousry [Argonne National Lab. (ANL), Argonne, IL (United States)

2016-01-01

Medical isotope production analyses in Kharkov Institute of Physics and Technology (KIPT) neutron source facility were performed to include the details of the irradiation cassette and the self-shielding effect. An updated detailed model of the facility was used for the analyses. The facility consists of an accelerator-driven system (ADS), which has a subcritical assembly using low-enriched uranium fuel elements with a beryllium-graphite reflector. The beryllium assemblies of the reflector have the same outer geometry as the fuel elements, which permits loading the subcritical assembly with different number of fuel elements without impacting the reflector performance. The subcritical assembly is driven by an external neutron source generated from the interaction of 100-kW electron beam with a tungsten target. The facility construction was completed at the end of 2015, and it is planned to start the operation during the year of 2016. It is the first ADS in the world, which has a coolant system for removing the generated fission power. Argonne National Laboratory has developed the design concept and performed extensive design analyses for the facility including its utilization for the production of different radioactive medical isotopes. ⁹⁹Mo is the parent isotope of ^99mTc, which is the most commonly used medical radioactive isotope. Detailed analyses were performed to define the optimal sample irradiation location and the generated activity, for several radioactive medical isotopes, as a function of the irradiation time.

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

Science.gov (United States)

Goldzweig, Caroline Lubick; Parkerton, Patricia H; Washington, Donna L; Lanto, Andrew B; Yano, Elizabeth M

2004-04-01

Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates. To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates. Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women. We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median. While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance. Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

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

Science.gov (United States)

2016-12-01

Congressional Requesters December 2016 GAO-17-52 United States Government Accountability Office United States Government Accountability Office...VHA officials said not all facilities require onsite gynecologists and facilities may authorize gynecological services from non-VA providers. They...including previously closed combat positions, which could contribute to the increase in the women veteran population. See GAO, Military Personnel: DOD Is

The Medical Cyclotron Facility in RMC, Parel, BARC

International Nuclear Information System (INIS)

Gopalakrishna, Arjun; Banerjee, Sharmila

2017-01-01

The Medical Cyclotron Facility in Radiation Medicine Centre (RMC) is the first one of its kind, installed in 2002. "1"8F based radiotracers are produced in this facility on a routine basis for Positron Emission Tomography (PET), of in-house patients, as well as for supply to other nuclear medicine centers in Mumbai as well as Pune. The facility consists of the following sub parts - Cyclotron and support equipment; Radiochemistry synthesis laboratory; Quality control (QC) laboratory

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

Science.gov (United States)

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-12-16

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... 2900-0474.'' SUPPLEMENTARY INFORMATION: Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt, VA Form 26-8986. OMB Control Number: 2900...

CoVaCS: a consensus variant calling system.

Science.gov (United States)

Chiara, Matteo; Gioiosa, Silvia; Chillemi, Giovanni; D'Antonio, Mattia; Flati, Tiziano; Picardi, Ernesto; Zambelli, Federico; Horner, David Stephen; Pesole, Graziano; Castrignanò, Tiziana

2018-02-05

The advent and ongoing development of next generation sequencing technologies (NGS) has led to a rapid increase in the rate of human genome re-sequencing data, paving the way for personalized genomics and precision medicine. The body of genome resequencing data is progressively increasing underlining the need for accurate and time-effective bioinformatics systems for genotyping - a crucial prerequisite for identification of candidate causal mutations in diagnostic screens. Here we present CoVaCS, a fully automated, highly accurate system with a web based graphical interface for genotyping and variant annotation. Extensive tests on a gold standard benchmark data-set -the NA12878 Illumina platinum genome- confirm that call-sets based on our consensus strategy are completely in line with those attained by similar command line based approaches, and far more accurate than call-sets from any individual tool. Importantly our system exhibits better sensitivity and higher specificity than equivalent commercial software. CoVaCS offers optimized pipelines integrating state of the art tools for variant calling and annotation for whole genome sequencing (WGS), whole-exome sequencing (WES) and target-gene sequencing (TGS) data. The system is currently hosted at Cineca, and offers the speed of a HPC computing facility, a crucial consideration when large numbers of samples must be analysed. Importantly, all the analyses are performed automatically allowing high reproducibility of the results. As such, we believe that CoVaCS can be a valuable tool for the analysis of human genome resequencing studies. CoVaCS is available at: https://bioinformatics.cineca.it/covacs .

VA's National PTSD Brain Bank: a National Resource for Research.

Science.gov (United States)

Friedman, Matthew J; Huber, Bertrand R; Brady, Christopher B; Ursano, Robert J; Benedek, David M; Kowall, Neil W; McKee, Ann C

2017-08-25

The National PTSD Brain Bank (NPBB) is a brain tissue biorepository established to support research on the causes, progression, and treatment of PTSD. It is a six-part consortium led by VA's National Center for PTSD with participating sites at VA medical centers in Boston, MA; Durham, NC; Miami, FL; West Haven, CT; and White River Junction, VT along with the Uniformed Services University of Health Sciences. It is also well integrated with VA's Boston-based brain banks that focus on Alzheimer's disease, ALS, chronic traumatic encephalopathy, and other neurological disorders. This article describes the organization and operations of NPBB with specific attention to: tissue acquisition, tissue processing, diagnostic assessment, maintenance of a confidential data biorepository, adherence to ethical standards, governance, accomplishments to date, and future challenges. Established in 2014, NPBB has already acquired and distributed brain tissue to support research on how PTSD affects brain structure and function.

Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.

Science.gov (United States)

Seal, Karen H; Bertenthal, Daniel; Miner, Christian R; Sen, Saunak; Marmar, Charles

2007-03-12

Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Directory of Open Access Journals (Sweden)

Abbasali Ebrahimian

2014-01-01

Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

Science.gov (United States)

Tran, Hong Thi; Nguyen, Hoa Phuong; Walker, Sue M; Hill, Peter S; Rao, Chalapati

2018-05-18

Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death

The Geometric-VaR Backtesting Method

DEFF Research Database (Denmark)

Wei, Wei; Pelletier, Denis

2014-01-01

This paper develops a new test to evaluate Value af Risk (VaR) forecasts. VaR is a standard risk measure widely utilized by financial institutions and regulators, yet estimating VaR is a challenging problem, and popular VaR forecast relies on unrealistic assumptions. Hence, assessing...

Regulatory control and challenges in Medical facilities using ionising radiation sources

International Nuclear Information System (INIS)

Agarwal, S.P.

2008-01-01

Medical facilities utilising ionising radiation sources for diagnostic and treatment of cancer are regulated under the provisions of Atomic Energy (Radiation Protection) Rules, 2004 promulgated under the Atomic Energy Act 1962. The Competent Authority for the enforcement of the rules is Chairman, Atomic Energy Regulatory Board (AERB). Practice specific codes are issued by AERB for medical facilities such as Radiotherapy, Nuclear Medicine and Radiology. Regulatory process for control of medical facilities covers the entire life cycle of the radiation sources in three stages viz pre-Iicensing, during useful life and decommissioning and disposal. Pre-Iicensing requirements include use of type approved sources and equipment, approval of design layout of the facility and installation, exclusive (safe and secure) source storage facility when the equipment is not in use, radiation (area/individual) monitoring devices, qualified, trained and certified manpower, emergency response plans and commitment from the licensee for the safe disposal of disused/decayed sources. Compliance to these requirements makes the applicant eligible to obtain license from AERB for the operation of the medical facility. During the use of radiation sources, specific prior approval of the Competent Authority is required in respect of every source replacement, sale, transfer, transport, import and export. Further, all licensees are required to send the periodic safety Status reports to AERB as well as reporting of any off normal events. AERB conducts inspection of the facilities to ensure compliance with the safety requirements during operation of the facility. Violation of safety norms by licensee attracts enforcement action which includes suspension, modification or withdrawal of licensee for operation of the facility. Upon completion of the useful life of the source, the licensee decommissions the facility and returns the source to the original supplier. For returning the source, prior

VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities

Science.gov (United States)

2012-09-01

approximately 150 hospitals, 130 nursing homes, 800 community-based outpatient clinics, as well as other facilities to provide care to veterans. VA also...receive care and have to return for rescheduled appointments. Such missed appointments can lead to lost revenue for the military treatment facility

Nuclear security of Cuba’s medical facilities

International Nuclear Information System (INIS)

Dahlstrom, Danielle

2016-01-01

Cuba is a leading hub for medical research and cancer treatment in Latin America and the Caribbean. Physical protection is installed at radiotherapy facilities to detect entry of and delay access to an intruder. This minimizes the likelihood of unauthorized access and maximizes nuclear security.

76 FR 25409 - Privacy Act of 1974

Science.gov (United States)

2011-05-04

... performing this required function, VA must collect, collate and analyze full statistical data regarding... and timely assess the current health care usage by the patient population served by VA, to forecast future demand for VA medical care by individuals currently eligible for service by VA medical facilities...

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

Science.gov (United States)

Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

2017-10-01

Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

78 FR 59771 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2013-09-27

... Payment Request for the VA Funding Fee Payment System (VA FFPS); a Computer Generated Funding Fee Receipt.... Title: Create Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated... through the Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger...

75 FR 61252 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-10-04

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

Science.gov (United States)

2010-10-06

... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... Payment Request for the VA Funding Fee Payment System (VA FFPS); A Computer Generated Funding Fee Receipt... information through the Federal Docket Management System (FDMS) at http://www.Regulations.gov or to Nancy J...

Medical team training: applying crew resource management in the Veterans Health Administration.

Science.gov (United States)

Dunn, Edward J; Mills, Peter D; Neily, Julia; Crittenden, Michael D; Carmack, Amy L; Bagian, James P

2007-06-01

Communication failure, a leading source of adverse events in health care, was involved in approximately 75% of more than 7,000 root cause analysis reports to the Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS). The VA NCPS Medical Team Training (MTT) program, which is based on aviation principles of crew resource management (CRM), is intended to improve outcomes of patient care by enhancing communication between health care professionals. Unique features of MTT include a full-day interactive learning session (facilitated entirely by clinical peers in a health care context), administration of pre-and postintervention safety attitudes questionnaires, and follow-up semistructured interviews with reports of program activities and lessons learned. Examples of projects in these facilities include intensive care unit (ICU) teams' patient-centered multidisciplinary rounds, surgical teams' preoperative briefings and debriefings, an entire operating room (OR) unit's adoption of "Rules of Conduct" for expected staff behavior, and an ICU team's use of the model for daily administrative briefings. An MTT program based on applied CRM principles was successfully developed and implemented in 43 VA medical centers from September 2003 to May 2007.

Employment status, employment functioning, and barriers to employment among VA primary care patients.

Science.gov (United States)

Zivin, Kara; Yosef, Matheos; Levine, Debra S; Abraham, Kristen M; Miller, Erin M; Henry, Jennifer; Nelson, C Beau; Pfeiffer, Paul N; Sripada, Rebecca K; Harrod, Molly; Valenstein, Marcia

2016-03-15

Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. Single VA primary care clinic; cross-sectional study. Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes. Published by Elsevier B.V.

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Science.gov (United States)

2010-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

Development of a Medical Cyclotron Production Facility

Science.gov (United States)

Allen, Danny R.

2003-08-01

Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply. We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes.

Development of a Medical Cyclotron Production Facility

International Nuclear Information System (INIS)

Allen, Danny R.

2003-01-01

Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply. We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes

Patients, privacy and trust: patients' willingness to allow researchers to access their medical records.

Science.gov (United States)

Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A

2007-01-01

The federal Privacy Rule, implemented in the United States in 2003, as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), created new restrictions on the release of medical information for research. Many believe that its restrictions have fallen disproportionately on researchers prompting some to call for changes to the Rule. Here we ask what patients think about researchers' access to medical records, and what influences these opinions. A sample of 217 patients from 4 Veteran Affairs (VA) facilities deliberated in small groups at each location with the opportunity to question experts and inform themselves about privacy issues related to medical records research. After extensive deliberation, these patients were united in their inclination to share their medical records for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medical records are used for research. We integrated qualitative and quantitative results to derive a better understanding of this apparent paradox. Our findings can best be presented as answers to questions related to five dimensions of trust: Patients' trust in VA researchers was the most powerful determinant of the kind of control they want over their medical records. More specifically, those who had lower trust in VA researchers were more likely to recommend a more stringent process for obtaining individual consent. Insights on the critical role of trust suggest actions that researchers and others can take to more fully engage patients in research.

Feasibility and acceptability of interventions to delay gun access in VA mental health settings.

Science.gov (United States)

Walters, Heather; Kulkarni, Madhur; Forman, Jane; Roeder, Kathryn; Travis, Jamie; Valenstein, Marcia

2012-01-01

The majority of VA patient suicides are completed with firearms. Interventions that delay patients' gun access during high-risk periods may reduce suicide, but may not be acceptable to VA stakeholders or may be challenging to implement. Using qualitative methods, stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods were explored. Ten focus groups and four individual interviews were conducted with key stakeholders, including VA mental health patients, mental health clinicians, family members and VA facility leaders (N=60). Transcripts were consensus-coded by two independent coders, and structured summaries were developed and reviewed using a consensus process. All stakeholder groups indicated that VA health system providers had a role in increasing patient safety and emphasized the need for providers to address gun access with their at-risk patients. However, VA mental health patients and clinicians reported limited discussion regarding gun access in VA mental health settings during routine care. Most, although not all, patients and clinicians indicated that routine screening for gun access was acceptable, with several noting that it was more acceptable for mental health patients. Most participants suggested that family and friends be involved in reducing gun access, but expressed concerns about potential family member safety. Participants generally found distribution of trigger locks acceptable, but were skeptical about its effectiveness. Involving Veteran Service Organizations or other individuals in temporarily holding guns during high-risk periods was acceptable to many participants but only with numerous caveats. Patients, clinicians and family members consider the VA health system to have a legitimate role in addressing gun safety. Several measures to delay gun access during high-risk periods for suicide were seen as acceptable and feasible if implemented thoughtfully. Published by Elsevier Inc.

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

Science.gov (United States)

Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

2009-01-01

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

75 FR 62348 - Reimbursement Offsets for Medical Care or Services

Science.gov (United States)

2010-10-08

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

Making housing first happen: organizational leadership in VA's expansion of permanent supportive housing.

Science.gov (United States)

Kertesz, Stefan G; Austin, Erika Laine; Holmes, Sally K; Pollio, David E; Schumacher, Joseph E; White, Bert; Lukas, Carol VanDeusen

2014-12-01

While most organizational literature has focused on initiatives that transpire inside the hospital walls, the redesign of American health care increasingly asks that health care institutions address matters outside their walls, targeting the health of populations. The US Department of Veterans Affairs (VA)'s national effort to end Veteran homelessness represents an externally focused organizational endeavor. Our aim was to evaluate the role of organizational practices in the implementation of Housing First (HF), an evidence-based homeless intervention for chronically homeless individuals. This was an interview-based comparative case study conducted across eight VA Medical Centers (VAMCs). Front line staff, mid-level managers, and senior leaders at VA Medical Centers were interviewed between February and December 2012. Using a structured narrative and numeric scoring, we assessed the correlation between successful HF implementation and organizational practices devised according to the organizational transformation model (OTM). Scoring results suggested a strong association between HF implementation and OTM practice. Strong impetus to house Veterans came from national leadership, reinforced by Medical Center directors closely tracking results. More effective Medical Center leaders differentiated themselves by joining front-line staff in the work (at public events and in process improvement exercises), by elevating homeless-knowledgeable persons into senior leadership, and by exerting themselves to resolve logistic challenges. Vertical alignment and horizontal integration advanced at sites that fostered work groups cutting across service lines and hierarchical levels. By contrast, weak alignment from top to bottom typically also hindered cooperation across departments. Staff commitment to ending homelessness was high, though sustainability planning was limited in this baseline year of observation. Key organizational practices correlated with more successful

Non-VA Hospital System (NVH)

Data.gov (United States)

Department of Veterans Affairs — The Veterans Health Administration (VHA) pays for care provided to VA beneficiaries in non-VA hospitals through its contract hospitalization program as mandated by...

42 CFR 431.105 - Consultation to medical facilities.

Science.gov (United States)

2010-10-01

... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... 42 Public Health 4 2010-10-01 2010-10-01 false Consultation to medical facilities. 431.105 Section 431.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

Proposed medical applications of the National Accelerator Centre facilities

International Nuclear Information System (INIS)

Jones, D.T.L.

1982-01-01

The National Accelerator Centre is at present under construction at Faure, near Cape Town. The complex will house a 200 MeV separated-sector cyclotron which will provide high quality beams for nuclear physics and related diciplines as well as high intensity beams for medical use. The medical aspects catered for will include particle radiotherapy, isotope production and possibly proton radiography. A 30-bed hospital is to be constructed on the site. Building operations are well advanced and the medical facilities should be available for use by the end of 1984

A national medical cyclotron facility: report to the Minister of Health by the Medical Cyclotron Committee

International Nuclear Information System (INIS)

1985-01-01

Research and training in nuclear medicine in Australia are both limited by the lack of a medical cyclotron facility. The Committee recommends the establishment of a national medical cyclotron to provide a supply of short-lived radioisotopes for research in relevant fields of medicine, and for diagnostic use in nuclear medicine

VA office of inspector general releases scathing report of Phoenix VA

Directory of Open Access Journals (Sweden)

Robbins RA

2014-08-01

Full Text Available No abstract available. Article truncated at 150 words. The long-awaited Office of Inspector General’s (OIG report on the Phoenix VA Health Care System (PVAHCS was released on August 27, 2014 (1. The report was scathing in its evaluation of VA practices and leadership. Five questions were investigated: 1.Were there clinically significant delays in care? 2. Did PVAHCS omit the names of veterans waiting for care from its Electronic Wait List (EWL? 3. Were PVAHCS personnel not following established scheduling procedures? 4. Did the PVAHCS culture emphasize goals at the expense of patient care? 5. Are scheduling deficiencies systemic throughout the VA? In each case, the OIG found that the allegations were true. Despite initial denials, the OIG report showed that former PVAHCS director Sharon Helman, associate director Lance Robinson, hospital administration director Brad Curry, chief of staff Darren Deering and other senior executives were aware of delays in care and unofficial wait lists. Perhaps most disturbing is ...

Questionnaire survey and technical guideline of blood irradiation on medical facilities

International Nuclear Information System (INIS)

Matsumoto, Mitsuhiro; Hasegawa, Hironori; Okumura, Masahiko; Sonoda, Tatsuo; Osada, Koji.

1997-01-01

We know that transfusion-associated graft versus host disease (TA-GVHD) is a serious side effect associated with blood transfusion and the onset is independent on the immunological conditions of patients. We have only prophylactic treatment against TA-GVHD. The most reliable method is to irradiate the blood for transfusion. In Japanese medical facilities, however, the risk of TA-GVHD is poorly understood and actual conditions of the blood irradiation are unclear. We sent a questionnaire to randomly selected 426 medical facilities in Japan, which had the department of radiology, to investigate the actual conditions of blood irradiation for transfusion and the problems on the irradiation dose measurement of the external apparatus for blood irradiation. The questionnaire involved 19 questions about the blood irradiation for transfusion. The survey took place for one month (June 1-June 30, 1995). Replies were obtained from a total of 306 medical facilities (72%). The results showed that blood irradiation was done by several methods in the 75% of the medical facilities, and the external irradiation apparatus was used in 83%. Some problems were shown, including irradiation period, cost of the irradiation, the operating procedure of the apparatus, requested number of the irradiation, and the request after usual hours. There was no significant problem on the irradiation dose, irradiation method, etc. We also sent a questionnaire to 74 facilities of the Red Cross Blood Center, in which the frequency of blood irradiation have increased since May, 1976. The X-ray apparatus as the external irradiation apparatus has practical advantages; lower cost, compact and out of the legal control on the ionizing radiation, however, it has some problems on the uniformity of the absorption dose when a single X-ray tube-type apparatus is used. We discuss about the possible onset of TA-GVHD or other accidents by the incorrect irradiation of the blood preparations. (K.H.)

Medical and radiological aspects of emergency preparedness and response at SevRAO facilities.

Science.gov (United States)

Savkin, M N; Sneve, M K; Grachev, M I; Frolov, G P; Shinkarev, S M; Jaworska, A

2008-12-01

Regulatory cooperation between the Norwegian Radiation Protection Authority and the Federal Medical Biological Agency (FMBA) of the Russian Federation has the overall goal of promoting improvements in radiation protection in Northwest Russia. One of the projects in this programme has the objectives to review and improve the existing medical emergency preparedness capabilities at the sites for temporary storage of spent nuclear fuel and radioactive waste. These are operated by SevRAO at Andreeva Bay and in Gremikha village on the Kola Peninsula. The work is also intended to provide a better basis for regulation of emergency response and medical emergency preparedness at similar facilities elsewhere in Russia. The purpose of this paper is to present the main results of that project, implemented by the Burnasyan Federal Medical Biophysical Centre. The first task was an analysis of the regulatory requirements and the current state of preparedness for medical emergency response at the SevRAO facilities. Although Russian regulatory documents are mostly consistent with international recommendations, some distinctions lead to numerical differences in operational intervention criteria under otherwise similar conditions. Radiological threats relating to possible accidents, and related gaps in the regulation of SevRAO facilities, were also identified. As part of the project, a special exercise on emergency medical response on-site at Andreeva Bay was prepared and carried out, and recommendations were proposed after the exercise. Following fruitful dialogue among regulators, designers and operators, special regulatory guidance has been issued by FMBA to account for the specific and unusual features of the SevRAO facilities. Detailed sections relate to the prevention of accidents, and emergency preparedness and response, supplementing the basic Russian regulatory requirements. Overall it is concluded that (a) the provision of medical and sanitary components of emergency

VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes.

Science.gov (United States)

Nazi, Kim M; Turvey, Carolyn L; Klein, Dawn M; Hogan, Timothy P; Woods, Susan S

2015-03-01

To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. A web-based survey of VA patient portal users from June 22 to September 15, 2013. 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

KENO V.a Primer: A Primer for Criticality Calculations with SCALE/KENO V.a Using CSPAN for Input

International Nuclear Information System (INIS)

Busch, R.D.

2003-01-01

The SCALE (Standardized Computer Analyses for Licensing Evaluation) computer software system developed at Oak Ridge National Laboratory (ORNL) is widely used and accepted around the world for criticality safety analyses. The well-known KENO V.a three-dimensional Monte Carlo criticality computer code is the primary criticality safety analysis tool in SCALE. The KENO V.a primer is designed to help a new user understand and use the SCALE/KENO V.a Monte Carlo code for nuclear criticality safety analyses. It assumes that the user has a college education in a technical field. There is no assumption of familiarity with Monte Carlo codes in general or with SCALE/KENO V.a in particular. The primer is designed to teach by example, with each example illustrating two or three features of SCALE/KENO V.a that are useful in criticality analyses. The primer is based on SCALE 4.4a, which includes the Criticality Safety Processor for Analysis (CSPAN) input processor for Windows personal computers (PCs). A second edition of the primer, which uses the new KENO Visual Editor, is currently under development at ORNL and is planned for publication in late 2003. Each example in this first edition of the primer uses CSPAN to provide the framework for data input. Starting with a Quickstart section, the primer gives an overview of the basic requirements for SCALE/KENO V.a input and allows the user to quickly run a simple criticality problem with SCALE/KENO V.a. The sections that follow Quickstart include a list of basic objectives at the beginning that identifies the goal of the section and the individual SCALE/KENO V.a features which are covered in detail in the example problems in that section. Upon completion of the primer, a new user should be comfortable using CSPAN to set up criticality problems in SCALE/KENO V.a

[Marketing in the system of military-medical facilities].

Science.gov (United States)

Kostiuchenko, O M; Sviridova, T B

2014-02-01

Military medical facilities of the Ministry of Defence of the Russian, have received the right to provide additional services and have been involved in the sphere of market relations. The strong influence of market relations - an objective reality that must be used for the development of military medical institutions and improving quality of care.Effective commercial activity can improve capabilities of the military medical institutions. This requires constant study of market mechanisms to implement and develop their competitive advantage. The paper substantiates the need for the participation of military medical institutions in the provision of health services to the public on the terms of compensation incurred by financial institutions costs (paid medical services, medical assistance program of compulsory and voluntary health insurance). Taking into account the specifics of military medical institutions set out basic principles and recommendations have been implementing marketing approach in their management, the practical application of which will not only increase efficiency, but also create conditions to improve the financial and economic indicators. This knowledge will help the mechanism of functioning health care market and the rules of interaction of market counterparties.

Electroencephalogram (EEG spectral features discriminate between Alzheimer’s (AD and Vascular dementia (VaD

Directory of Open Access Journals (Sweden)

Emanuel eNeto

2015-02-01

Full Text Available Alzheimer’s disease (AD and vascular dementia (VaD present with similar clinical symptoms of cognitive decline, but the underlying pathophysiological mechanisms differ. To determine whether clinical electroencephalography (EEG can provide information relevant to discriminate between these diagnoses, we used quantitative EEG analysis to compare the spectra between non-medicated patients with AD (n=77 and VaD (n=77 and healthy elderly normal controls (NC (n=77. We use curve-fitting with a combination of a power loss and Gaussian function to model the averaged resting-state spectra of each EEG channel extracting six parameters. We assessed the performance of our model and tested the extracted parameters for group differentiation. We performed regression analysis in a MANCOVA with group, age, gender, and number of epochs as predictors and further explored the topographical group differences with pair-wise contrasts. Significant topographical differences between the groups were found in several of the extracted features. Both AD and VaD groups showed increased delta power when compared to NC, whereas the AD patients showed a decrease in alpha power for occipital and temporal regions when compared with NC. The VaD patients had higher alpha power than NC and AD. The AD and VaD groups showed slowing of the alpha rhythm. Variability of the alpha frequency was wider for both AD and VaD groups. There was a general decrease in beta power for both AD and VaD. The proposed model is a useful to parameterize spectra which allowed extracting relevant clinical EEG key features that move towards simple and interpretable diagnostic criteria.

Production of medical radioactive isotopes using KIPT electron driven subcritical facility

International Nuclear Information System (INIS)

Talamo, Alberto; Gohar, Yousry

2008-01-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, γ), (n, 2n), (n, p), and (γ, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope

Production of medical radioactive isotopes using KIPT electron driven subcritical facility

Energy Technology Data Exchange (ETDEWEB)

Talamo, Alberto [Nuclear Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60439 (United States)], E-mail: alby@anl.gov; Gohar, Yousry [Nuclear Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60439 (United States)

2008-05-15

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, {gamma}), (n, 2n), (n, p), and ({gamma}, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope.

Production of medical radioactive isotopes using KIPT electron driven subcritical facility.

Science.gov (United States)

Talamo, Alberto; Gohar, Yousry

2008-05-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, gamma), (n, 2n), (n, p), and (gamma, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope.

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...

76 FR 30598 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

Science.gov (United States)

2011-05-26

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN86 Payment or Reimbursement for Emergency...) ``Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities... Reimbursement Act. Some of the revisions in this proposed rule are purely technical, matching the language of...

Smoke-Free Medical Facility Campus Legislation: Support, Resistance, Difficulties and Cost

Directory of Open Access Journals (Sweden)

J. Gary Wheeler

2009-01-01

Full Text Available Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113 were surveyed pre- and post-implementation. Administrators reported more support and less difficulty than anticipated. Actual cost was 10-50% of anticipated cost. Few negative effects and numerous positive effects on employee performance and retention were reported. The results may be of interest to hospital administrators and demonstrate that state legislation can play a positive role in facilitating broad health-related policy change.

Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

Directory of Open Access Journals (Sweden)

Yamada Yukari

2006-01-01

Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

Importance of Pharmaceutical Training and Clinical Research at Medical Facilities.

Science.gov (United States)

Myotoku, Michiaki

2017-01-01

To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

Erectile Dysfunction Medication Use in Veterans Eligible for Medicare Part D.

Science.gov (United States)

Spencer, Samantha H; Suda, Katie J; Smith, Bridget M; Huo, Zhiping; Bailey, Lauren; Stroupe, Kevin T

2016-07-01

Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008. To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits. Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate. From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels. Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications. The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and

Strategies from a nationwide health information technology implementation: the VA CART story.

Science.gov (United States)

Box, Tamára L; McDonell, Mary; Helfrich, Christian D; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S

2010-01-01

The VA Cardiovascular Assessment, Reporting, and Tracking (CART) system is a customized electronic medical record system which provides standardized report generation for cardiac catheterization procedures, serves as a national data repository, and is the centerpiece of a national quality improvement program. Like many health information technology projects, CART implementation did not proceed without some barriers and resistance. We describe the nationwide implementation of CART at the 77 VA hospitals which perform cardiac catheterizations in three phases: (1) strategic collaborations; (2) installation; and (3) adoption. Throughout implementation, success required a careful balance of technical, clinical, and organizational factors. We offer strategies developed through CART implementation which are broadly applicable to technology projects aimed at improving the quality, reliability, and efficiency of health care.

Emergency situation in a medical cyclotron facility

International Nuclear Information System (INIS)

Kumar, Rajeev; Bhat, M.K.; Singh, D.K.; Pthania, B.S.; Pandit, A.G.; Jacob, M.J.

2010-01-01

Full text: Medical cyclotron is a particle accelerator used in producing short lived radioisotopes such as 18 F, 11 C, 15 O, 13 N, 18 F-2 gas etc. Positron Emission Tomography (PET) is a nuclear imaging modality that has rapidly gained favour. 18 F-FDG is the most widely used radiopharmaceutical with a half-life of 109.8 min. Having more than five years experience in this field we face lots of emergency conditions in the medical cyclotron facility. On the basis of harm we have divided in to three categories i.e. Harm of (a) working personnel, (b) Equipment and (c) environment. Radioactive gas leak and Target foil rupture is considered as the major emergency situations during medical cyclotron operations because there is a potential of over exposure to the working personnel. Radiation protection survey of a self-shielded medical cyclotron installation was carried out during normal and emergency conditions. It is found that the induced activity in the target foil increases with its successive usages. Recommendations have also been made to reduce personal exposure while handling the radioactive gas leak and target foil rupture conditions

Visual Dysfunction and Associated Co-morbidities as Predictors of Mild Traumatic Brain Injury Seen Among Veterans in Non-VA Facilities: Implications for Clinical Practice.

Science.gov (United States)

Urosevich, Thomas G; Boscarino, Joseph J; Hoffman, Stuart N; Kirchner, H Lester; Figley, Charles R; Adams, Richard E; Withey, Carrie A; Boscarino, Joseph A

2018-05-24

Traumatic brain injury (TBI) and post-traumatic stress disorder are considered the signature injuries of the Iraq and Afghanistan conflicts. With the extensive use of improvised explosive devices by the enemy, the concussive effects from blast have a greater potential to cause mild TBI (mTBI) in military Service Members. These mTBI can be associated with other physical and psychological health problems, including mTBI-induced visual processing and eye movement dysfunctions. Our study assessed if any visual dysfunctions existed in those surveyed in non-Veterans Administration (VA) facilities who had suffered mTBI (concussive effect), in addition to the presence of concussion-related co-morbidities. As part of a larger study involving veterans from different service eras, we surveyed 235 Veterans who had served during the Iraq and/or Afghanistan conflict era. Data for the study were collected using diagnostic telephone interviews of these veterans who were outpatients of the Geisinger Health System. We assess visual dysfunction in this sample and compare visual dysfunctions of those who had suffered a mTBI (concussive effect), as well as co-morbidities, with those in the cohort who had not suffered concussion effects. Of those veterans who experienced visual dysfunctions, our results reflected that the visual symptoms were significant for concussion with the subjects surveyed, even though all had experienced a mTBI event greater than five years ago. Although we did find an association with concussion and visual symptoms, the association for concussion was strongest with the finding of greater than or equal to three current TBI symptoms, therefore we found this to be the best predictor of previous concussion among the veterans. Veterans from the Iraq/Afghanistan era who had suffered concussive blast effects (mTBI) can present with covert visual dysfunction as well as additional physical and psychological health problems. The primary eye care providers, especially

Radioactive isotope production for medical applications using Kharkov electron driven subcritical assembly facility

International Nuclear Information System (INIS)

Talamo, A.; Gohar, Y.

2007-01-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine has a plan to construct an accelerator driven subcritical assembly. The main functions of the subcritical assembly are the medical isotope production, neutron thereby, and the support of the Ukraine nuclear industry. Reactor physics experiments and material research will be carried out using the capabilities of this facility. The United States of America and Ukraine have started collaboration activity for developing a conceptual design for this facility with low enrichment uranium (LEU) fuel. Different conceptual designs are being developed based on the facility mission and the engineering requirements including nuclear physics, neutronics, heat transfer, thermal hydraulics, structure, and material issues. Different fuel designs with LEU and reflector materials are considered in the design process. Safety, reliability, and environmental considerations are included in the facility conceptual design. The facility is configured to accommodate future design improvements and upgrades. This report is a part of the Argonne National Laboratory Activity within this collaboration for developing and characterizing the subcritical assembly conceptual design. In this study, the medical isotope production function of the Kharkov facility is defined. First, a review was carried out to identify the medical isotopes and its medical use. Then a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Finally, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and irradiation location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes were considered and all transmutation channels are used including (n,γ), (n,2n), (n,p), and (γ,n). In the second part, the parent

Radioactive isotope production for medical applications using Kharkov electron driven subcritical assembly facility.

Energy Technology Data Exchange (ETDEWEB)

Talamo, A.; Gohar, Y.; Nuclear Engineering Division

2007-05-15

Kharkov Institute of Physics and Technology (KIPT) of Ukraine has a plan to construct an accelerator driven subcritical assembly. The main functions of the subcritical assembly are the medical isotope production, neutron thereby, and the support of the Ukraine nuclear industry. Reactor physics experiments and material research will be carried out using the capabilities of this facility. The United States of America and Ukraine have started collaboration activity for developing a conceptual design for this facility with low enrichment uranium (LEU) fuel. Different conceptual designs are being developed based on the facility mission and the engineering requirements including nuclear physics, neutronics, heat transfer, thermal hydraulics, structure, and material issues. Different fuel designs with LEU and reflector materials are considered in the design process. Safety, reliability, and environmental considerations are included in the facility conceptual design. The facility is configured to accommodate future design improvements and upgrades. This report is a part of the Argonne National Laboratory Activity within this collaboration for developing and characterizing the subcritical assembly conceptual design. In this study, the medical isotope production function of the Kharkov facility is defined. First, a review was carried out to identify the medical isotopes and its medical use. Then a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Finally, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and irradiation location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes were considered and all transmutation channels are used including (n,{gamma}), (n,2n), (n,p), and ({gamma},n). In the second part

New irradiation facilities at the Australian national medical cyclotron

International Nuclear Information System (INIS)

Parcell, S.K.; Arnott, D.W.; Conard, E.M.

1999-01-01

Two new irradiation facilities have been developed at the National Medical Cyclotron for radionuclide production. The first relocates PET irradiations from the cyclotron vault to a dedicated PET beam room, to improve accessibility and reduce radiation exposures associated with target maintenance. This new facility consists of a beam line to transport 16-30 MeV proton beams from the cyclotron to 1 of 8 PET targets mounted on a target rack. The target rack has increased the number of targets available for production and experimentation. The second is a completely independent solid target irradiation facility for SPECT. This facility consists of a beam line to transport 26-30 MeV proton beams from the cyclotron to a dedicated beam room containing one solid target station. A new pneumatic target transfer system was also developed to transport the solid target to and from the existing chemistry hot cells. The beam line and target components are operated under the control of a dedicated PLC with a PC based user interface. The development and some technical aspects of these new irradiation facilities are discussed here. (author)

VaR Methodology Application for Banking Currency Portfolios

Directory of Open Access Journals (Sweden)

Daniel Armeanu

2007-02-01

Full Text Available VaR has become the standard measure that financial analysts use to quantify market risk. VaR measures can have many applications, such as in risk management, to evaluate the performance of risk takers and for regulatory requirements, and hence it is very important to develop methodologies that provide accurate estimates. In particular, the Basel Committee on Banking Supervision at the Bank for International Settlements imposes to financial institutions such as banks and investment firms to meet capital requirements based on VaR estimates. In this paper we determine VaR for a banking currency portfolio and respect rules of National Bank of Romania regarding VaR report.

77 FR 70893 - Authorization for Non-VA Medical Services

Science.gov (United States)

2012-11-28

... care, nursing home care, domiciliary care, or medical services and who requires medical services to... care, nursing home care, domiciliary care, or medical services, and requires medical services to... may contract for certain hospital care (inpatient care) and medical services (outpatient care) for...

Decommissioning of small medical, industrial and research facilities

International Nuclear Information System (INIS)

2003-01-01

Most of the technical literature on decommissioning addresses the regulatory, organizational, technical and other aspects for large facilities such as nuclear power plants, reprocessing plants and relatively large prototype, research and test reactors. There are, however, a much larger number of licensed users of radioactive material in the fields of medicine, research and industry. Most of these nuclear facilities are smaller in size and complexity and may present a lower radiological risk during their decommissioning. Such facilities are located at research establishments, biological and medical laboratories, universities, medical centres, and industrial and manufacturing premises. They are often operated by users who have not been trained or are unfamiliar with the decommissioning, waste management and associated safety aspects of these types of facility at the end of their operating lives. Also, for many small users of radioactive material such as radiation sources, nuclear applications are a small part of the overall business or process and, although the operating safety requirements may be adhered to, concern or responsibility may not go much beyond this. There is concern that even the minimum requirements of decommissioning may be disregarded, resulting in avoidable delays, risks and safety implications (e.g. a loss of radioactive material and a loss of all records). Incidents have occurred in which persons have been injured or put at risk. It is recognized that the strategies and specific requirements for small facilities may be much less onerous than for large ones such as nuclear power plants or fuel processing facilities, but many of the same principles apply. There has been considerable attention given to nuclear facilities and many IAEA publications are complementary to this report. This report, however, attempts to give specific guidance for small facilities. 'Small' in this report does not necessarily mean small in size but generally modest in terms

VaST: A variability search toolkit

Science.gov (United States)

Sokolovsky, K. V.; Lebedev, A. A.

2018-01-01

Variability Search Toolkit (VaST) is a software package designed to find variable objects in a series of sky images. It can be run from a script or interactively using its graphical interface. VaST relies on source list matching as opposed to image subtraction. SExtractor is used to generate source lists and perform aperture or PSF-fitting photometry (with PSFEx). Variability indices that characterize scatter and smoothness of a lightcurve are computed for all objects. Candidate variables are identified as objects having high variability index values compared to other objects of similar brightness. The two distinguishing features of VaST are its ability to perform accurate aperture photometry of images obtained with non-linear detectors and handle complex image distortions. The software has been successfully applied to images obtained with telescopes ranging from 0.08 to 2.5 m in diameter equipped with a variety of detectors including CCD, CMOS, MIC and photographic plates. About 1800 variable stars have been discovered with VaST. It is used as a transient detection engine in the New Milky Way (NMW) nova patrol. The code is written in C and can be easily compiled on the majority of UNIX-like systems. VaST is free software available at http://scan.sai.msu.ru/vast/.

Facility to disinfect medical wastes by 10 MeV electron beam

International Nuclear Information System (INIS)

Kerluke, D.R.

1998-01-01

As regulations related to the disposal of infectious hospital and other medical waste are become increasingly stringent, hospitals and governments worldwide are looking to develop more effective and economical means to disinfect such waste materials prior to them being ultimately landfilled, incinerated or recycled. With the advent of reliable high-energy, high-power industrial electron accelerators, the prospect now exists to centralize collection of much of the infectious medical waste for major metropolitan areas at a single facility, and render it harmless using irradiation. Using much of the same or similar methodologies already developed for single-use medical device sterilization and for bioburden reduction in other goods, high energy electron beam treatment offers unique process advantages which become increasingly attractive with the economies of scale available at higher power. This paper will explore some of the key issues related to the safe disposition of infectious hospital and other medical waste, related irradiation research projects, and the design and economic factors related to an electron beam facility dedicated to this application. This will be presented in the context of the Rhodotron family of electron beam accelerators manufactured by Ion Beam Applications s.a. (author)

Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

Science.gov (United States)

Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

2016-06-01

Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care

Technology Reference Model (TRM) Reports: VA Category Mapping Report

Data.gov (United States)

Department of Veterans Affairs — The One VA Enterprise Architecture (OneVA EA) is a comprehensive picture of the Department of Veterans Affairs' (VA) operations, capabilities and services and the...

Visionary leadership and the future of VA health system.

Science.gov (United States)

Bezold, C; Mayer, E; Dighe, A

1997-01-01

As the U.S. Department of Veterans Affairs (VA) makes the change over to Veterans Integrated Service Network (VISNs) the need for new and better leadership is warranted if VA wants to not only survive, but thrive in the emerging twenty-first century healthcare system. VA can prepare for the future and meet the challenges facing them by adopting a system of visionary leadership. The use of scenarios and vision techniques are explained as they relate to VA's efforts to move toward their new system of VISNs. The four scenarios provide snapshots of possible futures for the U.S. healthcare system as well as the possible future role and mission of VA--from VA disappearing to its becoming a premier virtual organization.

Safety measures to address the year 2000 issue at medical facilities which use radiation generators and radioactive materials

International Nuclear Information System (INIS)

1999-03-01

In resolution GC(42)/RES/11 on 'Measures to Address the Year 2000 (Y2K) Issue', adopted on 25 September 1998, the General Conference of the International Atomic Energy Agency (IAEA) - inter alia - urged Member States 'to share information with the Secretariat regarding diagnostic and corrective actions being planned or implemented by operating and regulatory organizations at their ... medical facilities which use radioactive materials to make those facilities Year 2000 ready', encouraged the Secretariat 'within existing resources to act as a clearing-house and central point of contact for Member States to exchange information regarding diagnostic and remediation actions being taken at ... medical facilities which use radioactive materials to make these facilities Year 2000 ready', urged the Secretariat 'to handle the information provided by Member States carefully' and requested the Director General to report to it at its next (1999) regular session on the implementation of that resolution. The IAEA Secretariat convened a group of consultants who met in Vienna from 14 to 18 December 1998 and produced this report. The consultants decided that the report should cover not just 'medical facilities which use radioactive materials' but also medical facilities which, while perhaps not using radioactive materials, use ionizing radiation produced by radiation generators such as accelerators. The reports issued together are: Achieving Year 2000 Readiness: Basic Processes; Safety Measures to Address the Year 2000 Issue at Medical Facilities Which Use Radiation Generators and Radioactive Materials; and Safety Measures to Address the Year 2000 Issue at Radioactive Waste Management Facilities. This report addresses means of dealing with the Y2K problem at medical facilities which use radiation generators and radioactive materials

ESTIMASI NILAI VaR PORTOFOLIO MENGGUNAKAN FUNGSI ARCHIMEDEAN COPULA

Directory of Open Access Journals (Sweden)

AULIA ATIKA PRAWIBTA SUHARTO

2017-01-01

Full Text Available Value at Risk explains the magnitude of the worst losses occurred in financial products investments with a certain level of confidence and time interval. The purpose of this study is to estimate the VaR of portfolio using Archimedean Copula family. The methods for calculating the VaR are as follows: (1 calculating the stock return; (2 calculating descriptive statistics of return; (3 checking for the nature of autocorrelation and heteroscedasticity effects on stock return data; (4 checking for the presence of extreme value by using Pareto tail; (5 estimating the parameters of Achimedean Copula family; (6 conducting simulations of Archimedean Copula; (7 estimating the value of the stock portfolio VaR. This study uses the closing price of TLKM and GGRM. At 90% the VaR obtained using Clayton, Gumbel, Frank copulas are 0.9562%, 1.0189%, 0.9827% respectively. At 95% the VaR obtained using Clayton, Gumbel, Frank copulas are 1.2930%, 1.2522%, 1.3152% respectively. At 99% the VaR obtained using Clayton, Gumbel, Frank copulas are 2.0327%, 1.9164%, is 1.8678% respectively. In conclusion estimation of VaR using Clayton copula yields the highest VaR.

Revenue Based Budgeting at VA Northern California Health Care System: A Model for Financially Aligning Organizational Incentives and Operations

National Research Council Canada - National Science Library

Stockwell, David

1999-01-01

.... Changes in sharing agreement regulations, TRICARE, and Medical Care Cost Recovery (MCCR) also provided each network with the ability to generate revenue from sources outside the traditional VA appropriation...

Facilities and medical care for on-site nuclear power plant radiological emergencies

International Nuclear Information System (INIS)

Anon.

1979-01-01

The operation of a nuclear power plant introduces risks of injury or accidents that could also result in the exposure of personnel to radiation or radioactive materials. It is important in such an event to have adequate first aid and medical facilities, supplies, equipment, transportation capabilities and trained personnel available to provide necessary care. This standard provides guidance for first aid during an emergency and for initial medical care of those overexposed to penetrating radiation or contaminated with radioactive material or radionuclides. Recommendations cover facilities, supplies, equipment and the extent of care on-site, where first aid and initial care may be provided, and off-site at a local hospital, where further medical and surgical care may be provided. Additional recommendations are also provided for the transportation of patients and the training of personnel. A brief discussion of specialized care is provided in an appendix

Large-scale User Facility Imaging and Scattering Techniques to Facilitate Basic Medical Research

International Nuclear Information System (INIS)

Miller, Stephen D.; Bilheux, Jean-Christophe; Gleason, Shaun Scott; Nichols, Trent L.; Bingham, Philip R.; Green, Mark L.

2011-01-01

Conceptually, modern medical imaging can be traced back to the late 1960's and into the early 1970's with the advent of computed tomography . This pioneering work was done by 1979 Nobel Prize winners Godfrey Hounsfield and Allan McLeod Cormack which evolved into the first prototype Computed Tomography (CT) scanner in 1971 and became commercially available in 1972. Unique to the CT scanner was the ability to utilize X-ray projections taken at regular angular increments from which reconstructed three-dimensional (3D) images could be produced. It is interesting to note that the mathematics to realize tomographic images was developed in 1917 by the Austrian mathematician Johann Radon who produced the mathematical relationships to derive 3D images from projections - known today as the Radon Transform . The confluence of newly advancing technologies, particularly in the areas of detectors, X-ray tubes, and computers combined with the earlier derived mathematical concepts ushered in a new era in diagnostic medicine via medical imaging (Beckmann, 2006). Occurring separately but at a similar time as the development of the CT scanner were efforts at the national level within the United States to produce user facilities to support scientific discovery based upon experimentation. Basic Energy Sciences within the United States Department of Energy currently supports 9 major user facilities along with 5 nanoscale science research centers dedicated to measurement sciences and experimental techniques supporting a very broad range of scientific disciplines. Tracing back the active user facilities, the Stanford Synchrotron Radiation Lightsource (SSRL) a SLAC National Accelerator Laboratory was built in 1974 and it was realized that its intense x-ray beam could be used to study protein molecular structure. The National Synchrotron Light Source (NSLS) at Brookhaven National Laboratory was commissioned in 1982 and currently has 60 x-ray beamlines optimized for a number of different

[The development of the system of medical rehabilitation based at the Russian health resort facilities: investment prospects].

Science.gov (United States)

Povazhnaya, E L; Gusakova, E V; Moiseenko, S V

2018-05-21

The present work is devoted to the prospects for attracting investments for the maintenance and development of the medical rehabilitation practices based at the Russian health resort facilities. The article describes the prerequisites for the enhancement of the investment attractiveness of the development of the system of medical rehabilitation in the said institutions including the formulation and strengthening of the legal and regulatory framework, the capacity for the organization of the second and third stages of medical rehabilitation in the existing spa and health resort facilities, the attraction of the funds of compulsory medical insurance as an additional source of the financial support. The main legal documents regulating the organization and provision of medical rehabilitation based at the spa and health resort facilities are presented. The results of the implementation of the investment concept of the development of medical rehabilitation in the framework of the system of health resort treatment as exemplified by the experience of JSC «The group of companies «Medsi» are discussed. It is shown that the development of medical rehabilitation based at the spa and health resort facilities greatly contributes to the significant expansion of the potential customer base and promotes the further growth of business scale.

38 CFR 1.203 - Information to be reported to VA Police.

Science.gov (United States)

2010-07-01

... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component with...

38 CFR 21.294 - Selecting the training or rehabilitation facility.

Science.gov (United States)

2010-07-01

... AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under... the veteran's preference for a particular training or rehabilitation facility but VA has final...

Brand-Name Prescription Drug Use Among Diabetes Patients in the VA and Medicare Part D: A National Comparison

Science.gov (United States)

Gellad, Walid F.; Donohue, Julie M.; Zhao, Xinhua; Mor, Maria K.; Thorpe, Carolyn T.; Smith, Jeremy; Good, Chester B.; Fine, Michael J.; Morden, Nancy E.

2013-01-01

Background Medicare Part D and the Department of Veterans Affairs (VA) use different approaches to manage prescription drug benefits, with implications for spending. Medicare relies on private plans with distinct formularies, whereas VA administers its own benefit using a national formulary. Objective To compare overall and regional rates of brand-name drug use among older adults with diabetes in Medicare and VA. Design Retrospective cohort Setting Medicare and VA Patients National sample in 2008 of 1,061,095 Part D beneficiaries and 510,485 Veterans age 65+ with diabetes. Measurements Percent of patients on oral hypoglycemics, statins, and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers who filled brand-name drugs and percent of patients on long-acting insulin who filled analogues. We compared sociodemographic and health-status adjusted hospital referral region (HRR) brand-name use to examine local practice patterns, and calculated changes in spending if each system’s brand-name use mirrored the other. Results Brand-name use in Medicare was 2–3 times that of VA: 35.3% vs. 12.7% for oral hypoglycemics, 50.7% vs. 18.2% for statins, 42.5% vs. 20.8% for angiotensin-converting-enzyme inhibitors/angiotensin-receptor-blockers, and 75.1% vs. 27.0% for insulin analogues. Adjusted HRR brand-name statin use ranged (5th to 95th percentile) from 41.0%–58.3% in Medicare and 6.2%–38.2% in VA. For each drug group, the HRR at the 95th percentile in VA had lower brand-name use than the 5th percentile HRR in Medicare. Medicare spending in this population would have been $1.4 billion less if brand-name use matched the VA for these medications. Limitation This analysis cannot fully describe the factors underlying differences in brand-name use. Conclusions Medicare beneficiaries with diabetes use 2–3 times more brand-name drugs than a comparable group within VA, at substantial excess cost. Primary Funding Sources VA; NIH; RWJF PMID:23752663

SlaVaComp: Konvertierungstool (= SlaVaComp Fonts Converter

Directory of Open Access Journals (Sweden)

Simon Skilevic

2013-12-01

Full Text Available Der vorliegende Beitrag informiert über ein Tool, das im Rahmen eines Freiburger Projekts zur historischen Korpuslinguistik entwickelt wurde und dazu dient, kirchenslavische Texte, die ohne Einsatz von Unicode digitalisiert wurden, ohne Verlust von Information bzw. Formatierung ins Unicode-Format zu überführen. Das Tool heißt SlaVaComp-Konvertierer. Es eignet sich für die Konvertierung aller idiosynkratischen Fonts und kann somit nicht nur in der Paläoslavistik, sondern in allen historisch arbeitenden Philologien eingesetzt werden. ____________________ This paper presents a fonts converter that was developed as a part of the Freiburg project on historical corpus linguistics. The tool named SlaVaComp-Konvertierer converts Church Slavonic texts digitized with non-Unicode fonts into the Unicode format without any loss of information contained in the original file and without damage to the original formatting. It is suitable for the conversion of all idiosyncratic fonts—not only Church Slavonic—and therefore can be used not only in Palaeoslavistic, but also in all historical and philological studies.

Poststroke Rehabilitation and Restorative Care Utilization: A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes.

Science.gov (United States)

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Bates, Barbara E; Vogel, W Bruce; Bidelspach, Douglas E; Wang, Xinping; Hoffman, Nannette

2016-03-01

Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices. This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs. Retrospective observational. All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission. The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases. For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, Pcare, CLC Veterans had higher user rates (33.5% vs. 30.6%, Pcare days (9.4 vs. 5.9, Pcare (coefficient=5.48±0.37, Pcare both before and after risk adjustment.

Using Tools of Strategic Management in Medical Facilities of Lublin Region

Directory of Open Access Journals (Sweden)

Jaworzynska Magdalena

2017-06-01

Full Text Available The purpose of this article is to evaluate the use of tools of strategic management in hospitals in Lublin region. The study was conducted among 14 medical entities from the area of Lublin Voivodeship. The survey was addressed to economic directors or chief accountants of health care facilities and sent by post. The questionnaire was also helpful in conducting an in-depth interview as it provided a required structure. As part of the interviews with managers of health care facilities, information beyond the questionnaire was acquired, e.g. about the mission. According to studies, most health care facilities develop strategic plans (71.4%. For 21.4% of the studied facilities, the strategic plan is known mainly to management. In contrast, 28.6% of entities do not have a strategic plan. The presented results of the research can increase the effectiveness of activities in each area of the health care facility, continuous process improvement and rapid response to changes in the environment.

Helman defends decision to pull VA sponsorship of Veterans day parade

Directory of Open Access Journals (Sweden)

Robbins RA

2013-04-01

Full Text Available No abstract available. Article truncated after 150 words. Sharon Helman, Phoenix VA Director, defended her decision to cancel VA sponsorship of the annual Phoenix Veterans Day Parade in a 4/10/13 email to VA employees. Helman said that VA sponsorship was cancelled because of “…priorities in the organization (specifically access, and heightened awareness over liability concerns which VA Legal Counsel brought forward”. She concluded her letter by warning “… that all media inquiries should be forwarded to Paul Coupaud, Acting Public Affairs Officer”. VA officials initially said fear of litigation prompted the review of VA support. Last year, a float carrying wounded Veterans in a Midland, Texas, parade collided with a freight train, killing four and injuring 17. Crash victims and their families filed lawsuits in Texas against Union Pacific Railroad and the float owner. The VA was not a defendant, and the VA has not issued any national directives on liability as a result of the tragedy.In…

Radiation monitoring system in medical facilities

International Nuclear Information System (INIS)

Matsuno, Kiyoshi

1981-01-01

(1) RI selective liquid effluent monitor is, in many cases, used at medical facilities to obtain data for density of radioactivity of six radionuclides. In comparison with the conventional gross measuring systems, over-evaluation is less, and the monitor is more practical. (2) Preventive monitor for loss of radium needle is a system which prevents missing of radium needle at a flush-toilet in radium treatment wards, and this monitor is capable of sensing a drop-off of radium needle of 0.5 mCi (minimum). (3) Short-lived positron gas measuring device belongs to a BABY CYCLOTRON installed in a hospital, and this device is used to measure density of radioactivity, radioactive impurity and chemical impurity of produced radioactive gas. (author)

The SAPPHIRE and 50 MT projects at BWXT, Lynchburg, VA

International Nuclear Information System (INIS)

Thiele, R.; Horn, B.; Coates, C.W.; Stainback, J.R.

2001-01-01

Full text: When the SAPPHIRE project for the down-blending of HEU material of Khazak origin was initiated in 1996 at BWX Technologies (BWXT) formally Babcock and Wilcox in Lynchburg, VA and the Agency was requested to apply its specially designed safeguards measures to the process with a view to provide assurance to the international community that down-blending had actually taken place as stipulated in the USA-Khazak agreement a learning process was initiated from this effort culminating in the current 50 MT downblending process at the same facility with BWXT, the USA Authorities, and the Agency as partners in this technologically advanced enterprise aimed at the downgrading of a substantial quantity of weapons grade material. In the present paper an overview is provided of the road leading to an effective, and mutually agreeable safeguards approach for carrying out verifications in the sensitive environment of a facility devoted to HEU uranium processing. (author)

Comparison of topical fixed-combination fortified vancomycin-amikacin (VA solution) to conventional separate therapy in the treatment of bacterial corneal ulcer.

Science.gov (United States)

Chiang, C-C; Lin, J-M; Chen, W-L; Chiu, Y-T; Tsai, Y-Y

2009-02-01

In an in vitro study, fixed-combination fortified vancomycin and amikacin ophthalmic solutions (VA solution) had the same potency and stable physical properties as the separate components. In this retrospective clinical study, we evaluated the efficacy of the topical VA solution in the treatment of bacterial corneal ulcer and comparison with separate topical fortified vancomycin and amikacin. Separate topical fortified eye drops was used prior to January 2004 and switched to the VA solution afterwards in the treatment of bacterial corneal ulcer. The medical records of 223 patients diagnosed with bacterial corneal ulcers between January 2002 and December 2005 were reviewed retrospectively. There were 122 patients in the VA group and 101 in the separate group. Cure was defined as complete healing of the ulcer accompanied by a nonprogressive stromal infiltrate on two consecutive visits. No significant difference was found between the VA and separate therapy group. The mean treatment duration was 15.4 days in the VA group and 16.1 days in the separate therapy group. The average hospital stay was 5.4 days (VA) and 7.2 days (separate antibiotics). Stromal infiltration regressed significantly without further expansion in both groups. All corneal ulcers completely re-epithelialized without complications related to drugs. VA solution provided similar efficacy to the conventional separate therapy in the treatment of bacterial corneal ulcers; however, it is more convenient and tolerable, promotes patient's compliance, avoids the washout effect, and reduces nurse utilization. Hence, VA solution is a good alternative to separate therapy.

Technology Reference Model (TRM) Reports: VA Category Framework Count Report

Data.gov (United States)

Department of Veterans Affairs — The One VA Enterprise Architecture (OneVA EA) is a comprehensive picture of the Department of Veterans Affairs' (VA) operations, capabilities and services and the...

Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

Directory of Open Access Journals (Sweden)

Patricia L Schirmer

Full Text Available BACKGROUND: Although dengue is endemic in Puerto Rico (PR, 2007 and 2010 were recognized as epidemic years. In the continental United States (US, outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL, in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. METHODOLOGY: Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010 with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE. Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. FINDINGS: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. CONCLUSIONS: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to

Medical Applications of Non-Medical Research: Applications Derived from BES-Supported Research and Research at BES Facilities

Science.gov (United States)

1998-07-01

This publication contains stories that illustrate how the Office of Basic Energy Sciences (BES) research and major user facilities have impacted the medical sciences in the selected topical areas of disease diagnosis, treatment (including drug development, radiation therapy, and surgery), understanding, and prevention.

75 FR 10347 - Federal Property Suitable as Facilities To Assist the Homeless

Science.gov (United States)

2010-03-05

... plan, existing sanitary facilities, exact street address), providers should contact the appropriate... story stone structure, no sanitary or heating facilities, Natl Register of Historic Places Bldg. 10 VA..., State Hwy 52 Celina Co: Clay TN 38551 Landholding Agency: COE Property Number: 31199140006 Status...

Medication-use evaluation with a Web application.

Science.gov (United States)

Burk, Muriel; Moore, Von; Glassman, Peter; Good, Chester B; Emmendorfer, Thomas; Leadholm, Thomas C; Cunningham, Francesca

2013-12-15

A Web-based application for coordinating medication-use evaluation (MUE) initiatives within the Veterans Affairs (VA) health care system is described. The MUE Tracker (MUET) software program was created to improve VA's ability to conduct national medication-related interventions throughout its network of 147 medical centers. MUET initiatives are centrally coordinated by the VA Center for Medication Safety (VAMedSAFE), which monitors the agency's integrated databases for indications of suboptimal prescribing or drug therapy monitoring and adverse treatment outcomes. When a pharmacovigilance signal is detected, VAMedSAFE identifies "trigger groups" of at-risk veterans and uploads patient lists to the secure MUET application, where locally designated personnel (typically pharmacists) can access and use the data to target risk-reduction efforts. Local data on patient-specific interventions are stored in a centralized database and regularly updated to enable tracking and reporting for surveillance and quality-improvement purposes; aggregated data can be further analyzed for provider education and benchmarking. In a three-year pilot project, the MUET program was found effective in promoting improved prescribing of erythropoiesis-stimulating agents (ESAs) and enhanced laboratory monitoring of ESA-treated patients in all specified trigger groups. The MUET initiative has since been expanded to target other high-risk drugs, and efforts are underway to refine the tool for broader utility. The MUET application has enabled the increased standardization of medication safety initiatives across the VA system and may serve as a useful model for the development of pharmacovigilance tools by other large integrated health care systems.

Development of a continuous energy version of KENO V.a

International Nuclear Information System (INIS)

Dunn, M.E.; Bentley, C.L.; Goluoglu, S.; Paschal, L.S.; Dodds, H.L.

1997-01-01

KENO V.a is a multigroup Monte Carlo code that solves the Boltzmann transport equation and is used extensively in the nuclear criticality safety community to calculate the effective multiplication factor k eff of systems containing fissile material. Because of the smaller amount of disk storage and CPU time required in calculations, multigroup approaches have been preferred over continuous energy (point) approaches in the past to solve the transport equation. With the advent of high-performance computers, storage and CPU limitations are less restrictive, thereby making continuous energy methods viable for transport calculations. Moreover, continuous energy methods avoid many of the assumptions and approximations inherent in multigroup methods. Because a continuous energy version of KENO V.a does not exist, the objective of the work is to develop a new version of KENO V.a that utilizes continuous energy cross sections. Currently, a point cross-section library, which is based on a raw continuous energy cross-section library such as ENDF/B-V is not available for implementation in KENO V.a; however, point cross-section libraries are available for MCNP, another widely used Monte Carlo transport code. Since MCNP cross sections are based on ENDF data and are readily available, a new version of KENO V.a named PKENO V.a has been developed that performs the random walk using MCNP cross sections. To utilize point cross sections, extensive modifications have been made to KENO V.a. At this point in the research, testing of the code is underway. In particular, PKENO V.a, KENO V.a, and MCNP have been used to model nine critical experiments and one subcritical problem. The results obtained with PKENO V.a are in excellent agreement with MCNP, KENO V.a, and experiments

Safety Analysis Report: X17B2 beamline Synchrotron Medical Research Facility

International Nuclear Information System (INIS)

Gmuer, N.F.; Thomlinson, W.

1990-02-01

This report contains a safety analysis for the X17B2 beamline synchrotron medical research facility. Health hazards, risk assessment and building systems are discussed. Reference is made to transvenous coronary angiography

76 FR 44086 - Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity...

Science.gov (United States)

2011-07-22

... Medical Examination for Disability Evaluation, VA Form 21-2545. OMB Control Number: 2900-0052. Type of... of Medical Examination for Disability Evaluation) Activity Under OMB Review AGENCY: Veterans Benefits... prior to undergoing a VA examination for disability benefits. The examining physician also completes the...

Approval of devices and facilities using ionizing radiations for medical purposes

International Nuclear Information System (INIS)

1977-01-01

This Order made by the Ministers of Health and Social Security, Agriculture and Labour amends a previous Decree of 23 April 1969 in particular concerning the classification of medical or dental radiodiagnostic devices subject to approval. The technical conditions to be complied with for such devices and facilities have also been amended. Finally, it is provided that, as regards facilities with heavy equipment subject to licensing (Act of 31 December 1970), approval is subject to compliance with the licensing conditions and is requested together with the application for a licence. (NEA) [fr

Development of a parallelization method for KENO V.a

International Nuclear Information System (INIS)

Basoglu, B.; Bentley, C.; Dunn, M.

1995-01-01

The KENO V.a codes is a widely used Monte carlo codes that is part of the SCALE modular codes system for performing standardized computer analysis of nuclear systems for licensing evaluation. In the past few years, attempts have been made to speed up KENO V.a using new generation computers. In this paper we report on the initial development of a parallel version of KENO V.a for the Kendall Square Research supercomputer (KSRI) at ORNL. Investigations thus far have shown that the parallel code provides accurate results with significantly reduced computation times relative to the conventional KENO V.a code

Prototype interface facility for intelligent handling and processing of medical image and data

Science.gov (United States)

Lymberopoulos, Dimitris C.; Garantziotis, Giannis; Spiropoulos, Kostas V.; Kotsopoulos, Stavros A.; Goutis, Costas E.

1993-06-01

This paper introduces an interface facility (IF) developed within the overall framework of RACE research project. Due to the nature of the project which it has been focused in the Remote Medical Expert Consultation, the involvement of distances, the versatile user advocation and familiarity with newly introduced methods of medical diagnosis, considerable deficiencies can arise. The aim was to intelligently assist the user/physician by providing an ergonomic environment which would contain operational and functional deficiencies to the lowest possible levels. IF, energizes and activates system and application level commands and procedures along with the necessary exemplified and instructional help facilities, in order to concisely allow the user to interact with the system safely and easily at all levels.

Analysis of VaR on Stock Investing%股票投资的风险价值VaR分析

Institute of Scientific and Technical Information of China (English)

张江红; 唐泉

2011-01-01

VaR is a tool to measure financial risk,which is supported and recognized by the international financial community in recent years.For equity portfolios consisting of different market factors or different financial instruments,VaR can reliably evaluate the market risks.In the paper the basic principle and calculation of VaR is introduced,the company stock value at risk has been analyzed using normal method,which company has issued convertible bond and stock.Meanwhile the affect that the issuance of convertible bond to the underlying stock fluctuation has been taken into account in order to provide reference for the different types of investors.%VaR是近年来受到国际金融界广泛支持和认可的一种度量金融风险的工具.对于不同市场因子和不同金融工具的投资组合,VaR可以相对可靠地衡量其市场风险.本文介绍了VaR的基本原理和计算方法,并用正态分布对发行有可转债的上市公司股票的风险价值进行分析,考虑了可转债的发行对标的股票波动的影响,以期为资本市场不同类型的投资者在进行资本投资前估计风险提供参考.

KNOWLEDGE IS REFERENCE FACILITIES OF SUPPORT OF PROCESSES OF INFORMATIVE ACCOMPANIMENT OF MEDICAL SERVICE OF POPULATION (first report

Directory of Open Access Journals (Sweden)

O. P. Mintser

2012-11-01

Full Text Available Described approaches, models and facilities of forming of the systems of knowledges, by the s purpose of support of grant informatively consultative services at medical practice of doctor. Ontological models, facilities of linguistic analysis and visualization of reflection of objects of medical industry, are determined.

Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay.

Science.gov (United States)

de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W

2014-04-01

In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.

US veterans use vitamins and supplements as substitutes for prescription medication.

Science.gov (United States)

Goldstein, Jennifer N; Long, Judith A; Arevalo, Doris; Ibrahim, Said A; Mao, Jun J

2014-12-01

Vitamins and supplements are the most commonly used form of complementary and alternative medicine in the United States. Growing research suggests that patients substitute vitamins and supplements for their prescription medications. The reasons might include cost of prescription medications and discordant patient and doctor health belief systems. To investigate the prevalence of substitution of vitamins and supplements for prescription medications among veterans who receive care in the VA health care system and whether substitution is associated with prescription rationing due to cost, treatment beliefs, or distrust of the health system. Cross-sectional observational survey. Primary care patients (n=275) at the Philadelphia VA Medical Center. Medication substitution, prescription medication rationing, treatment beliefs, and health system distrust were measured with structured instruments. Multivariate logistic regression was performed with substitution as the dependent variable. A significant number of primary care patients in the VA system use vitamins and supplements 206 (75%). The prevalence of medication substitution is high 48 (18%). Medication substitution is strongly associated with prescription rationing due to cost (adjusted odds ratio 6.3, 95% confidence interval: 2.0-19.5, P=0.001). Similarly, greater belief in complementary and alternative approaches to care positively predicts medication substitution (adjusted odds ratio 1.08, 95% confidence interval: 1.01-1.15, P=0.011). There is no significant association between health system distrust and likelihood of medication substitution. Medication substitution is prevalent in this sample of inner city primary care patients who receive care in the VA system. Cost of prescriptions and belief in the value of complementary and alternative approaches to care appear to be associated with this patient-driven treatment decision.

77 FR 45717 - Proposed Information Collection (Former Prisoner of War Medical History); Comment Request

Science.gov (United States)

2012-08-01

... use of other forms of information technology. Title: Former Prisoner of War (FPOW) Medical History, VA... Prisoner of War veteran. VA will use the data collected as a guide and reference for treatment planning for... Prisoner of War Medical History); Comment Request AGENCY: Veterans Health Administration, Department of...

The VA mission act: Funding to fail?

Directory of Open Access Journals (Sweden)

Robbins RA

2018-06-01

Full Text Available No abstract available. Article truncated after 150 words. Yesterday on D-Day, the 74th anniversary of the invasion of Normandy, President Trump signed the VA Mission Act. The law directs the VA to combine a number of existing private-care programs, including the so-called Choice program, which was created in 2014 after veterans died waiting for appointments at the Phoenix VA (1. During the signing Trump touted the new law saying “there has never been anything like this in the history of the VA” and saying that veterans “can go right outside [the VA] to a private doctor”-but can they? Although the bill authorizes private care, it appropriates no money to pay for it. Although a bipartisan plan to fund the expansion is proposed in the House, the White House has been lobbying Republicans to vote the plan down (2. Instead Trump has been asking Congress to pay for veteran’s programs by cutting spending elsewhere (2. We in Arizona are …

77 FR 17086 - Section 8 Housing Choice Vouchers: Revised Implementation of the HUD-VA Supportive Housing Program

Science.gov (United States)

2012-03-23

... Housing g. Mobility and Portability of HUD-VASH Vouchers h. Case Management Requirements i. Turnover of... veterans with case management and clinical services provided by the VA through its community medical... services sites and Community-Based Outpatient Clinics (CBOCs) across the nation. The HUD- VASH program is a...

The conceptual design of waste repository for radioactive waste from medical, industrial and research facilities containing comparatively high radioactivity

International Nuclear Information System (INIS)

Yamamoto, Masayuki; Hashimoto, Naro

2002-02-01

Advisory Committee on Nuclear Fuel Cycle Backend Policy reported the basic approach to the RI and Institute etc. wastes on March 2002. According to it, radioactive waste form medical, industrial and research facilities should be classified by their radioactivity properties and physical and chemical properties, and should be disposed in the appropriate types of repository with that classification. For the radioactive waste containing comparatively high radioactivity generated from reactors, NSC has established the Concentration limit for disposal. NSC is now discussing about the limit for the radioactive waste from medical, industrial and research facilities containing comparatively high radioactivity. Japan Nuclear Cycle Development Institute (JNC) preliminary studied about the repository for radioactive waste from medical, industrial and research facilities and discussed about the problems for design on H12. This study was started to consider those problems, and to develop the conceptual design of the repository for radioactive waste from medical, industrial and research facilities. Safety assessment for that repository is also performed. The result of this study showed that radioactive waste from medical, industrial and research facilities of high activity should be disposed in the repository that has higher performance of barrier system comparing with the vault type near surface facility. If the conditions of the natural barrier and the engineering barrier are clearer, optimization of the design will be possible. (author)

An evaluation related to the effect of strategic facility management on choice of medical tourism destination

Directory of Open Access Journals (Sweden)

Tarcan Ertugrul

2015-01-01

Full Text Available This study based on literature review aims to evaluate and emphasize the affect of the strategic facility management (SFM on choice of medical tourism destination. Medical Tourism, which ranges from the health care services involving a cure to the wellness services involving no specific health trouble to pleasure and amusement services, is one of the most growing sectors in the world. Cost and quality of medical services are among the main reasons for the choice of destination. Strategic facility management has a positive correlation on the levels of quality, cost and customer satisfaction. Thus medical tourism and destination managers should take into account of the potential advantages of value creation offered through SFM in order to be chosen by customers (stakeholders.

Pitfalls and Security Measures for the Mobile EMR System in Medical Facilities.

Science.gov (United States)

Yeo, Kiho; Lee, Keehyuck; Kim, Jong-Min; Kim, Tae-Hun; Choi, Yong-Hoon; Jeong, Woo-Jin; Hwang, Hee; Baek, Rong Min; Yoo, Sooyoung

2012-06-01

The goal of this paper is to examine the security measures that should be reviewed by medical facilities that are trying to implement mobile Electronic Medical Record (EMR) systems designed for hospitals. The study of the security requirements for a mobile EMR system is divided into legal considerations and sectional security investigations. Legal considerations were examined with regard to remote medical services, patients' personal information and EMR, medical devices, the establishment of mobile systems, and mobile applications. For the 4 sectional security investigations, the mobile security level SL-3 from the Smartphone Security Standards of the National Intelligence Service (NIS) was used. From a compliance perspective, legal considerations for various laws and guidelines of mobile EMR were executed according to the model of the legal considerations. To correspond to the SL-3, separation of DMZ and wireless network is needed. Mobile access servers must be located in only the smartphone DMZ. Furthermore, security measures like 24-hour security control, WIPS, VPN, MDM, and ISMS for each section are needed to establish a secure mobile EMR system. This paper suggested a direction for applying regulatory measures to strengthen the security of a mobile EMR system in accordance with the standard security requirements presented by the Smartphone Security Guideline of the NIS. A future study on the materialization of these suggestions after their application at actual medical facilities can be used as an illustrative case to determine the degree to which theory and reality correspond with one another.

78 FR 56271 - FY 2014-2020 Draft VA Strategic Plan

Science.gov (United States)

2013-09-12

... DEPARTMENT OF VETERANS AFFAIRS FY 2014-2020 Draft VA Strategic Plan AGENCY: Department of Veterans... Affairs (VA) is announcing the availability of the FY 2014-2020 Draft VA Strategic Plan (Strategic Plan... Act of 2010 (GPRAMA) (Pub. L. 111-352). The Strategic Plan provides the Department's long-term...

Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

Science.gov (United States)

Daniels, Cheryl Andrea

2013-01-01

With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

Science.gov (United States)

Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

2007-10-01

Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

Troubles continue for the Phoenix VA

Directory of Open Access Journals (Sweden)

Robbins RA

2014-10-01

Full Text Available No abstract available. Article truncated after 150 words. According to the Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission, JCAHO, an independent organization that reviews hospitals, the Phoenix VA does not comply with U.S. standards for safety, patient care and management (1. The hospital was at the epicenter of the national scandal over the quality of care being afforded to the nation's veterans where the now notorious practice of double-booking patient appointments was first exposed. The hospital's indifferent management provoked congressional investigations that uncovered still more system-wide abuses leading to the removal of the hospital director and the resignation of then VA secretary, Eric Shinseki. The hospital maintains its accreditation but with a follow-up survey in 1-6 months where it must show that it has successfully addressed the 13 identified problems (1. Inspectors who conducted the review in July found that VA employees were unable to report concerns "without retaliatory action from the hospital." Other alarming ...

Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.

Science.gov (United States)

Birs, Antoinette; Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

2016-02-19

Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

38 CFR 26.7 - VA environmental decision making and documents.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision making and documents. 26.7 Section 26.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) ENVIRONMENTAL EFFECTS OF THE DEPARTMENT OF VETERANS AFFAIRS (VA) ACTIONS § 26.7 VA environmental decision making and document...

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

Science.gov (United States)

Tsai, Jack; Middleton, Margaret; Villegas, Jennifer; Johnson, Cindy; Retkin, Randye; Seidman, Alison; Sherman, Scott; Rosenheck, Robert A

2017-12-01

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

Protecting patients. Y2K and medical facilities using radiation sources

International Nuclear Information System (INIS)

Ibbott, G.S.; Ortiz, P.; Andreo, P.

1999-01-01

For all types of medical care, the Year 2000 problem could cause an almost unlimited number of potential problems associated with particular scheduling. As a part of its assistance to Member States on Year 2000 issues, the IAEA has prepared a report 'Safety Measures to Address the Year 2000 Issue at Medical facilities which use Radiation Generators and Radioactive Materials (TECDOC-1074) for the attention of State Authorities. The mid-1999 international workshop organized by IAEA and WHO helped to promote even greater awareness of steps that should be taken to prevent the Year 2000 bug from seriously affecting the health care community

Pitfalls and Security Measures for the Mobile EMR System in Medical Facilities

Science.gov (United States)

Yeo, Kiho; Lee, Keehyuck; Kim, Jong-Min; Kim, Tae-Hun; Choi, Yong-Hoon; Jeong, Woo-Jin; Hwang, Hee; Baek, Rong Min

2012-01-01

Objectives The goal of this paper is to examine the security measures that should be reviewed by medical facilities that are trying to implement mobile Electronic Medical Record (EMR) systems designed for hospitals. Methods The study of the security requirements for a mobile EMR system is divided into legal considerations and sectional security investigations. Legal considerations were examined with regard to remote medical services, patients' personal information and EMR, medical devices, the establishment of mobile systems, and mobile applications. For the 4 sectional security investigations, the mobile security level SL-3 from the Smartphone Security Standards of the National Intelligence Service (NIS) was used. Results From a compliance perspective, legal considerations for various laws and guidelines of mobile EMR were executed according to the model of the legal considerations. To correspond to the SL-3, separation of DMZ and wireless network is needed. Mobile access servers must be located in only the smartphone DMZ. Furthermore, security measures like 24-hour security control, WIPS, VPN, MDM, and ISMS for each section are needed to establish a secure mobile EMR system. Conclusions This paper suggested a direction for applying regulatory measures to strengthen the security of a mobile EMR system in accordance with the standard security requirements presented by the Smartphone Security Guideline of the NIS. A future study on the materialization of these suggestions after their application at actual medical facilities can be used as an illustrative case to determine the degree to which theory and reality correspond with one another. PMID:22844648

Infection prevention and control in deployed military medical treatment facilities.

Science.gov (United States)

Hospenthal, Duane R; Green, Andrew D; Crouch, Helen K; English, Judith F; Pool, Jane; Yun, Heather C; Murray, Clinton K

2011-08-01

Infections have complicated the care of combat casualties throughout history and were at one time considered part of the natural history of combat trauma. Personnel who survived to reach medical care were expected to develop and possibly succumb to infections during their care in military hospitals. Initial care of war wounds continues to focus on rapid surgical care with debridement and irrigation, aimed at preventing local infection and sepsis with bacteria from the environment (e.g., clostridial gangrene) or the casualty's own flora. Over the past 150 years, with the revelation that pathogens can be spread from patient to patient and from healthcare providers to patients (including via unwashed hands of healthcare workers, the hospital environment and fomites), a focus on infection prevention and control aimed at decreasing transmission of pathogens and prevention of these infections has developed. Infections associated with combat-related injuries in the recent operations in Iraq and Afghanistan have predominantly been secondary to multidrug-resistant pathogens, likely acquired within the military healthcare system. These healthcare-associated infections seem to originate throughout the system, from deployed medical treatment facilities through the chain of care outside of the combat zone. Emphasis on infection prevention and control, including hand hygiene, isolation, cohorting, and antibiotic control measures, in deployed medical treatment facilities is essential to reducing these healthcare-associated infections. This review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

38 CFR 74.27 - How will VA store information?

Science.gov (United States)

2010-07-01

... (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.27 How will VA store information? VA... examination visits will be scanned onto portable media and fully secured in the Center for Veterans Enterprise...

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

OpenAIRE

Bankole K. Fasanya; Emmanuel A. Dada

2016-01-01

Background: Workplace violence (WPV) is becoming an issue that needs immediate attention in the United States, especially during this period as more states are adopting the “stand your ground laws to promote worker protection.” This study was conducted to investigate how WPV has contributed to an unsafe environment for nurses and nursing assistants who work in long-term medical care facilities. Methods: A structure questionnaire was used to collect data for the study. Three facilities were...

The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

International Nuclear Information System (INIS)

Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G

2015-01-01

There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care

Drone Defense System Architecture for U.S. Navy Strategic Facilities

Science.gov (United States)

2017-09-01

unlimited. DRONE DEFENSE SYSTEM ARCHITECTURE FOR U.S. NAVY STRATEGIC FACILITIES by David Arteche, Kenneth Chivers, Bryce Howard, Terrell Long, Walter...and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction...project report 4. TITLE AND SUBTITLE DRONE DEFENSE SYSTEM ARCHITECTURE FOR U.S. NAVY STRATEGIC FACILITIES 5. FUNDING NUMBERS 6. AUTHOR(S) David Arteche

48 CFR 852.219-71 - VA mentor-protégé program.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA mentor-protégÃ....219-71 VA mentor-protégé program. As prescribed in 819.7115(a), insert the following clause: VA Mentor-Protégé Program (DEC 2009) (a) Large businesses are encouraged to participate in the VA Mentor-Protégé...

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

Directory of Open Access Journals (Sweden)

Bankole K. Fasanya

2016-06-01

Conclusion: WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

What does Shulkin's firing mean for the VA?

Directory of Open Access Journals (Sweden)

Robbins RA

2018-03-01

Full Text Available No abstract available. Article truncated at 150 words. David Shulkin MD, Secretary for Veterans Affairs (VA was finally fired by President Donald Trump ending long speculation (1. Trump nominated his personal physician, Ronny Jackson MD, to fill Shulkin’s post. The day after his firing, Shulkin criticized his firing in a NY Times op-ed claiming pro-privatization factions within the Trump administration led to his ouster (2. “They saw me as an obstacle to privatization who had to be removed,” Dr. Shulkin wrote. “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.” Former Secretary Shulkin’s tenure at the VA has had several controversies. First, as undersecretary of Veterans Healthcare and later as secretary money appropriated to the VA to obtain private care under the Veterans Access, Choice, and Accountability Acts of 2014 and the VA Choice and Quality Employment Act of …

Empirical analysis on future-cash arbitrage risk with portfolio VaR

Science.gov (United States)

Chen, Rongda; Li, Cong; Wang, Weijin; Wang, Ze

2014-03-01

This paper constructs the positive arbitrage position by alternating the spot index with Chinese Exchange Traded Fund (ETF) portfolio and estimating the arbitrage-free interval of futures with the latest trade data. Then, an improved Delta-normal method was used, which replaces the simple linear correlation coefficient with tail dependence correlation coefficient, to measure VaR (Value-at-risk) of the arbitrage position. Analysis of VaR implies that the risk of future-cash arbitrage is less than that of investing completely in either futures or spot market. Then according to the compositional VaR and the marginal VaR, we should increase the futures position and decrease the spot position appropriately to minimize the VaR, which can minimize risk subject to certain revenues.

Important changes in medical x-ray imaging facility shielding design methodology. A brief summary of recommendations in NCRP Report No. 147

International Nuclear Information System (INIS)

Archer, Benjamin R.; Gray, Joel E.

2005-01-01

The recently published Report No. 147 of The National Council on Radiation Protection and Measurements entitled 'Structural shielding design for medical x-ray imaging facilities' provides an update of shielding recommendations for x rays used for medical imaging. The goal of this report is to ensure that the shielding in these facilities limits radiation exposures to employees and members of the public to acceptable levels. Board certified medical and health physicists, as defined in this report, are the 'qualified experts' who are competent to design radiation shielding for these facilities. As such, physicists must be aware of the new technical information and the changes from previous reports that Report No. 147 supersedes. In this article we summarize the new data, models and recommendations for the design of radiation barriers in medical imaging facilities that are presented in Report No. 147

77 FR 67063 - VA Directive 0005 on Scientific Integrity

Science.gov (United States)

2012-11-08

... in multiple areas, including data integrity, ethics, privacy, and human research protections, as well... replace the Association for the Accreditation of Human Research Protection Programs (AAHRPP) with Alion... human research protection programs. VA Response: VA is currently reviewing its accreditation...

Difference between Japanese Secondary and Tertiary Medical Facilities Regarding Changes in the Hospitalization of Children for Pneumonia after the Introduction of the Pneumococcal Conjugate Vaccine.

Science.gov (United States)

Haro, Kaoru; Ogawa, Masato; Hoshina, Takayuki; Kojiro, Masumi; Kusuhara, Koichi

2017-05-24

This study aimed to compare hospitalization of children for pneumonia between secondary and tertiary medical facilities, which hospitalize many children without and with underlying diseases, respectively, after the introduction of the pneumococcal conjugate vaccine (PCV). Our retrospective study included children admitted to the Department of Pediatrics at Kitakyushu General Hospital, a secondary medical facility, and the Hospital of the University of Occupational and Environment Health, Japan, a tertiary medical facility, from 2009 to 2013 for pneumonia. We compared the change in the rate of hospitalization for pneumonia after the introduction of the 7-valent PCV between the secondary and tertiary medical facilities. Hospitalization of patients with pneumonia declined by 28.8% in our secondary medical facility. In particular, hospitalization for pneumonia other than confirmed mycoplasmal or viral pneumonia was significantly reduced by 49.2%. In contrast, hospitalization of patients with pneumonia did not decline in our tertiary medical facility. After the introduction of PCV, hospitalization of children for pneumonia was not reduced at the tertiary medical facility. Various other pathogens besides pneumococcus may be associated with the development of pneumonia in children with underlying diseases.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Science.gov (United States)

Hussey, Peter S.; Ringel, Jeanne S.; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W.; Lovejoy, Susan L.; Martsolf, Grant R.; Rudin, Robert S.; Schultz, Dana; Sloss, Elizabeth M.; Watkins, Katherine E.; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian; Broyles, James R.; Burns, Rachel M.; Chen, Emily K.; DeSantis, Amy Soo Jin; Ecola, Liisa; Fischer, Shira H.; Friedberg, Mark W.; Gidengil, Courtney A.; Ginsburg, Paul B.; Gulden, Timothy; Gutierrez, Carlos Ignacio; Hirshman, Samuel; Huang, Christina Y.; Kandrack, Ryan; Kress, Amii; Leuschner, Kristin J.; MacCarthy, Sarah; Maksabedian, Ervant J.; Mann, Sean; Matthews, Luke Joseph; May, Linnea Warren; Mishra, Nishtha; Miyashiro, Lisa; Muchow, Ashley N.; Nelson, Jason; Naranjo, Diana; O'Hanlon, Claire E.; Pillemer, Francesca; Predmore, Zachary; Ross, Rachel; Ruder, Teague; Rutter, Carolyn M.; Uscher-Pines, Lori; Vaiana, Mary E.; Vesely, Joseph V.; Hosek, Susan D.; Farmer, Carrie M.

2016-01-01

Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth. PMID:28083424

75 FR 9277 - Proposed Information Collection (VA National Rehabilitation Special Events, Event Registration...

Science.gov (United States)

2010-03-01

... Sports Clinic Application, VA Form 0924--233 hours. b. National Veterans Wheelchair Games Application, VA.... National Veterans TEE Tournament Application, VA Form 0927--133 hours. e. National Veterans Summer Sports... Form 0929--67 hours. OMB Control Number: 2900-New (VA Form 0924). Type of Review: Existing collection...

VA National Bed Control System

Data.gov (United States)

Department of Veterans Affairs — The VA National Bed Control System records the levels of operating, unavailable and authorized beds at each VAMC, and it tracks requests for changes in these levels....

Scoping assessment on medical isotope production at the Fast Flux Test Facility

International Nuclear Information System (INIS)

Scott, S.W.

1997-01-01

The Scoping Assessment addresses the need for medical isotope production and the capability of the Fast Flux Test Facility to provide such isotopes. Included in the discussion are types of isotopes used in radiopharmaceuticals, which types of cancers are targets, and in what way isotopes provide treatment and/or pain relief for patients

Scoping assessment on medical isotope production at the Fast Flux Test Facility

Energy Technology Data Exchange (ETDEWEB)

Scott, S.W.

1997-08-29

The Scoping Assessment addresses the need for medical isotope production and the capability of the Fast Flux Test Facility to provide such isotopes. Included in the discussion are types of isotopes used in radiopharmaceuticals, which types of cancers are targets, and in what way isotopes provide treatment and/or pain relief for patients.

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

Science.gov (United States)

2017-01-01

Defense (DOD) responsibility for contracting support Quality assurance Accreditation and oversight from external entities and credentialing and...MTF designation would introduce additional operational requirements and challenges to the FHCC, including financial management and quality assurance...departments—including DOD’s operational readiness mission—by integrating services previously provided by the former North Chicago VA Medical Center

VA Telemedicine: An Analysis of Cost and Time Savings.

Science.gov (United States)

Russo, Jack E; McCool, Ryan R; Davies, Louise

2016-03-01

The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.

VA Dental Insurance Program--federalism. Direct final rule.

Science.gov (United States)

2013-10-22

The Department of Veterans Affairs (VA) is taking direct final action to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. Specifically, this rule will add language to clarify the limited preemptive effect of certain criteria in the VADIP regulations.

VA INFORMATION SYSTEMS: Computer Security Weaknesses Persist at the Veterans Health Administration

National Research Council Canada - National Science Library

2000-01-01

.... To determine the status of computer security within VHA, we (1) evaluated information system general controls at the VA Maryland Health Cafe System, the New Mexico VA Health Care System, and the VA North Texas Health Care System and (2...

A conversion development program to LEU targets for medical isotope production in the MAPLE Facilities

International Nuclear Information System (INIS)

Malkoske, G.R.

2000-01-01

Historically, the production of molybdenum-99 in the NRU research reactors at Chalk River, Canada has been extracted from reactor targets employing highly enriched uranium (HEU). The molybdenum extraction process from the HEU targets provided predictable, consistent yields for our high-volume molybdenum production process. A reliable supply of HEU for the NRU research reactor targets has enabled MDS Nordion to develop a secure chain of medical isotope supply for the international nuclear medicine community. Each link of the isotope supply chain, from isotope production to patient application, has been established on a proven method of HEU target irradiation and processing. To ensure a continued reliable and timely supply of medical isotopes, the design of the MAPLE facilities was based on our established process - extraction of isotopes from HEU target material. However, in concert with the global trend to utilize low enriched uranium (LEU) in research reactors, MDS Nordion has launched a program to convert the MAPLE facilities to LEU targets. An initial feasibility study was initiated to identify the technical issues to convert the MAPLE targets from HEU to LEU. This paper will present the results of the feasibility study. It will also describe future challenges and opportunities in converting the MAPLE facilities to LEU targets for large scale, commercial medical isotope production. (author)

The Veterans Choice Program (VCP): Program Implementation

Science.gov (United States)

2017-01-05

First, veterans would send a notice of disagreement to their facility. Then the facility is to generate a statement of case (SOC). Lastly, the...an area agency on aging, or a state agency or a center for independent living. VA employees are excluded from providing care or services under VCP...unless the provider is an employee of VA, and is not acting within the scope of such employment while providing hospital care or medical services

Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.

Science.gov (United States)

Blanchard, Kelly; Lince-Deroche, Naomi; Fetters, Tamara; Devjee, Jaymala; de Menezes, Ilundi Durão; Trueman, Karen; Sudhinaraset, May; Nkonko, Errol; Moodley, Jack

2015-10-01

Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, ppublic sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings. Copyright © 2015 Elsevier Inc. All rights reserved.

Naval Research Laboratory Major Facilities 2008

Science.gov (United States)

2008-10-01

consists of two equipment shelters, a chiller for cooling the transmitter, and a 175 kVA diesel generator for use at remote sites. A 40-ft-long... bioremediation , and biodeterioration. INSTRUMENTATION: • ESEM equipped with an energy-dispersive X-ray detector and an image acquisition and...a 125 kW uninterruptible power system with diesel backup. Magnetic sensitivity testing of precision Precision Clock Evaluation Facility CONTACT

Hazardous medical waste generation rates of different categories of health-care facilities

International Nuclear Information System (INIS)

Komilis, Dimitrios; Fouki, Anastassia; Papadopoulos, Dimitrios

2012-01-01

Highlights: ► We calculated hazardous medical waste generation rates (HMWGR) from 132 hospitals. ► Based on a 22-month study period, HMWGR were highly skewed to the right. ► The HMWGR varied from 0.00124 to 0.718 kg bed −1 d −1 . ► A positive correlation existed between the HMWGR and the number of hospital beds. ► We used non-parametric statistics to compare rates among hospital categories. - Abstract: Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed −1 d −1 , using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed −1 d −1 , for the public psychiatric hospitals, to up to 0.72 kg bed −1 d −1 , for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed −1 d −1 , for the psychiatric clinics, to up to 0.49 kg bed −1 d −1 , for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively.

Job satisfaction and burnout among VA and community mental health workers.

Science.gov (United States)

Salyers, Michelle P; Rollins, Angela L; Kelly, Yu-Fan; Lysaker, Paul H; Williams, Jane R

2013-03-01

Building on two independent studies, we compared burnout and job satisfaction of 66 VA staff and 86 community mental health center staff in the same city. VA staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). VA staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas VA administrators may focus on reducing, and helping workers navigate, administrative policies.

48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed in subpart 819.709, insert the following clause: VA Small Business Subcontracting Plan Minimum Requirements...

Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

Science.gov (United States)

Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

2018-04-01

To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

Social network analysis of duplicative prescriptions: One-month analysis of medical facilities in Japan.

Science.gov (United States)

Takahashi, Yoshimitsu; Ishizaki, Tatsuro; Nakayama, Takeo; Kawachi, Ichiro

2016-03-01

Duplicative prescriptions refer to situations in which patients receive medications for the same condition from two or more sources. Health officials in Japan have expressed concern about medical "waste" resulting from this practices. We sought to conduct descriptive analysis of duplicative prescriptions using social network analysis and to report their prevalence across ages. We analyzed a health insurance claims database including 1.24 million people from December 2012. Through social network analysis, we examined the duplicative prescription networks, representing each medical facility as nodes, and individual prescriptions for patients as edges. The prevalence of duplicative prescription for any drug class was strongly correlated with its frequency of prescription (r=0.90). Among patients aged 0-19, cough and colds drugs showed the highest prevalence of duplicative prescriptions (10.8%). Among people aged 65 and over, antihypertensive drugs had the highest frequency of prescriptions, but the prevalence of duplicative prescriptions was low (0.2-0.3%). Social network analysis revealed clusters of facilities connected via duplicative prescriptions, e.g., psychotropic drugs showed clustering due to a few patients receiving drugs from 10 or more facilities. Overall, the prevalence of duplicative prescriptions was quite low - less than 10% - although the extent of the problem varied by drug class and age group. Our approach illustrates the potential utility of using a social network approach to understand these practices. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A Role for Myosin Va in Human Cytomegalovirus Nuclear Egress.

Science.gov (United States)

Wilkie, Adrian R; Sharma, Mayuri; Pesola, Jean M; Ericsson, Maria; Fernandez, Rosio; Coen, Donald M

2018-03-15

Herpesviruses replicate and package their genomes into capsids in replication compartments within the nuclear interior. Capsids then move to the inner nuclear membrane for envelopment and release into the cytoplasm in a process called nuclear egress. We previously found that nuclear F-actin is induced upon infection with the betaherpesvirus human cytomegalovirus (HCMV) and is important for nuclear egress and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Despite these and related findings, it has not been shown that any specific motor protein is involved in herpesvirus nuclear egress. In this study, we have investigated whether the host motor protein, myosin Va, could be fulfilling this role. Using immunofluorescence microscopy and coimmunoprecipitation, we observed associations between a nuclear population of myosin Va and the viral major capsid protein, with both concentrating at the periphery of replication compartments. Immunoelectron microscopy showed that nearly 40% of assembled nuclear capsids associate with myosin Va. We also found that myosin Va and major capsid protein colocalize with nuclear F-actin. Importantly, antagonism of myosin Va with RNA interference or a dominant negative mutant revealed that myosin Va is important for the efficient production of infectious virus, capsid accumulation in the cytoplasm, and capsid localization away from replication compartment-like inclusions toward the nuclear rim. Our results lead us to suggest a working model whereby human cytomegalovirus capsids associate with myosin Va for movement from replication compartments to the nuclear periphery during nuclear egress. IMPORTANCE Little is known regarding how newly assembled and packaged herpesvirus capsids move from the nuclear interior to the periphery during nuclear egress. While it has been proposed that an actomyosin-based mechanism facilitates intranuclear movement of alphaherpesvirus capsids, a functional role for

An academic-VA partnership: Student interprofessional teams integrated with VA PACT teams.

Science.gov (United States)

Swenty, Constance L; Schaar, Gina L; Butler, Ryan M

2016-12-01

Veterans are challenged with multiple unique healthcare issues related to their military service environment. Likewise, health care providers must understand the special concerns associated with military conflict and recognize how the veteran's care can be optimized by interprofessional care delivery. Little is taught didactically or clinically that supports nursing students in addressing the unique issues of the veteran or the student's need to work collaboratively with allied health team members to enhance the veteran's care. Because of limited exposure to the veteran's special conditions, nursing students who may seek a career with the veteran population often face challenges in rendering appropriate care. The VA offers an invaluable opportunity for health profession students to collaborate with VA interprofessional Patient Aligned Care Teams (PACT) ultimately optimizing veteran health outcomes. This academic partnership, that implements an interprofessional model, will prepare students to better embrace the veteran population. This article describes the immersion of health profession students in interprofessional collaborative practice (IPCP) using PACT team principles which ultimately promotes the students' ability to link theory content to patient care delivery. Copyright © 2016 Elsevier Ltd. All rights reserved.

OneVA EA Vision and Strategy

Data.gov (United States)

Department of Veterans Affairs — The outcomes/goals supported by effective use of an EA are: Improved Service Delivery, Functional Integration, Resource Optimization and Authoritative Reference. VA...

Durability test of geomembrane liners presumed to avail near surface disposal facilities for low-level waste generated from research, industrial and medical facilities

International Nuclear Information System (INIS)

Nakata, Hisakazu; Amazawa, Hiroya; Sakai, Akihiro; Kurosawa, Ryohei; Sakamoto, Yoshiaki; Kanno, Naohiro; Kashima, Takahiro

2014-02-01

The Low-level Radioactive Waste Disposal Project Center will construct near surface disposal facilities for radioactive wastes from research, industrial and medical facilities. The disposal facilities consist of “concrete pit type” for low-level radioactive wastes and “trench type” for very low level radioactive wastes. As for the trench type disposal facility, two kinds of facility designs are on projects – one for a normal trench type disposal facility without any of engineered barriers and the other for a trench type disposal facility with geomembrane liners that could prevent from causing environmental effects of non radioactive toxic materials contained in the waste packages. The disposal facility should be designed taking basic properties of durability on geomembrane liners into account, for it is exposed to natural environment on a long-term basis. This study examined mechanical strength and permeability properties to assess the durability on the basis of an indoor accelerated exposure experiment targeting the liner materials presumed to avail the conceptual design so far. Its results will be used for the basic and detailed design henceforth by confirming the empirical degradation characteristic with the progress of the exposure time. (author)

Flexural Stiffness of Myosin Va Subdomains as Measured from Tethered Particle Motion

Science.gov (United States)

Michalek, Arthur J.; Kennedy, Guy G.; Warshaw, David M.; Ali, M. Yusuf

2015-01-01

Myosin Va (MyoVa) is a processive molecular motor involved in intracellular cargo transport on the actin cytoskeleton. The motor's processivity and ability to navigate actin intersections are believed to be governed by the stiffness of various parts of the motor's structure. Specifically, changes in calcium may regulate motor processivity by altering the motor's lever arm stiffness and thus its interhead communication. In order to measure the flexural stiffness of MyoVa subdomains, we use tethered particle microscopy, which relates the Brownian motion of fluorescent quantum dots, which are attached to various single- and double-headed MyoVa constructs bound to actin in rigor, to the motor's flexural stiffness. Based on these measurements, the MyoVa lever arm and coiled-coil rod domain have comparable flexural stiffness (0.034 pN/nm). Upon addition of calcium, the lever arm stiffness is reduced 40% as a result of calmodulins potentially dissociating from the lever arm. In addition, the flexural stiffness of the full-length MyoVa construct is an order of magnitude less stiff than both a single lever arm and the coiled-coil rod. This suggests that the MyoVa lever arm-rod junction provides a flexible hinge that would allow the motor to maneuver cargo through the complex intracellular actin network. PMID:26770194

VaRank: a simple and powerful tool for ranking genetic variants

Directory of Open Access Journals (Sweden)

Véronique Geoffroy

2015-03-01

Full Text Available Background. Most genetic disorders are caused by single nucleotide variations (SNVs or small insertion/deletions (indels. High throughput sequencing has broadened the catalogue of human variation, including common polymorphisms, rare variations or disease causing mutations. However, identifying one variation among hundreds or thousands of others is still a complex task for biologists, geneticists and clinicians.Results. We have developed VaRank, a command-line tool for the ranking of genetic variants detected by high-throughput sequencing. VaRank scores and prioritizes variants annotated either by Alamut Batch or SnpEff. A barcode allows users to quickly view the presence/absence of variants (with homozygote/heterozygote status in analyzed samples. VaRank supports the commonly used VCF input format for variants analysis thus allowing it to be easily integrated into NGS bioinformatics analysis pipelines. VaRank has been successfully applied to disease-gene identification as well as to molecular diagnostics setup for several hundred patients.Conclusions. VaRank is implemented in Tcl/Tk, a scripting language which is platform-independent but has been tested only on Unix environment. The source code is available under the GNU GPL, and together with sample data and detailed documentation can be downloaded from http://www.lbgi.fr/VaRank/.

Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

Science.gov (United States)

Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

2008-01-01

Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

Guidelines for the characterization of wastes from medical facilities

International Nuclear Information System (INIS)

Ortiz, M.T.; Sainz, C. Correa

2002-01-01

The waste generated in medicine may be managed following conventional routes or via the Spanish National Radioactive Waste Management (ENRESA), depending on their residual activity. Radiological characterisation may, however, be a complex process, due to the wide variety of wastes existing, as regards activity, isotopes, presentation, physical form, difficulties in handling, etc. The main objective here is to establish general methods for the assessment of activity, applicable to the largest possible number of medical practices involving radioactive material and, therefore, potentially generating wastes. This report has been drawn up out by a working group on wastes from radioactive facilities, belonging to the Spanish Radiological Protection Society and sponsored by ENRESA

38 CFR 17.61 - Eligibility.

Science.gov (United States)

2010-07-01

... or VA medical center, domiciliary, or nursing home care; or (2) Such care or services were furnished... Residential Care § 17.61 Eligibility. VA health care personnel may assist a veteran by referring such veteran for placement in a privately or publicly-owned community residential care facility if: (a) At the time...

Comparison of historically simulated VaR: Evidence from oil prices

International Nuclear Information System (INIS)

Costello, Alexandra; Asem, Ebenezer; Gardner, Eldon

2008-01-01

Cabedo and Moya [Cabedo, J.D., Moya, I., 2003. Estimating oil price 'Value at Risk' using the historical simulation approach. Energy Economics 25, 239-253] find that ARMA with historical simulation delivers VaR forecasts that are superior to those from GARCH. We compare the ARMA with historical simulation to the semi-parametric GARCH model proposed by Barone-Adesi et al. [Barone-Adesi, G., Giannopoulos, K., Vosper, L., 1999. VaR without correlations for portfolios of derivative securities. Journal of Futures Markets 19 (5), 583-602]. The results suggest that the semi-parametric GARCH model generates VaR forecasts that are superior to the VaR forecasts from the ARMA with historical simulation. This is due to the fact that GARCH captures volatility clustering. Our findings suggest that Cabedo and Moya's conclusion is mainly driven by the normal distributional assumption imposed on the future risk structure in the GARCH model. (author)

48 CFR 803.7000 - Display of the VA Hotline poster.

Science.gov (United States)

2010-10-01

... poster. 803.7000 Section 803.7000 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Improper Business Practices 803.7000 Display of the VA Hotline poster. (a) Under the circumstances described in paragraph (b) of this section, a contractor must display prominently a VA Hotline poster...

76 FR 67561 - Privacy Act of 1974; System of Records

Science.gov (United States)

2011-11-01

... hospital (Federal, state, and local public or private) or other medical installation having hospital... medical installation having hospital facilities, organ banks, blood banks, or similar institutions... provider or institution when VA refers a patient for hospital or nursing home care or medical services, or...

The Design of Diagnostic Medical Facilities where Ionising Radiation is used

International Nuclear Information System (INIS)

Malone, J.; O'Reilly, G.; O'Connor, U.; Gallagher, A.; Sheahan, N.; Fennell, S.

2009-06-01

The original Code of Practice on The Design of Diagnostic Medical Facilities Using Ionising Radiation was first published by the Nuclear Energy Board in 1988. In the intervening years the 'Blue Book' as it became known has served the medical community well as the sector has expanded and modernised and the late Dr Noel Nowlan, then Chief Executive of the Nuclear Energy Board, deserves much credit for initiating this pioneering contribution to radiation safety in Ireland. There have been significant developments since its publication in terms of the underlying radiation protection legislation, regulatory practice as well as developments in new technologies that have given rise to the need for a revision of the Code. This revised Code is based on a comprehensive draft document produced by the Haughton Institute under contract to the RPII and was finalised following extensive consultations with the relevant stakeholders. The revised Code includes a brief review of the current legislative framework and its specific impact on the management of building projects (Chapters 1 and 2), a presentation of the main types of radiological (Chapter 3) and nuclear medicine (Chapter 4) facilities, a treatment of the technical aspects of shielding calculations (Chapter 5) and a discussion of the practical aspects of implementing shielding solutions in a building context (Chapter 6). The primary purpose of the Code is to assist in the design of diagnostic facilities to the highest radiation protection standards in order to ensure the safety of workers and members of the public and the delivery of a safe service to patients. Diagnostic radiology is a dynamic environment and the Code is intended to be used in consultation with the current literature, an experienced Radiation Protection Advisor and a multidisciplinary project team

ESTIMATING RISK ON THE CAPITAL MARKET WITH VaR METHOD

Directory of Open Access Journals (Sweden)

Sinisa Bogdan

2015-06-01

Full Text Available The two basic questions that every investor tries to answer before investment are questions about predicting return and risk. Risk and return are generally considered two positively correlated sizes, during the growth of risk it is expected increase of return to compensate the higher risk. The quantification of risk in the capital market represents the current topic since occurrence of securities. Together with estimated future returns it represents starting point of any investment. In this study it is described the history of the emergence of VaR methods, usefulness in assessing the risks of financial assets. Three main Value at Risk (VaR methodologies are decribed and explained in detail: historical method, parametric method and Monte Carlo method. After the theoretical review of VaR methods it is estimated risk of liquid stocks and portfolio from the Croatian capital market with historical and parametric VaR method, after which the results were compared and explained.

Comparison of historically simulated VaR: Evidence from oil prices

Energy Technology Data Exchange (ETDEWEB)

Costello, Alexandra [Seminole Canada Energy, Calgary, AB (Canada); Asem, Ebenezer; Gardner, Eldon [Faculty of Management, University of Lethbridge, Lethbridge, AB (Canada)

2008-09-15

Cabedo and Moya [Cabedo, J.D., Moya, I., 2003. Estimating oil price 'Value at Risk' using the historical simulation approach. Energy Economics 25, 239-253] find that ARMA with historical simulation delivers VaR forecasts that are superior to those from GARCH. We compare the ARMA with historical simulation to the semi-parametric GARCH model proposed by Barone-Adesi et al. [Barone-Adesi, G., Giannopoulos, K., Vosper, L., 1999. VaR without correlations for portfolios of derivative securities. Journal of Futures Markets 19 (5), 583-602]. The results suggest that the semi-parametric GARCH model generates VaR forecasts that are superior to the VaR forecasts from the ARMA with historical simulation. This is due to the fact that GARCH captures volatility clustering. Our findings suggest that Cabedo and Moya's conclusion is mainly driven by the normal distributional assumption imposed on the future risk structure in the GARCH model. (author)

Study on patient-induced radioactivity during proton treatment in hengjian proton medical facility.

Science.gov (United States)

Wu, Qingbiao; Wang, Qingbin; Liang, Tianjiao; Zhang, Gang; Ma, Yinglin; Chen, Yu; Ye, Rong; Liu, Qiongyao; Wang, Yufei; Wang, Huaibao

2016-09-01

At present, increasingly more proton medical facilities have been established globally for better curative effect and less side effect in tumor treatment. Compared with electron and photon, proton delivers more energy and dose at its end of range (Bragg peak), and has less lateral scattering for its much larger mass. However, proton is much easier to produce neutron and induced radioactivity, which makes radiation protection for proton accelerators more difficult than for electron accelerators. This study focuses on the problem of patient-induced radioactivity during proton treatment, which has been ignored for years. However, we confirmed it is a vital factor for radiation protection to both patient escort and positioning technician, by FLUKA's simulation and activation formula calculation of Hengjian Proton Medical Facility (HJPMF), whose energy ranges from 130 to 230MeV. Furthermore, new formulas for calculating the activity buildup process of periodic irradiation were derived and used to study the relationship between saturation degree and half-life of nuclides. Finally, suggestions are put forward to lessen the radiation hazard from patient-induced radioactivity. Copyright © 2016 Elsevier Ltd. All rights reserved.

VA Veterans Health Administration Access Data

Data.gov (United States)

Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...

Semi-nonparametric VaR forecasts for hedge funds during the recent crisis

Science.gov (United States)

Del Brio, Esther B.; Mora-Valencia, Andrés; Perote, Javier

2014-05-01

The need to provide accurate value-at-risk (VaR) forecasting measures has triggered an important literature in econophysics. Although these accurate VaR models and methodologies are particularly demanded for hedge fund managers, there exist few articles specifically devoted to implement new techniques in hedge fund returns VaR forecasting. This article advances in these issues by comparing the performance of risk measures based on parametric distributions (the normal, Student’s t and skewed-t), semi-nonparametric (SNP) methodologies based on Gram-Charlier (GC) series and the extreme value theory (EVT) approach. Our results show that normal-, Student’s t- and Skewed t- based methodologies fail to forecast hedge fund VaR, whilst SNP and EVT approaches accurately success on it. We extend these results to the multivariate framework by providing an explicit formula for the GC copula and its density that encompasses the Gaussian copula and accounts for non-linear dependences. We show that the VaR obtained by the meta GC accurately captures portfolio risk and outperforms regulatory VaR estimates obtained through the meta Gaussian and Student’s t distributions.

Research on Interval Forecast For Metal Futures Market′s VaR Based on Bootstrap%基于Bootstrap的金属期货市场风险VaR区间预测

Institute of Scientific and Technical Information of China (English)

沈盟; 王璐

2016-01-01

金属期货市场风险VaR的准确测度对防范期货交易风险及保持市场健康平稳运行有重要作用.传统的VaR测度方法主要以点预测为主,无法反映预测近似值的精确程度及范围. 因此,提出了一种基于Bootstrap的金属期货市场风险VaR区间预测方法,同时引入LR检验区间预测的有效性,最后利用我国铜和铝期货市场数据进行了VaR风险的区间预测. 结果表明,新的VaR区间预测方法能克服点预测的不足,准确有效地描述VaR的估计风险,同时置信区间上下限可用于风险的预警及控制.%The accurate measurement on metal futures market′s VaR is important to prevent the futures′transaction risk and maintain the market healthy and stable operation.The traditional methods measuring VaR focus on point forecast which can't re-flect the accuracy of the predictive value.A new method to measure the interval forecast for metal futures market's VaR based on bootstrap is put forward.LR test is used to test the effectiveness of interval forecast.Finally,we empirical study the interval fore-cast of copper and aluminum futures market's VaR in China.The results show that the new method can overcome the lack of point forecast,while the upper and lower confidence interval can be used for early warning and control financial risks.

76 FR 52230 - Establishment of Class E Airspace; Forest, VA

Science.gov (United States)

2011-08-22

...-0378; Airspace Docket No. 11-AEA-11] Establishment of Class E Airspace; Forest, VA AGENCY: Federal... at Forest, VA, to accommodate the new Area Navigation (RNAV) Global Positioning System (GPS) Standard... published in the Federal Register a notice of proposed rulemaking to establish Class E airspace at Forest...

VA Personal Health Record Sample Data

Data.gov (United States)

Department of Veterans Affairs — My HealtheVet (www.myhealth.va.gov) is a Personal Health Record portal designed to improve the delivery of health care services to Veterans, to promote health and...

Assisted Living Facilities, Locations of Assisted Living Facilities identifed visually and placed on the Medical Multi-Hazard Mitigation layer., Published in 2006, 1:1200 (1in=100ft) scale, Noble County Government.

Data.gov (United States)

NSGIC Local Govt | GIS Inventory — Assisted Living Facilities dataset current as of 2006. Locations of Assisted Living Facilities identifed visually and placed on the Medical Multi-Hazard Mitigation...

Shielding of Medical Facilities. Shielding Design Considerations for PET-CT Facilities

International Nuclear Information System (INIS)

Cruzate, J.A.; Discacciatti, A.P.

2011-01-01

The radiological evaluation of a Positron Emission Tomography (PET) facility consists of the assessment of the annual effective dose both to workers occupationally exposed, and to members of the public. This assessment takes into account the radionuclides involved, the facility features, the working procedures, the expected number of patients per year, and so on. The evaluation embraces the distributions of rooms, the thickness and physical material of walls, floors and ceilings. This work detail the methodology used for making the assessment of a PET facility design taking into account only radioprotection aspects. The assessment results must be compared to the design requirements established by national regulations in order to determine whether or not, the facility complies with those requirements, both for workers and for members of the public. The analysis presented is useful for both, facility designers and regulators. In addition, some guidelines for improving the shielding design and working procedures are presented in order to help facility designer's job. (authors)

Computing Conditional VaR using Time-varying CopulasComputing Conditional VaR using Time-varying Copulas

Directory of Open Access Journals (Sweden)

Beatriz Vaz de Melo Mendes

2005-12-01

Full Text Available It is now widespread the use of Value-at-Risk (VaR as a canonical measure at risk. Most accurate VaR measures make use of some volatility model such as GARCH-type models. However, the pattern of volatility dynamic of a portfolio follows from the (univariate behavior of the risk assets, as well as from the type and strength of the associations among them. Moreover, the dependence structure among the components may change conditionally t past observations. Some papers have attempted to model this characteristic by assuming a multivariate GARCH model, or by considering the conditional correlation coefficient, or by incorporating some possibility for switches in regimes. In this paper we address this problem using time-varying copulas. Our modeling strategy allows for the margins to follow some FIGARCH type model while the copula dependence structure changes over time.

Radiation protection training for personnel employed in medical facilities

International Nuclear Information System (INIS)

McElroy, N.L.; Brodsky, A.

1985-05-01

This report provides information useful for planning and conducting radiation safety training in medical facilities to keep exposures as low as reasonably achievable, and to meet other regulatory, safety and loss prevention requirements in today's hospitals. A brief discussion of the elements and basic considerations of radation safety training programs is followed by a short bibliography of selected references and sample lecture (or session) outlines for various job categories. This information is intended for use by a professional who is thoroughly acquainted with the science and practice of radiation protection as well as the specific procedures and circumstances of the particular hospital's operations. Topics can be added or substracted, amplified or condensed as appropriate. 8 refs

Decommissioning of Medical, Industrial and Research Facilities. Safety Guide

International Nuclear Information System (INIS)

2010-01-01

Radioactive waste is produced in the generation of nuclear power and the use of radioactive materials in industry, research and medicine. The importance of the safe management of radioactive waste for the protection of human health and the environment has long been recognized, and considerable experience has been gained in this field. The IAEA's Radioactive Waste Safety Standards Programme aimed at establishing a coherent and comprehensive set of principles and requirements for the safe management of waste and formulating the guidelines necessary for their application. This is accomplished within the IAEA Safety Standards Series in an internally consistent set of publications that reflect an international consensus. The publications will provide Member States with a comprehensive series of internationally agreed publications to assist in the derivation of, and to complement, national criteria, standards and practices. The Safety Standards Series consists of three categories of publications: Safety Fundamentals, Safety Requirements and Safety Guides. With respect to the Radioactive Waste Safety Standards Programme, the set of publications is currently undergoing review to ensure a harmonized approach throughout the Safety Standards Series. This Safety Guide addresses the subject of decommissioning of medical, industrial and research facilities where radioactive materials and sources are produced, received, used and stored. It is intended to provide guidance to national authorities and operating organizations, particularly to those in developing countries (as such facilities are predominant in these countries), for the planning and safe management of the decommissioning of such facilities. The Safety Guide has been prepared through a series of Consultants meetings and a Technical Committee meeting

Decommissioning of medical, industrial and research facilities. Safety guide

International Nuclear Information System (INIS)

2005-01-01

Radioactive waste is produced in the generation of nuclear power and the use of radioactive materials in industry, research and medicine. The importance of the safe management of radioactive waste for the protection of human health and the environment has long been recognized, and considerable experience has been gained in this field. The IAEA's Radioactive Waste Safety Standards Programme aimed at establishing a coherent and comprehensive set of principles and requirements for the safe management of waste and formulating the guidelines necessary for their application. This is accomplished within the IAEA Safety Standards Series in an internally consistent set of publications that reflect an international consensus. The publications will provide Member States with a comprehensive series of internationally agreed publications to assist in the derivation of, and to complement, national criteria, standards and practices. The Safety Standards Series consists of three categories of publications: Safety Fundamentals, Safety Requirements and Safety Guides. With respect to the Radioactive Waste Safety Standards Programme, the set of publications is currently undergoing review to ensure a harmonized approach throughout the Safety Standards Series. This Safety Guide addresses the subject of decommissioning of medical, industrial and research facilities where radioactive materials and sources are produced, received, used and stored. It is intended to provide guidance to national authorities and operating organizations, particularly to those in developing countries (as such facilities are predominant in these countries), for the planning and safe management of the decommissioning of such facilities. The Safety Guide has been prepared through a series of Consultants meetings and a Technical Committee meeting

Code of practice for the design and safe operation of non-medical irradiation facilities (1988)

International Nuclear Information System (INIS)

1988-01-01

This Code establishes requirements for the design and operation of irradiation facilities which use X-rays, electrons or gamma radiation for non-medical purposes such as the sterilisation of therapeutic goods. These requirements aim to ensure that exposure of workers and members of the public to ionizing and non-ionizing radiation as well as to noxious gases and radioactive contamination of the environment and facilities are controlled through the design of engineering safety features, approved administrative controls and appropriate radiation monitoring [fr

Neutron measurements at BRIT/BARC medical cyclotron facility of RMC, Parel

International Nuclear Information System (INIS)

Sathian, Deepa; Sathian, V.; Phandnis, U.V.; Soni, P.S.; Mohite, D.Y.

2005-01-01

Neutron leakage and its long distance propagation in the atmosphere from the intense neutron facilities such as high energy accelerators like Cyclotron are very important for the shielding design of the facilities and resulting dose reduction to nearby population, because of strong penetrability of high energy neutrons. The neutron interaction cross sections are highly energy dependent, so different methods are adopted for measuring different energy neutrons. The method also depends on the amount of neutron fluence rate expected at the location. When the fluence rate is very high, the foil activation is the best method for the measurement of neutron fluence rate. In foil activation technique an inactive material is activated by neutrons and the activity is measured and correlated to the neutron fluence rate. In this paper, neutron fluence rate measurement using different activation foils at medical cyclotron room of Radiation Medicine Centre (RMC) is discussed. (author)

Isolation and characterization of specific bacteriophage Va1 to Vibrio alginolyticus

Directory of Open Access Journals (Sweden)

Carla Fernández Espinel

2017-04-01

Full Text Available Vibrio alginolyticus is associated with diseases in aquaculture. The misuse of antibiotics has led to the search for alternatives in the treatment of bacterial diseases, among them the application of bacteriophages that infect and destroy bacteria selectively. In this way, a highly lytic V. alginolyticus bacteriophage, termed Va1, was isolated, with the aim to evaluate its physical chemical parameters. For this purpose, different temperature, pH, chloroform exposure and host range conditions were evaluated. The temperature stability of phage Va1 showed higher titers at 20 and 30 °C decreasing from 40 °C. With respect to pH, the highest titers for the bacteriophage were between 5 and 8, and chloroform exposure reduced viability of the Va1 phage by 25%. The one-step curve determined that the latency period and the burst size were 20 minutes and 192 PFU / infective center respectively. Under the transmission electron microscope, the Va1 phage showed an icosahedral head and a non-contractile tail, belonging to the Podoviridae family. In conclusion, Va1 phage presents potential characteristics for use in phage therapy.

Current status of personnel exposure at nuclear power plants and other medical, industrial and educational facilities in JAPAN

International Nuclear Information System (INIS)

Sasaki, Fumiaki

1991-01-01

The state of radiation exposure of the workers engaging in radiation works in Japanese nuclear power stations, the factors of the radiation exposure of the workers engaging in radiation works, the countermeasures for reducing exposure in nuclear power stations, the state of radiation exposure of doctors, the workers engaging in radiation works, researchers and others in medical, industrial, research and educational and other facilities in Japan, the factors of their radiation exposure and the countermeasures for reducing the exposure, and the comparison of the exposure in nuclear power stations with that in medical, industrial, research and educational facilities are reported. (K.I.)

The Application of VaR Method to Risk Evaluation of Bank Loans%VaR方法在银行贷款风险评估中的应用

Institute of Scientific and Technical Information of China (English)

邹新月

2005-01-01

Value-at-Risk model developed recently is a mathemetical medol to measure and monitor market risk. The article focuses on discussing calculate procedure and calculate method about applying VaR means for the bank loan risk in evaluation, we make clear differentiate both the Bank for International Settlements draw credit risk reserve and VaR means calculate bank loan risk value, find VaR means in application practicality value and extensity perspective in our bank loan risk for evaluation

Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

Science.gov (United States)

Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

2010-12-01

In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

78 FR 76412 - Agency Information Collection (VA National Rehabilitation Special Events, Event Registration...

Science.gov (United States)

2013-12-17

... INFORMATION: Titles: a. National Disabled Veterans Winter Sports Clinic Application, VA Form 0924a, c, d and..., c, e. j. Voluntary Service Application, VA Form 0927f. k. National Veterans Summer sports Clinic... Festival Event Application, VA0929a, b, c, d, e, f, g, h. Type of Review: Revision of an already approved...

PERHITUNGAN VaR PORTOFOLIO SAHAM MENGGUNAKAN DATA HISTORIS DAN DATA SIMULASI MONTE CARLO

Directory of Open Access Journals (Sweden)

WAYAN ARTHINI

2012-09-01

Full Text Available Value at Risk (VaR is the maximum potential loss on a portfolio based on the probability at a certain time.  In this research, portfolio VaR values calculated from historical data and Monte Carlo simulation data. Historical data is processed so as to obtain stock returns, variance, correlation coefficient, and variance-covariance matrix, then the method of Markowitz sought proportion of each stock fund, and portfolio risk and return portfolio. The data was then simulated by Monte Carlo simulation, Exact Monte Carlo Simulation and Expected Monte Carlo Simulation. Exact Monte Carlo simulation have same returns and standard deviation  with historical data, while the Expected Monte Carlo Simulation satistic calculation similar to historical data. The results of this research is the portfolio VaR  with time horizon T=1, T=10, T=22 and the confidence level of 95 %, values obtained VaR between historical data and Monte Carlo simulation data with the method exact and expected. Value of VaR from both Monte Carlo simulation is greater than VaR historical data.

A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: can medical assistants be considered an alternative to physicians?

Science.gov (United States)

2010-01-01

Objective This study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh. Methods The study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers. Results Of the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51. Conclusion This study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death. PMID:20712906

STRESSFUL SITUATIONS IN THE WORK OF A MULTIPROFILE PEDIATRIC MEDICAL FACILITY'S CALL CENTER

Directory of Open Access Journals (Sweden)

I. M. Spivak

2015-01-01

Full Text Available Stressful situations in the work of a pediatric medical facility's call center are associated with patients' violation of social communication norms and aggressive behavior, as well as the operator's professional/maternal conflict. The following psychological resources facilitate better stress resistance of operators: self-confidence, mature and rational attitude, personal activity, inner satisfaction, optimism, emotional breadth and emotional colleague support. 

Poincare group, SU(3) and V-A in leptonic decay

International Nuclear Information System (INIS)

Boehm, A.

1975-07-01

From as few assumptions as possible about the relations between the Poincare group, the particle classifying SU(3) and V-A we derive properties of the K/sub l 3 / and K/sub L 2 / decays. From the assumed relation between SU(3) and the Poincare group and the first class condition it follows that the formfactor ratio Xi of K/sub l 3 / decay is Xi = --0.57, and that a value of Xi = 0 is in disagreement with very general and well accepted theoretical assumptions. Assuming universality of V-A, the Cabibbo suppression is derived from the relations between SU(3) and V-A as a consequence of the brokenness of SU(3). (U.S.)

78 FR 18425 - Proposed Information Collection VA Police Officer Pre-Employment Screening Checklist); Comment...

Science.gov (United States)

2013-03-26

... techniques or the use of other forms of information technology. Title: VA Police Officer Pre-Employment... Police Officer Pre-Employment Screening Checklist); Comment Request AGENCY: Office of Operations... approved collection. Abstract: VA personnel complete VA Form 0120 to document pre- employment history and...

76 FR 24570 - Proposed Information Collection (Application for VA Education Benefits) Activity; Comment Request

Science.gov (United States)

2011-05-02

... (Application for VA Education Benefits) Activity; Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA... Under the Montgomery GI Bill, VA Form 22-1990E. c. Application for VA Education Benefits Under the...

Validation of KENO V.a for the Portsmouth Gaseous Diffusion Plant

International Nuclear Information System (INIS)

Felsher, H.D.; Fentiman, A.W.; Tayloe, R.W.; D'Aquila, D.

1992-01-01

At the Portsmouth Gaseous Diffusion Plant, KENO V.a is used to make criticality calculations for complex configurations and a wide range of 235 U enrichments. It is essential that the calculated critical conditions either accurately reflect the true critical state or that the bias from the true critical conditions are well known. Accordingly, a study has been initiated to validate KENO V.a over the ranges of parameters expected to be used when modeling equipment and processes at Portsmouth. Preliminary results of that study are reported in this paper. The ultimate goal of this study is to identify a set of data from existing critical experiments that will exercise all KENO V.a parameters commonly used by Portsmouth's criticality safety personnel. A second goal is to identify a relatively small subset of those experiments that may be run frequently to ensure that KENO V.a provides consistent results

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

Science.gov (United States)

2014-11-01

2009-2013 13 Contents Page ii GAO-15-55 VA Psychiatric Medications and Suicide Data Table 2: Number of Veterans in GAO’s Sample...anxiety, depressed mood, ruminations , suicidal ideation, sleep problems, intrusive memories, drug seeking behaviors, flashbacks, guilt/remorse...recommendation, with estimated completion dates in calendar year 2015. As agreed with your office, unless you publicly announce the contents of this

Performance specifications for proton medical facility

Energy Technology Data Exchange (ETDEWEB)

Chu, W.T.; Staples, J.W.; Ludewigt, B.A.; Renner, T.R.; Singh, R.P.; Nyman, M.A.; Collier, J.M.; Daftari, I.K.; Petti, P.L.; Alonso, J.R. [Lawrence Berkeley Lab., CA (United States); Kubo, H.; Verhey, L.J. [University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine; Castro, J.R. [Lawrence Berkeley Lab., CA (United States)]|[University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine

1993-03-01

Performance specifications of technical components of a modern proton radiotherapy facility are presented. The technical items specified include: the accelerator; the beam transport system including rotating gantry; the treatment beamline systems including beam scattering, beam scanning, and dosimetric instrumentation; and an integrated treatment and accelerator control system. Also included are treatment ancillary facilities such as diagnostic tools, patient positioning and alignment devices, and treatment planning systems. The facility specified will accommodate beam scanning enabling the three-dimensional conformal therapy deliver .

Geographic Distribution of VA Expenditures FY 2016

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2010

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2012

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2004

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY1998

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2009

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2013

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

Geographic Distribution of VA Expenditures FY2002

Data.gov (United States)

Department of Veterans Affairs — This report details VA expenditures at the state, county, and Congressional District level. It includes categories such as Compensation and Pension, Construction,...

76 FR 2702 - Federal Property Suitable as Facilities To Assist the Homeless

Science.gov (United States)

2011-01-14

..., Arlington, VA 22202; (703) 601-2545; COAST GUARD: Commandant, United States Coast Guard, Attn: Jennifer... Facilities To Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... surplus Federal property reviewed by HUD for suitability for possible use to assist the homeless. FOR...

76 FR 78294 - Federal Property Suitable as Facilities to Assist the Homeless

Science.gov (United States)

2011-12-16

..., 2511 Jefferson Davis Hwy, Arlington, VA 22202: (571) 256-8145; Coast Guard: Commandant, United States... Facilities to Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... surplus Federal property reviewed by HUD for suitability for use to assist the homeless. FOR FURTHER...

76 FR 82317 - Federal Property Suitable as Facilities To Assist the Homeless

Science.gov (United States)

2011-12-30

..., 2511 Jefferson Davis Hwy, Arlington, VA 22202: (571) 256-8145; Coast Guard: Commandant, United States... Facilities To Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... surplus Federal property reviewed by HUD for suitability for use to assist the homeless. FOR FURTHER...

76 FR 76984 - Federal Property Suitable as Facilities To Assist the Homeless

Science.gov (United States)

2011-12-09

..., Arlington, VA 22202: (571) 256-8145; COAST GUARD: Commandant, United States Coast Guard, Attn: Jennifer... Facilities To Assist the Homeless AGENCY: Office of the Assistant Secretary for Community Planning and... surplus Federal property reviewed by HUD for suitability for use to assist the homeless. FOR FURTHER...

78 FR 76061 - Authorization for Non-VA Medical Services

Science.gov (United States)

2013-12-16

... rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the... Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical Resources; 64...

1000-kVA arc power supply

International Nuclear Information System (INIS)

Wright, R.E.; Barber, G.C.; Ponte, N.S.

1979-01-01

Because of ever-increasing power demands for the development of the Oak Ridge duoPIGatron ion source, a continuous-duty arc power supply was constructed for the Medium Energy Test Facility (METF) to furnish power for the plasma generator of experimental ion sources. The power supply utilizes 12-pulse rectification with half-wave switching in a delta and wye full-wave bridge that may be connected in series or parallel. It will deliver 340 V dc, 2500 A to an ion source when series connected and 170 V dc, 5000 A when paralleled connected. Silicon-controlled rectifiers (SCR) in each rectifier bridge can be switched for pulses as short as 10 ms through continuous duty. The filter section that reduces the ripple in the output consists of an inductor-to-capacitor (L-C) filter to smooth the 720-Hz pulses. The power transformer serves as an isolation transformer allowing the secondary to be elevated to the accelerating potential of the ion source. The dc output level is controlled with a 1000-kVA auto transformer connected to the primary of the power transformer. All elevated voltages and currents are monitored at ground potential with an optical telemetry system. This paper describes the power supply in detail, including block diagrams, component specifications, and waveforms when supplying power to an ion source

Continuous-energy version of KENO V.a for criticality safety applications

International Nuclear Information System (INIS)

Dunn, Michael E.; Greene, N. Maurice; Petrie, Lester M.

2003-01-01

KENO V.a is a multigroup Monte Carlo code that solves the Boltzmann transport equation and is used extensively in the criticality safety community to calculate the effective multiplication factor of systems with fissionable material. In this work, a continuous-energy or pointwise version of KENO V.a has been developed by first designing a new continuous-energy cross-section format and then by developing the appropriate Monte Carlo transport procedures to sample the new cross-section format. In order to generate pointwise cross sections for a test library, a series of cross-section processing modules were developed and used to process 50 ENDF/B-6 Release 7 nuclides for the test library. Once the cross-section processing procedures were in place, a continuous-energy version of KENO V.a was developed and tested by calculating 21 critical benchmark experiments. The point KENO-calculated results for the 21 benchmarks are in agreement with calculated results obtained with the multigroup version of KENO V.a using the 238-group ENDF/B-5 and 199-group ENDF/B-6 Release 3 libraries. Based on the calculated results with the prototypic cross-section library, a continuous-energy version of the KENO V.a code has been successfully developed and demonstrated for modeling systems with fissionable material. (author)

77 FR 70967 - Authorization for Non-VA Medical Services

Science.gov (United States)

2012-11-28

... regulatory action that is likely to result in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy..., Sharing Specialized Medical Resources; 64.019, Veterans Rehabilitation Alcohol and Drug Dependence; 64.022...

Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

2016-01-01

Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

76 FR 44288 - Establishment of Class E Airspace; New Market, VA

Science.gov (United States)

2011-07-25

...-380; Airspace Docket No. 11-AEA-12] Establishment of Class E Airspace; New Market, VA AGENCY: Federal... proposes to establish Class E Airspace at New Market, VA, to accommodate the additional airspace needed for the Standard Instrument Approach Procedures developed for New Market Airport. This action would...

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives.

Science.gov (United States)

Fasanya, Bankole K; Dada, Emmanuel A

2016-06-01

Workplace violence (WPV) is becoming an issue that needs immediate attention in the United States, especially during this period as more states are adopting the "stand your ground laws to promote worker protection." This study was conducted to investigate how WPV has contributed to an unsafe environment for nurses and nursing assistants who work in long-term medical care facilities. A structure questionnaire was used to collect data for the study. Three facilities were sampled and 80 nurses and certified nursing assistants participated in the study. Ninety-two percent (n = 74) were female and 8% (n = 6) were male. Approximately 62% were black or African American, approximately 33% were Caucasians, and only 2% were from other ethnicities. We found that 65% of the participants had experienced WPV while 41% believed that management shows little or no concern for their safety. Approximately 23% of respondents believed that reporting supervisor's WPV act is an unsafe action. In addition, 22% of those who reported that they have experienced WPV believed that the work environment is not safe to perform their duties. This significant difference in perception of workplace safety between those who had experienced WPV and those who had not was significant (t = 3.95, df = 158, p < 0.0001). WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

76 FR 40453 - Agency Information Collection (Application for VA Education Benefits) Activity Under OMB Review

Science.gov (United States)

2011-07-08

... (Application for VA Education Benefits) Activity Under OMB Review AGENCY: Veterans Benefits Administration... Education Benefits, VA Form 22-1990. b. Application for Family Member to Use Transferred Benefits, VA Form 22-1990E. [[Page 40454

Association between women veterans' experiences with VA outpatient health care and designation as a women's health provider in primary care clinics.

Science.gov (United States)

Bastian, Lori A; Trentalange, Mark; Murphy, Terrence E; Brandt, Cynthia; Bean-Mayberry, Bevanne; Maisel, Natalya C; Wright, Steven M; Gaetano, Vera S; Allore, Heather; Skanderson, Melissa; Reyes-Harvey, Evelyn; Yano, Elizabeth M; Rose, Danielle; Haskell, Sally

2014-01-01

Women veterans comprise a small percentage of Department of Veterans Affairs (VA) health care users. Prior research on women veterans' experiences with primary care has focused on VA site differences and not individual provider characteristics. In 2010, the VA established policy requiring the provision of comprehensive women's health care by designated women's health providers (DWHPs). Little is known about the quality of health care delivered by DWHPs and women veterans' experience with care from these providers. Secondary data were obtained from the VA Survey of Healthcare Experience of Patients (SHEP) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient-centered medical home (PCMH) survey from March 2012 through February 2013, a survey designed to measure patient experience with care and the DWHPs Assessment of Workforce Capacity that discerns between DWHPs versus non-DWHPs. Of the 28,994 surveys mailed to women veterans, 24,789 were seen by primary care providers and 8,151 women responded to the survey (response rate, 32%). A total of 3,147 providers were evaluated by the SHEP-CAHPS-PCMH survey (40%; n = 1,267 were DWHPs). In a multivariable model, patients seen by DWHPs (relative risk, 1.02; 95% CI, 1.01-1.04) reported higher overall experiences with care compared with patients seen by non-DWHPs. The main finding is that women veterans' overall experiences with outpatient health care are slightly better for those receiving care from DWHPs compared with those receiving care from non-DWHPs. Our findings have important policy implications for how to continue to improve women veterans' experiences. Our work provides support to increase access to DWHPs at VA primary care clinics. Published by Elsevier Inc.

Nurses experiences with deaf patient and recommendations for an effective communication with deaf in medical facility

OpenAIRE

Boukalová, Naděžda

2010-01-01

This bachelor thesis whose name is Nurses experiences with deaf patient and recommendations for an effective communication with deaf in medical facility was conceived as pilot research. This thesis consists of two parts, theoretical and experimental. Theoretical part has several chapters, which deal with anatomy of ear, physiology of hearing, deaf in Czech Republic and communication. The last part of this chapter describes certain situations, where is possible to meet the deaf at medical faci...

VA/Q distribution during heavy exercise and recovery in humans: implications for pulmonary edema

Science.gov (United States)

Schaffartzik, W.; Poole, D. C.; Derion, T.; Tsukimoto, K.; Hogan, M. C.; Arcos, J. P.; Bebout, D. E.; Wagner, P. D.

1992-01-01

Ventilation-perfusion (VA/Q) inequality has been shown to increase with exercise. Potential mechanisms for this increase include nonuniform pulmonary vasoconstriction, ventilatory time constant inequality, reduced large airway gas mixing, and development of interstitial pulmonary edema. We hypothesized that persistence of VA/Q mismatch after ventilation and cardiac output subside during recovery would be consistent with edema; however, rapid resolution would suggest mechanisms related to changes in ventilation and blood flow per se. Thirteen healthy males performed near-maximal cycle ergometry at an inspiratory PO2 of 91 Torr (because hypoxia accentuates VA/Q mismatch on exercise). Cardiorespiratory variables and inert gas elimination patterns were measured at rest, during exercise, and between 2 and 30 min of recovery. Two profiles of VA/Q distribution behavior emerged during heavy exercise: in group 1 an increase in VA/Q mismatch (log SDQ of 0.35 +/- 0.02 at rest and 0.44 +/- 0.02 at exercise; P less than 0.05, n = 7) and in group 2 no change in VA/Q mismatch (n = 6). There were no differences in anthropometric data, work rate, O2 uptake, or ventilation during heavy exercise between groups. Group 1 demonstrated significantly greater VA/Q inequality, lower vital capacity, and higher forced expiratory flow at 25-75% of forced vital capacity for the first 20 min during recovery than group 2. Cardiac index was higher in group 1 both during heavy exercise and 4 and 6 min postexercise. However, both ventilation and cardiac output returned toward baseline values more rapidly than did VA/Q relationships. Arterial pH was lower in group 1 during exercise and recovery. We conclude that greater VA/Q inequality in group 1 and its persistence during recovery are consistent with the hypothesis that edema occurs and contributes to the increase in VA/Q inequality during exercise. This is supported by observation of greater blood flows and acidosis and, presumably therefore

MODEL NON LINIER GARCH (NGARCH UNTUK MENGESTIMASI NILAI VALUE at RISK (VaR PADA IHSG

Directory of Open Access Journals (Sweden)

I KOMANG TRY BAYU MAHENDRA

2015-06-01

Full Text Available In investment, risk measurement is important. One of risk measure is Value at Risk (VaR. There are many methods that can be used to estimate risk based on VaR framework. One of them Non Linier GARCH (NGARCH model. In this research, determination of VaR used NGARCH model. NGARCH model allowed for asymetric behaviour in the volatility such that “good news” or positive return and “bad news” or negative return. Based on calculations of VaR, the higher of the confidence level and the longer the investment period, the risk was greater. Determination of VaR using NGARCH model was less than GARCH model.

Vectorization of the KENO V.a criticality safety code

International Nuclear Information System (INIS)

Hollenbach, D.F.; Dodds, H.L.; Petrie, L.M.

1991-01-01

The development of the vector processor, which is used in the current generation of supercomputers and is beginning to be used in workstations, provides the potential for dramatic speed-up for codes that are able to process data as vectors. Unfortunately, the stochastic nature of Monte Carlo codes prevents the old scalar version of these codes from taking advantage of the vector processors. New Monte Carlo algorithms that process all the histories undergoing the same event as a batch are required. Recently, new vectorized Monte Carlo codes have been developed that show significant speed-ups when compared to the scalar version of themselves or equivalent codes. This paper discusses the vectorization of an already existing and widely used criticality safety code, KENO V.a All the changes made to KENO V.a are transparent to the user making it possible to upgrade from the standard scalar version of KENO V.a to the vectorized version without learning a new code

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...

The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans.

Science.gov (United States)

Watkins, Katherine E; Smith, Brad; Akincigil, Ayse; Sorbero, Melony E; Paddock, Susan; Woodroffe, Abigail; Huang, Cecilia; Crystal, Stephen; Pincus, Harold Alan

2016-04-01

The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender. In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment. Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.

Malaria epidemiology in the Pakaanóva (Wari') Indians, Brazilian Amazon.

Science.gov (United States)

Sá, D Ribeiro; Souza-Santos, R; Escobar, A L; Coimbra, C E A

2005-04-01

This paper reports the results of a longitudinal study of malaria incidence (1998-2002) among the Pakaanóva (Wari') Indians, Brazilian southwest Amazon region, based on data routinely gathered by Brazilian National Health Foundation outposts network in conjunction with the Indian health service. Malaria is present yearlong in the Pakaanóva. Statistically significant differences between seasons or months were not noticed. A total of 1933 cases of malaria were diagnosed in the Pakaanóva during this period. The P. vivax / P. falciparum ratio was 3.4. P. vivax accounted for 76.5% of the cases. Infections with P. malariae were not recorded. Incidence rates did not differ by sex. Most malaria cases were reported in children < 10 years old (45%). About one fourth of all cases were diagnosed on women 10-40 years old. An entomological survey carried out at two Pakaanóva villages yielded a total of 3.232 specimens of anophelines. Anopheles darlingi predominated (94.4%). Most specimens were captured outdoors and peak activity hours were noted at early evening and just before sunrise. It was observed that Pakaanóva cultural practices may facilitate outdoor exposure of individuals of both sexes and all age groups during peak hours of mosquito activities (e.g., coming to the river early in the morning for bathing or to draw water, fishing, engaging in hunting camps, etc). In a context in which anophelines are ubiquitous and predominantly exophilic, and humans of both sexes and all ages are prone to outdoor activities during peak mosquito activity hours, malaria is likely to remain endemic in the Pakaanóva, thus requiring the development of alternative control strategies that are culturally and ecologically sensitive.

Facility-level association of preoperative stress testing and postoperative adverse cardiac events.

Science.gov (United States)

Valle, Javier A; Graham, Laura; Thiruvoipati, Thejasvi; Grunwald, Gary; Armstrong, Ehrin J; Maddox, Thomas M; Hawn, Mary T; Bradley, Steven M

2018-06-22

Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE). We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE. Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%-15.9%; range 6.0%-21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%-5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%-17.4%) and postoperative MACE was 3.8% (IQR 2.3%-5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation. In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes. © Article author(s) (or their employer(s) unless otherwise

The Burr X Pareto Distribution: Properties, Applications and VaR Estimation

Directory of Open Access Journals (Sweden)

Mustafa Ç. Korkmaz

2017-12-01

Full Text Available In this paper, a new three-parameter Pareto distribution is introduced and studied. We discuss various mathematical and statistical properties of the new model. Some estimation methods of the model parameters are performed. Moreover, the peaks-over-threshold method is used to estimate Value-at-Risk (VaR by means of the proposed distribution. We compare the distribution with a few other models to show its versatility in modelling data with heavy tails. VaR estimation with the Burr X Pareto distribution is presented using time series data, and the new model could be considered as an alternative VaR model against the generalized Pareto model for financial institutions.

75 FR 33216 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

Science.gov (United States)

2010-06-11

... health care services for veterans).'' Proposed Sec. 17.121(a) would establish the clinical decision maker... practice to utilize the services of health care professionals, such as nurses, for purposes of clinical review. For this reason, establishing the clinical decision maker as a ``designated VA clinician'' would...

76 FR 17752 - Notice of Intent To Prepare an Environmental Impact Statement for the San Francisco Veterans...

Science.gov (United States)

2011-03-30

... Environmental Policy Act (NEPA) of 1969, as amended, (42 U.S.C. 4331 et seq.), the Council on Environmental... the San Francisco Veterans Affairs Medical Center (SFVAMC) Institutional Master Plan AGENCY...: Comments should be addressed to John Pechman, Facility Planner, San Francisco VA Medical Center (001), 4150...

Case-Mix Adjustment of the Bereaved Family Survey.

Science.gov (United States)

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Testing popular VaR models in EU new member and candidate states

Directory of Open Access Journals (Sweden)

Saša Žiković

2007-12-01

Full Text Available The impact of allowing banks to calculate their capital requirement based on their internal VaR models, and the impact of regulation changes on banks in transitional countries has not been well studied. This paper examines whether VaR models that are created and suited for developed markets apply to the volatile stock markets of EU new member and candidate states (Bulgaria, Romania, Croatia and Turkey. Nine popular VaR models are tested on five stock indexes from EU new member and candidate states. Backtesting results show that VaR models commonly used in developed stock markets are not well suited for measuring market risk in these markets. Presented findings bear very important implications that have to be addressed by regulators and risk practitioners operating in EU new member andcandidate states. Risk managers have to start thinking outside the frames set by their parent companies or else investors present in these markets may find themselves in serious trouble, dealing with losses that they have not been expecting. National regulators have to take into consideration that simplistic VaR models that are widely used in some developed countries are not well suited for these illiquid and developing stock markets.

76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

Science.gov (United States)

2011-11-21

... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

76 FR 51957 - Notice of Intent To Prepare an Environmental Impact Statement for the Medical Facilities...

Science.gov (United States)

2011-08-19

... Statement for the Medical Facilities Development and University Expansion at Naval Support Activity Bethesda...: Notice. SUMMARY: Pursuant to section (102)(2)(c) of the National Environmental Policy Act (NEPA) of 1969, the regulations implemented by the Council on Environmental Quality (40 Code of Federal Regulations...

Effects of inspired CO2, hyperventilation, and time on VA/Q inequality in the dog

Science.gov (United States)

Tsukimoto, K.; Arcos, J. P.; Schaffartzik, W.; Wagner, P. D.; West, J. B.

1992-01-01

In a recent study by Tsukimoto et al. (J. Appl. Physiol. 68: 2488-2493, 1990), CO2 inhalation appeared to reduce the size of the high ventilation-perfusion ratio (VA/Q) mode commonly observed in anesthetized mechanically air-ventilated dogs. In that study, large tidal volumes (VT) were used during CO2 inhalation to preserve normocapnia. To separate the influences of CO2 and high VT on the VA/Q distribution in the present study, we examined the effect of inspired CO2 on the high VA/Q mode using eight mechanically ventilated dogs (4 given CO2, 4 controls). The VA/Q distribution was measured first with normal VT and then with increased VT. In the CO2 group at high VT, data were collected before, during, and after CO2 inhalation. With normal VT, there was no difference in the size of the high VA/Q mode between groups [10.5 +/- 3.5% (SE) of ventilation in the CO2 group, 11.8 +/- 5.2% in the control group]. Unexpectedly, the size of the high VA/Q mode decreased similarly in both groups over time, independently of the inspired PCO2, at a rate similar to the fall in cardiac output over time. The reduction in the high VA/Q mode together with a simultaneous increase in alveolar dead space (estimated by the difference between inert gas dead space and Fowler dead space) suggests that poorly perfused high VA/Q areas became unperfused over time. A possible mechanism is that elevated alveolar pressure and decreased cardiac output eliminate blood flow from corner vessels in nondependent high VA/Q regions.

Investigation on proper materials of a liner system for trench type disposal facilities of radioactive wastes from research, industrial and medical facilities

International Nuclear Information System (INIS)

Nakata, Hisakazu; Amazawa, Hiroya; Sakai, Akihiro; Arikawa, Masanobu; Sakamoto, Yoshiaki

2011-08-01

The Low-level Radioactive Waste Disposal Project Center of Japan Atomic Energy Agency will settle on near surface disposal facilities with and without engineered barriers for radioactive wastes from research, industrial and medical facilities. Both of them are so called 'concrete pit type' and 'trench type', respectively. The technical standard of constructing and operating a disposal facility based on 'Law for the Regulations of Nuclear Source Material, Nuclear Fuel Material and Reactors' have been regulated partly by referring to that of 'Waste Management and Public Cleansing Law'. This means that the concrete pit type and the trench type disposal facility resemble an isolated type for specified industrial wastes and a non leachate controlled type final disposal site for stable industrial wastes, respectively. On the other, We plan to design a disposal facility with a liner system corresponding to a leachate controlled type final disposal site on a crucial assumption that radioactive wastes other than stable industrial wastes to be disposed into the trench type disposal facility is generated. By current nuclear related regulations in Japan, There are no technical standard of constructing the disposal facility with the liner system referring to that of 'Waste Management and Public Cleansing Law'. We investigate the function of the liner system in order to design a proper liner system for the trench type disposal facility. In this report, We investigated liner materials currently in use by actual leachate controlled type final disposal sites in Japan. Thereby important items such as tensile strength, durability from a view point of selecting proper liner materials were studied. The items were classified into three categories according to importance. We ranked proper liner materials for the trench type disposal facility by evaluating the important items per material. As a result, high density polyethylene(HDPE) of high elasticity type polymetric sheet was selected

78 FR 66265 - Drawbridge Operation Regulation; Elizabeth River, Eastern Branch, Norfolk, VA

Science.gov (United States)

2013-11-05

... Operation Regulation; Elizabeth River, Eastern Branch, Norfolk, VA AGENCY: Coast Guard, DHS. ACTION: Notice... Elizabeth River Eastern Branch, mile 1.1, at Norfolk, VA. This deviation is necessary to facilitate... maintenance. The Norfolk Southern 5 railroad Bridge, at mile 1.1, across the Elizabeth River (Eastern Branch...

46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2” to...

Can reported VaR be used as an indicator of the volatility of share prices? Evidence from UK banks.

OpenAIRE

Ou, Shian Kao

2006-01-01

Value at Risk (VaR) is used as an indicator to measure the risks contained in a firm. With the uprising development of VaR theory and computational techniques, the VaR is nowadays adopted by banks and reported in annual reports. Since the method to calculate VaR is questioned, and the reported VaR can not be thoroughly audited, this paper attempts to find the relationship between the reported VaR and the volatility of share price for UK listed banks. This paper reviews literature about VaR an...

Preliminary assessment report for Virginia Army National Guard Army Aviation Support Facility, Richmond International Airport, Installation 51230, Sandston, Virginia

International Nuclear Information System (INIS)

Dennis, C.B.

1993-09-01

This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Virginia Army National Guard (VaARNG) property in Sandston, Virginia. The Army Aviation Support Facility (AASF) is contiguous with the Richmond International Airport. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The PA is designed to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathways by which contamination could affect public health and the environment. The AASF, originally constructed as an active Air Force interceptor base, provides maintenance support for VaARNG aircraft. Hazardous materials used and stored at the facility include JP-4 jet fuel, diesel fuel, gasoline, liquid propane gas, heating oil, and motor oil

Community-level football injury epidemiology: traumatic injuries treated at Swedish emergency medical facilities.

Science.gov (United States)

Timpka, Toomas; Schyllander, Jan; Stark Ekman, Diana; Ekman, Robert; Dahlström, Örjan; Hägglund, Martin; Kristenson, Karolina; Jacobsson, Jenny

2018-02-01

Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties. An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location. Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries. One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A qualitative study exploring issues related to medication management in residential aged care facilities.

Science.gov (United States)

Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd

2017-01-01

Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents' medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

CERN-MEDICIS (Medical Isotopes Collected from ISOLDE: A New Facility

Directory of Open Access Journals (Sweden)

Ricardo Manuel dos Santos Augusto

2014-05-01

Full Text Available About 50% of the 1.4 GeV CERN (European Organization for Nuclear Research, www.cern.ch protons are sent onto targets to produce radioactive beams by online mass separation at the Isotope Separator Online Device (ISOLDE facility, for a wide range of studies in fundamental and applied physics. CERN-MEDICIS is a spin-off dedicated to R&D in life sciences and medical applications. It is located in an extension of the Class A building presently under construction. It will comprise laboratories to receive the irradiated targets from a new station located at the dump position behind the ISOLDE production targets. An increasing range of innovative isotopes will thus progressively become accessible from the start-up of the facility in 2015 onward; for fundamental studies in cancer research, for new imaging and therapy protocols in cell and animal models and for pre-clinical trials, possibly extended to specific early phase clinical studies up to Phase I trials. Five hundred megabecquerel isotope batches purified by electromagnetic mass separation combined with chemical methods will be collected on a weekly basis. A possible future upgrade with gigabecquerel pharmaceutical-grade i.e., current good manufacturing practices (cGMP batch production capabilities is finally presented.

[CERN-MEDICIS (Medical Isotopes Collected from ISOLDE): a new facility].

Science.gov (United States)

Viertl, David; Buchegger, Franz; Prior, John O; Forni, Michel; Morel, Philippe; Ratib, Osman; Bühler Léo H; Stora, Thierry

2015-06-17

CERN-MEDICIS is a facility dedicated to research and development in life science and medical applications. The research platform was inaugurated in October 2014 and will produce an increasing range of innovative isotopes using the proton beam of ISOLDE for fundamental studies in cancer research, for new imaging and therapy protocols in cell and animal models and for preclinical trials, possibly extended to specific early phase clinical studies (phase 0) up to phase I trials. CERN, the University Hospital of Geneva (HUG), the University Hospital of Lausanne (CHUV), the Swiss Institute for Experimental Cancer (ISREC) at Swiss Federal Institutes of Technology (EPFL) that currently support the project will benefit of the initial production that will then be extended to other centers.

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

Directory of Open Access Journals (Sweden)

Mokgobadibe V. Ntsiea

2017-06-01

Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

46 CFR 7.45 - Cape Henlopen, DE to Cape Charles, VA.

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Cape Henlopen, DE to Cape Charles, VA. 7.45 Section 7.45... Atlantic Coast § 7.45 Cape Henlopen, DE to Cape Charles, VA. (a) A line drawn from the easternmost extremity of Indian River Inlet North Jetty to latitude 38°36.5′ N. longitude 75°02.8′ W. (Indian River...

Use of the TACL [Thaumaturgic Automated Control Logic] system at CEBAF [Continuous Electron Beam Accelerator Facility] for control of the Cryogenic Test Facility

International Nuclear Information System (INIS)

Navarro, E.; Keesee, M.; Bork, R.; Grubb, C.; Lahti, G.; Sage, J.

1989-01-01

A logic-based control software system, called Thaumaturgic Automated Control Logic (TACL), is under development at the Continuous Electron Beam Accelerator Facility in Newport News, VA. The first version of the software was placed in service in November, 1987 for control of cryogenics during the first superconducting RF cavity tests at CEBAF. In August, 1988 the control system was installed at the Cryogenic Test Facility (CTF) at CEBAF. CTF generated liquid helium in September, 1988 and is now in full operation for the current round of cavity tests. TACL is providing a powerful and flexible controls environment for the operation of CTF. 3 refs

VA Enterprise Design Patterns - 5.1 (Mobility) Mobile

Data.gov (United States)

Department of Veterans Affairs — First of a set of guidance documents that establish the architectural foundation for mobile computing in the VA. This document outlines the enterprise capabilities...

VA Enterprise Design Patters - 2.5 (Enterprise Architecture)

Data.gov (United States)

Department of Veterans Affairs — Enterprise architectural guidelines and constraints that provide references to the use of enterprise capabilities that will enable the VA to access and exchange data...

38 CFR 74.26 - What types of business information will VA collect?

Science.gov (United States)

2010-07-01

... VETERANS AFFAIRS (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.26 What types of business information will VA collect? VA will examine a variety of business records. See § 74.12, “What is... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false What types of business...

Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century

Science.gov (United States)

2007-10-01

War or the 1899-1901 Philippine Insurrection.14 I.2 World War I By the early 20th century, the reconstituted Armed Forces of the United States...to the tardiness of the current system. Third, when medical evidence, possibly new, about the veteran from non-VA medical facilities is critical to

A qualitative study exploring issues related to medication management in residential aged care facilities

Directory of Open Access Journals (Sweden)

Ahmad Nizaruddin M

2017-11-01

Full Text Available Mariani Ahmad Nizaruddin, Marhanis-Salihah Omar, Adliah Mhd-Ali, Mohd Makmor-Bakry Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Background: Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs.Participants and methods: A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner.Results and discussion: Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes.Conclusion: There are important issues

Profile of medical waste management in two healthcare facilities in Lagos, Nigeria: a case study.

Science.gov (United States)

Idowu, Ibijoke; Alo, Babajide; Atherton, William; Al Khaddar, Rafid

2013-05-01

Proper management and safe disposal of medical waste (MW) is vital in the reduction of infection or illness through contact with discarded material and in the prevention of environmental contamination in hospital facilities. The management practices for MW in selected healthcare facilities in Lagos, Nigeria were assessed. The cross-sectional study involved the use of questionnaires, in-depth interviews, focused group discussions and participant observation strategies. It also involved the collection, segregation, identification and weighing of waste types from wards and units in the representative facilities in Lagos, Nigeria, for qualitative and quantitative analysis of the MW streams. The findings indicated that the selected Nigerian healthcare facilities were lacking in the adoption of sound MW management (MWM) practices. The average MW ranged from 0.01 kg/bed/day to 3.98 kg/bed/day. Moreover, about 30% of the domestic waste from the healthcare facilities consisted of MW due to inappropriate co-disposal practices. Multiple linear regression was applied to predict the volume of waste generated giving a correlation coefficient (R(2)) value of 0.99 confirming a good fit of the data. This study revealed that the current MWM practices and strategies in Lagos are weak, and suggests an urgent need for review to achieve vital reversals in the current trends.

Payment or reimbursement for certain medical expenses for Camp Lejeune family members. Interim final rule.

Science.gov (United States)

2014-09-24

The Department of Veterans Affairs (VA) is promulgating regulations to implement statutory authority to provide payment or reimbursement for hospital care and medical services provided to certain veterans' family members who resided at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. Under this rule, VA will reimburse family members, or pay providers, for medical expenses incurred as a result of certain illnesses and conditions that may be attributed to exposure to contaminated drinking water at Camp Lejeune during this time period. Payment or reimbursement will be made within the limitations set forth in statute and Camp Lejeune family members will receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans.

38 CFR 17.57 - Use of community nursing homes.

Science.gov (United States)

2010-07-01

... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following... currently receiving VA hospital based home health services. (Authority: 38 U.S.C. 1720; sec. 108, Pub. L. 99...

Interaction of blood coagulation factor Va with phospholipid vesicles examined by using lipophilic photoreagents

International Nuclear Information System (INIS)

Krieg, U.C.; Isaacs, B.S.; Yemul, S.S.; Esmon, C.T.; Bayley, H.; Johnson, A.E.

1987-01-01

Two different lipophilic photoreagents, [ 3 H]adamantane diazirine and 3-(trifluoromethyl)-3-(m-[ 125 I]iodophenyl)diazirine (TID), have been utilized to examine the interactions of blood coagulation factor Va with calcium, prothrombin, factor Xa, and, in particular, phospholipid vesicles. With each of these structurally dissimilar reagents, the extent of photolabeling of factor Va was greater when the protein was bound to a membrane surface than when it was free in solution. Specifically, the covalent photoreaction with Vl, the smaller subunit of factor Va, was 2-fold higher in the presence of phosphatidylcholine/phosphatidylserine (PC/PS, 3:1) vesicles, to which factor Va binds, than in the presence of 100% PC vesicles, to which the protein does not bind. However, the magnitude of the PC/PS-dependent photolabeling was much less than has been observed previously with integral membrane proteins. It therefore appears that the binding of factor Va to the membrane surface exposes Vl to the lipid core of the bilayer, but that only a small portion of the Vl polypeptide is exposed to, or embedded in, the bilayer core. Addition of either prothrombin or active-site-blocked factor Xa to PC/PS-bound factor Va had little effect on the photolabeling of Vl with TID, but reduced substantially the covalent labeling of Vh, the larger subunit of factor Va. This indicates that prothrombin and factor Xa each cover nonpolar surfaces on Vh when the macromolecules associate on the PC/PS surface. It therefore seems likely that the formation of the prothrombinase complex involves a direct interaction between Vh and factor Xa and between Vh and prothrombin.(ABSTRACT TRUNCATED AT 250 WORDS)

78 FR 36092 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

Science.gov (United States)

2013-06-17

... care, Dental health, Drug abuse, Foreign relations, Government contracts, Grant programs--Health, Grant programs--Veterans, Health care, Health facilities, Health professions, Health records, Homeless, Medical and dental schools, Medical devices, Medical research, Mental health programs, Nursing homes...

75 FR 25321 - Agency Information Collection (VA National Rehabilitation Special Events, Event Registration...

Science.gov (United States)

2010-05-07

... Winter Sports Clinic Application, VA Form 0924a series. b. National Veterans Wheelchair Games Application.... National Veterans TEE Tournament Application, VA Form 0927a series. e. National Veterans Summer Sports... Form 0929a series. Type of Review: Existing collection in use without an OMB control number. Abstract...

V.A. Gorodtsov and Kazan: tour 1920

Directory of Open Access Journals (Sweden)

Kuzminykh Sergey V.

2014-12-01

Full Text Available A fragment of an archival document is published, that is connected to the September 8-12, 1920, stay in Kazan of V.A. Gorodtsov, who headed the Archaeological Subdepartment with the Museum Department of the RSFSR People’s Commissariat for Education, in the framework of his inspecting tour around the towns of the Volga and Urals region. The document is a diary, and its entries reflect information about the tour and its results that had not been exhaustively reflected in official documentation. It narrates about meetings, polemic exchanges, Gorodtsov’s addresses to scientists and the public, his impressions of the archaeological investigations in the regions, and the state of the museums and collections. V.A. Gorodtsov’s encounters and personal contacts with B.F. Adler, N.F. Katanov, M.G. Hudyakov and other researchers had played a positive role in archaeology development in the Volga-Kama region during the hardest times after the revolution.

Vađenje podrtina i potonulih stvari u svjetlu novele Pomorskog zakonika iz 2013. godine

Directory of Open Access Journals (Sweden)

Vesna Skorupan Wolff

2017-11-01

Full Text Available Materiju vađenja podrtina i potonulih stvari uređuju odredbe upravnopravne prirode koje reguliraju odnose između vlasnika podrtine ili potonule stvari, odnosno ovlaštene osobe i upravnih tijela, a kojima se uređuju razni pravni aspekti postupka vađenja. Pravo vaditi podrtinu ili potonulu stvar primarno ima njezin vlasnik odnosno ovlaštena osoba. Zakon vlasnicima podrtina i potonulih stvari, odnosno ovlaštenim osobama, ostavlja primjeren rok u kojem mogu pokrenuti upravni postupak za dobivanje dozvole za vađenje podrtine ili potonule stvari. Na taj način jamči se nepovredivost vlasništva i utvrđuje načelo prema kojem činjenica da je stvar potonula ili se nasukala ne utječe izravno na vlasnička prava njezina dotadašnjeg vlasnika. Međutim, ako vlasnik, odnosno ovlaštena osoba ne zatraži odobrenje za vađenje podrtine ili potonule stvari, ili kad bez opravdanog razloga prekine ili napusti započeto vađenje kao i u slučaju ako je ovlaštena osoba nepoznata, PZ nudi pravni okvir i omogućuje da vađenje podrtine ili potonule stvari poduzme pošteni nalaznik ili lučka kapetanija. U okviru instituta vađenja podrtina i potonulih stvari uvodi se posebno pravno uređenje za nalaz stvari u moru te se precizno normiraju svi segmenti postupka vađenja kada ga poduzima pošteni nalaznik ili lučka kapetanija. Uređuju se i sva relevantna pitanja u svezi postupanja s izvađenim stvarima kao što su njihovo čuvanje te u propisanim slučajevima mogućnost prodaje na javnoj dražbi. PZ-om se precizno uređuju obvezni odnosi koji nastaju između vlasnika, odnosno ovlaštene osobe i poštenog nalaznika te vlasnika, odnosno ovlaštene osobe i lučke kapetanije, ovisno o tome tko je poduzeo vađenje, a koji se odnose na plaćanje naknade za vađenje, čuvanje, nalazninu i druge tražbine koje zakon priznaje poštenim nalaznicima i lučkim kapetanijama. U okviru toga, uređuje se i posebno stvarnopravno uređenje za stjecanje prava vlasni

VA Dental Insurance Program--federalism. Direct final rule; confirmation of effective date.

Science.gov (United States)

2014-03-20

The Department of Veterans Affairs (VA) published a direct final rule in the Federal Register on October 22, 2013, amending its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. Specifically, this rule adds language to clarify the limited preemptive effect of certain criteria in the VADIP regulations. VA received no comments concerning this rule or its companion substantially identical proposed rule published in the Federal Register on October 23, 2013. This document confirms that the direct final rule became effective on December 23, 2013. In a companion document in this issue of the Federal Register, we are withdrawing as unnecessary the proposed rule.

38 CFR 1.9 - Description, use, and display of VA seal and flag.

Science.gov (United States)

2010-07-01

... stars represent the five branches of military service. The crossed flags represent our nation's history... employees. (D) Official VA signs. (E) Official publications or graphics issued by and attributed to VA, or...) Souvenir or novelty items. (iii) Toys or commercial gifts or premiums. (iv) Letterhead design, except on...

Validation of KENO V.a for highly enriched uranium systems with hydrogen and/or carbon moderation

International Nuclear Information System (INIS)

Elliott, E.P.; Vornehm, R.G.; Dodds, H.L. Jr.

1993-01-01

This paper describes the validation in accordance with ANSI/ANS-8.1-1983(R1988) of KENO V.a using the 27-group ENDF/B-IV cross-section library for systems containing highly-enriched uranium, carbon, and hydrogen and for systems containing highly-enriched uranium and carbon with high carbon to uranium (C/U) atomic ratios. The validation has been performed for two separate computational platforms: an IBM 3090 mainframe and an HP 9000 Model 730 workstation, both using the Oak Ridge Y-12 Plant Nuclear Criticality Safety Software (NCSS) code package. Critical experiments performed at the Oak Ridge Critical Experiments Facility, in support of the Rover reactor program, and at the Pajarito site at Los Alamos National Laboratory were identified as having the constituents desired for this validation as well as sufficient experimental detail to allow accurate construction of KENO V.a calculational models. Calculated values of k eff for the Rover experiments, which contain uranium, carbon, and hydrogen, are between 1.0012 ± 0.0026 and 1.0245 ± 0.0023. Calculation of the Los Alamos experiments, which contain uranium and carbon at high C/U ratios, yields values of k eff between 0.9746 ± 0.0028 and 0.9983 ± 0.0027. Safety criteria can be established using this data for both types of systems

On Setting Day-Ahead Equity Trading Risk Limits: VaR Prediction at Market Close or Open?

Directory of Open Access Journals (Sweden)

Ana-Maria Fuertes

2016-09-01

Full Text Available This paper investigates the information content of the ex post overnight return for one-day-ahead equity Value-at-Risk (VaR forecasting. To do so, we deploy a univariate VaR modeling approach that constructs the forecast at market open and, accordingly, exploits the available overnight close-to-open price variation. The benchmark is the bivariate VaR modeling approach proposed by Ahoniemi et al. that constructs the forecast at the market close instead and, accordingly, it models separately the daytime and overnight return processes and their covariance. For a small cap portfolio, the bivariate VaR approach affords superior predictive ability than the ex post overnight VaR approach whereas for a large cap portfolio the results are reversed. The contrast indicates that price discovery at the market open is less efficient for small capitalization, thinly traded stocks.

Evaluation of medical isotope production with the accelerator production of tritium (APT) facility

International Nuclear Information System (INIS)

Benjamin, R.W.; Frey, G.D.; McLean, D.C., Jr; Spicer, K.M.; Davis, S.E.; Baron, S.; Frysinger, J.R.; Blanpied, G.; Adcock, D.

1997-01-01

The accelerator production of tritium (APT) facility, with its high beam current and high beam energy, would be an ideal supplier of radioisotopes for medical research, imaging, and therapy. By-product radioisotopes will be produced in the APT window and target cooling systems and in the tungsten target through spallation, neutron, and proton interactions. High intensity proton fluxes are potentially available at three different energies for the production of proton- rich radioisotopes. Isotope production targets can be inserted into the blanket for production of neutron-rich isotopes. Currently, the major production sources of radioisotopes are either aging or abroad, or both. The use of radionuclides in nuclear medicine is growing and changing, both in terms of the number of nuclear medicine procedures being performed and in the rapidly expanding range of procedures and radioisotopes used. A large and varied demand is forecast, and the APT would be an ideal facility to satisfy that demand

Topiramate Protects Pericytes from Glucotoxicity: Role for Mitochondrial CA VA in Cerebromicrovascular Disease in Diabetes.

Science.gov (United States)

Patrick, Ping; Price, Tulin O; Diogo, Ana L; Sheibani, Nader; Banks, William A; Shah, Gul N

Hyperglycemia in diabetes mellitus causes oxidative stress and pericyte depletion from the microvasculature of the brain thus leading to the Blood-Brain Barrier (BBB) disruption. The compromised BBB exposes the brain to circulating substances, resulting in neurotoxicity and neuronal cell death. The decline in pericyte numbers in diabetic mouse brain and pericyte apoptosis in high glucose cultures are caused by excess superoxide produced during enhanced respiration (mitochondrial oxidative metabolism of glucose). Superoxide is precursor to all Reactive Oxygen Species (ROS) which, in turn, cause oxidative stress. The rate of respiration and thus the ROS production is regulated by mitochondrial carbonic anhydrases (mCA) VA and VB, the two isoforms expressed in the mitochondria. Inhibition of both mCA: decreases the oxidative stress and restores the pericyte numbers in diabetic brain; and reduces high glucose-induced respiration, ROS, oxidative stress, and apoptosis in cultured brain pericytes. However, the individual role of the two isoforms has not been established. To investigate the contribution of mCA VA in ROS production and apoptosis, a mCA VA overexpressing brain pericyte cell line was engineered. These cells were exposed to high glucose and analyzed for the changes in ROS and apoptosis. Overexpression of mCA VA significantly increased pericyte ROS and apoptosis. Inhibition of mCA VA with topiramate prevented increases both in glucose-induced ROS and pericyte death. These results demonstrate, for the first time, that mCA VA regulates the rate of pericyte respiration. These findings identify mCA VA as a novel and specific therapeutic target to protect the cerebromicrovascular bed in diabetes.

77 FR 21158 - VA Directive 0005 on Scientific Integrity: Availability for Review and Comment

Science.gov (United States)

2012-04-09

... Draft VA Directive 0005 on Scientific Integrity: [square] Fosters a culture of transparency, integrity, and ethical behavior in the development and application of scientific and technological findings in VA... information from inappropriate political or commercial influence; [square] Ensures that selection and...

48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in 836...

Current trends in use of intracanal medications in dental care facilities: questionnaire-based survey on training dental hygienists at educational institutions.

Science.gov (United States)

Furusawa, Masahiro; Yoshida, Takashi; Hosokawa, Souhei; Ariizumi, Yuugo

2013-01-01

The success of root canal therapy is dependent not only on removal of infected pulp (pulpectomy) followed by root canal enlargement, but also on the pharmacological effects of intracanal medications. Various intracanal medications are used. Formaldehyde preparations such as formocresol were common in the past, but these are no longer used in Europe or the US due to the biological toxicity of formaldehyde. In this study, a questionnaire was used to determine current trends in the use of intracanal medications at dental care facilities where dental hygiene students undergo practical training. The questionnaire comprised questions regarding the types of frequently used intracanal medications and their methods of application at dental care facilities in Saitama and Shizuoka prefectures. The results indicated that calcium hydroxide preparations were more commonly used in Europe or the US. However, these results also revealed that formaldehyde preparations were frequently used, which slightly differs from the scenario in Europe and the US. This study revealed that multiple intracanal medications were used for root canal therapy. Furthermore, it was also observed that cotton plugs were generally used as applicator tips for intracanal medications, whereas the use of absorbent paper points was relatively uncommon. The results suggest that the cost of absorbent paper points needs to be reduced.

Management of radioactive material safety programs at medical facilities. Final report

International Nuclear Information System (INIS)

Camper, L.W.; Schlueter, J.; Woods, S.

1997-05-01

A Task Force, comprising eight US Nuclear Regulatory Commission and two Agreement State program staff members, developed the guidance contained in this report. This report describes a systematic approach for effectively managing radiation safety programs at medical facilities. This is accomplished by defining and emphasizing the roles of an institution's executive management, radiation safety committee, and radiation safety officer. Various aspects of program management are discussed and guidance is offered on selecting the radiation safety officer, determining adequate resources for the program, using such contractual services as consultants and service companies, conducting audits, and establishing the roles of authorized users and supervised individuals; NRC's reporting and notification requirements are discussed, and a general description is given of how NRC's licensing, inspection and enforcement programs work

Electrostatic hazards of charging of bedclothes and ignition in medical facilities.

Science.gov (United States)

Endo, Yuta; Ohsawa, Atsushi; Yamaguma, Mizuki

2018-02-26

We investigated the charge generated on bedclothes (cotton and polyester) during bedding exchange with different humidities and the ignitability of an alcohol-based hand sanitizer (72.3 mass% ethanol) due to static spark with different temperatures to identify the hazards of electrostatic shocks and ignitions occurring previously in medical facilities. The results indicated that charging of the polyester bedclothes may induce a human body potential of over about 10 kV, resulting in shocks even at a relative humidity of 50%, and a human body potential of higher than about 8 kV can cause a risk for the ignition of the hand sanitizer. The grounding of human bodies via footwear and flooring, therefore, is essential to avoid such hazards (or to reduce such risks).

American National Standard: for facilities and medical care for on-site nuclear-power-plant radiological emergencies

International Nuclear Information System (INIS)

Anon.

1979-01-01

This standard provides guidance for first aid during an emergency and for initial medical care of those persons on-site who are overexposed to penetrating radiation (irradiated). It also provides guidance for medical care of persons contaminated with radioactive material or radionuclides who may also be irradiated or injured as a result of an accident at a nuclear power plant. It provides recommendations for facilities, supplies, equipment, and the extent of care both on-site where first aid and initial care may be provided and off-site at a local hospital where further medical and surgical care may be provided. This initial care continues until either the patient is released or admitted, or referred to another, possibly distant, medical center for definitive care. Recommendations are also provided for the transportation of patients and the training of personnel. Recommendations for specialized care are considered to be beyond the scope of this standard on emergency medical care; however, since emergency and specialized care are related, a brief discussion of specialized care is provided in the Appendix

Kritika važećeg i prijedlog novog pravnog uređenja vađenja i uklanjanja podrtina i potonulih stvari

Directory of Open Access Journals (Sweden)

Vesna Skorupan Wolff

2012-12-01

Full Text Available Glavni cilj rada je ponuditi i prikazati rješenja koja predstavljaju prijedlog novog pravnog uređenja instituta vađenja i uklanjanja podrtina i potonulih stvari. Prije toga, autorice u radu prikazuju genezu pravnih izvora u povijesti i ranijem domaćem zakonodavstvu te proučavaju sva relevantna pitanja i sve odredbe važećeg Pomorskog zakonika (u nastavku PZ o ovoj materiji. Analizira se značenje i uporaba pojedinih izraza, sistematizacija zakonske građe unutar strukture zakona te sadržaj i domašaj pojedinih odredbi. Autorice preispituju razinu usklađenosti pozitivnog PZ-a sa suvremenom međunarodnom regulativom u ovom području. Ukazuje se na važne probleme koji mogu nastati zbog manjkavosti odredbi pozitivnog PZ-a i nepostojanja sustavne regulacije svih relevantnih pitanja koja se mogu pojaviti u praksi. U okviru istraživanja provodi se i poredbena analiza ovih instituta u drugim nacionalnim zakonodavstvima. Predložena zakonska rješenja odlikuju se cjelovitošću i sustavnošću u normiranju svih relevantnih pitanja. Uređivanje ovih instituta specijalnim odredbama pružit će viši stupanj pravne sigurnosti te viši stupanj sigurnosti plovidbe Jadranom, zaštite okoliša, njegovih prirodnih bogatstava i drugih povezanih interesa.

Forecasting VaR and ES of stock index portfolio: A Vine copula method

Science.gov (United States)

Zhang, Bangzheng; Wei, Yu; Yu, Jiang; Lai, Xiaodong; Peng, Zhenfeng

2014-12-01

Risk measurement has both theoretical and practical significance in risk management. Using daily sample of 10 international stock indices, firstly this paper models the internal structures among different stock markets with C-Vine, D-Vine and R-Vine copula models. Secondly, the Value-at-Risk (VaR) and Expected Shortfall (ES) of the international stock markets portfolio are forecasted using Monte Carlo method based on the estimated dependence of different Vine copulas. Finally, the accuracy of VaR and ES measurements obtained from different statistical models are evaluated by UC, IND, CC and Posterior analysis. The empirical results show that the VaR forecasts at the quantile levels of 0.9, 0.95, 0.975 and 0.99 with three kinds of Vine copula models are sufficiently accurate. Several traditional methods, such as historical simulation, mean-variance and DCC-GARCH models, fail to pass the CC backtesting. The Vine copula methods can accurately forecast the ES of the portfolio on the base of VaR measurement, and D-Vine copula model is superior to other Vine copulas.

38 CFR 3.2130 - Will VA accept a signature by mark or thumbprint?

Science.gov (United States)

2010-07-01

... signature by mark or thumbprint? 3.2130 Section 3.2130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF... of This Title General § 3.2130 Will VA accept a signature by mark or thumbprint? VA will accept signatures by mark or thumbprint if: (a) They are witnessed by two people who sign their names and give their...

Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

Science.gov (United States)

Yap, Glenn A; Platonova, Elena A; Musa, Philip F

2006-02-01

An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

38 CFR 70.21 - Where to apply.

Science.gov (United States)

2010-07-01

... BENEFICIARY TRAVEL UNDER 38 U.S.C. 111 § 70.21 Where to apply. Claimants for beneficiary travel must submit the information required in § 70.20 to the Chief of the Business Office or other designee at the VA medical facility responsible for the medical care or services being provided and for which travel is...

78 FR 62441 - VA Dental Insurance Program-Federalism

Science.gov (United States)

2013-10-22

...--Federalism AGENCY: Department of Veterans Affairs. ACTION: Direct final rule. SUMMARY: The Department of... that they are submitted in response to ``RIN 2900-AO85-VA Dental Insurance Program-- Federalism... add preemption language in accordance with the discussion above. Executive Order 13132, Federalism...

A Stochastic Dominance Approach to the Basel III Dilemma: Expected Shortfall or VaR?

NARCIS (Netherlands)

C-L. Chang (Chia-Lin); J.A. Jiménez-Martín (Juan-Ángel); E. Maasoumi (Esfandiar); M.J. McAleer (Michael); T. Pérez-Amaral (Teodosio)

2015-01-01

markdownabstract__Abstract__ The Basel Committee on Banking Supervision (BCBS) (2013) recently proposed shifting the quantitative risk metrics system from Value-at-Risk (VaR) to Expected Shortfall (ES). The BCBS (2013) noted that “a number of weaknesses have been identified with using VaR for

VaR: Exchange Rate Risk and Jump Risk

Directory of Open Access Journals (Sweden)

Fen-Ying Chen

2010-01-01

Full Text Available Incorporating the Poisson jumps and exchange rate risk, this paper provides an analytical VaR to manage market risk of international portfolios over the subprime mortgage crisis. There are some properties in the model. First, different from past studies in portfolios valued only in one currency, this model considers portfolios not only with jumps but also with exchange rate risk, that is vital for investors in highly integrated global financial markets. Second, in general, the analytical VaR solution is more accurate than historical simulations in terms of backtesting and Christoffersen's independence test (1998 for small portfolios and large portfolios. In other words, the proposed model is reliable not only for a portfolio on specific stocks but also for a large portfolio. Third, the model can be regarded as the extension of that of Kupiec (1999 and Chen and Liao (2009.

SlaVaComp Fonts Converter

Directory of Open Access Journals (Sweden)

Simon Skilevic

2013-12-01

Full Text Available This paper presents a fonts converter that was developed as a part of the Freiburg project on historical corpus linguistics. The tool named SlaVaComp-Konvertierer converts Church Slavonic texts digitized with non-Unicode fonts into the Unicode format without any loss of information contained in the original file and without damage to the original formatting. It is suitable for the conversion of all idiosyncratic fonts—not only Church Slavonic—and therefore can be used not only in Palaeoslavistic, but also in all historical and philological studies.

Validation of KENO V.a: Comparison with critical experiments

International Nuclear Information System (INIS)

Jordan, W.C.; Landers, N.F.; Petrie, L.M.

1986-12-01

Section 1 of this report documents the validation of KENO V.a against 258 critical experiments. Experiments considered were primarily high or low enriched uranium systems. The results indicate that the KENO V.a Monte Carlo Criticality Program accurately calculates a broad range of critical experiments. A substantial number of the calculations showed a positive or negative bias in excess of 1 1/2% in k-effective (k/sub eff/). Classes of criticals which show a bias include 3% enriched green blocks, highly enriched uranyl fluoride slab arrays, and highly enriched uranyl nitrate arrays. If these biases are properly taken into account, the KENO V.a code can be used with confidence for the design and criticality safety analysis of uranium-containing systems. Sections 2 of this report documents the results of investigation into the cause of the bias observed in Sect. 1. The results of this study indicate that the bias seen in Sect. 1 is caused by code bias, cross-section bias, reporting bias, and modeling bias. There is evidence that many of the experiments used in this validation and in previous validations are not adequately documented. The uncertainty in the experimental parameters overshadows bias caused by the code and cross sections and prohibits code validation to better than about 1% in k/sub eff/. 48 refs., 19 figs., 19 tabs

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

Directory of Open Access Journals (Sweden)

Enrique Jiménez-Rodríguez

2018-03-01

Full Text Available Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE. The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs. Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR concept in combination to the Loss Distribution Approach (LDA is proved to be a proactive tool, within the frame of balanced scorecard (BSC, in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management.

Science.gov (United States)

Jiménez-Rodríguez, Enrique; Feria-Domínguez, José Manuel; Sebastián-Lacave, Alonso

2018-03-30

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData ® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

Science.gov (United States)

Jiménez-Rodríguez, Enrique; Sebastián-Lacave, Alonso

2018-01-01

Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls. PMID:29601529

78 FR 63143 - VA Dental Insurance Program-Federalism

Science.gov (United States)

2013-10-23

...--Federalism AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. SUMMARY: The Department of Veterans... that they are submitted in response to ``RIN 2900-AO86-VA Dental Insurance Program-- Federalism... Order 13132, Federalism Section 6(c) of Executive Order 13132 (entitled ``Federalism'') requires an...

Maximum power per VA control of vector controlled interior ...

Indian Academy of Sciences (India)

Thakur Sumeet Singh

2018-04-11

Apr 11, 2018 ... Department of Electrical Engineering, Indian Institute of Technology Delhi, New ... The MPVA operation allows maximum-utilization of the drive-system. ... Permanent magnet motor; unity power factor; maximum VA utilization; ...

Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013.

Science.gov (United States)

Ganapathy, Shubash Shander; Yi Yi, Khoo; Omar, Mohd Azahadi; Anuar, Mohamad Fuad Mohamad; Jeevananthan, Chandrika; Rao, Chalapati

2017-08-11

Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study. A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths. Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good. We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more

A population approach to disease management: hepatitis C direct-acting antiviral use in a large health care system.

Science.gov (United States)

Belperio, Pamela S; Backus, Lisa I; Ross, David; Neuhauser, Melinda M; Mole, Larry A

2014-06-01

The introduction of the first direct-acting antiviral agents (DAAs) for the treatment of hepatitis C virus (HCV), telaprevir and boceprevir, marked a unique event in which 2 disease-changing therapies received FDA approval at the same time. Comparative safety and effectiveness data in real-world populations upon which to make formulary decisions did not exist. To describe the implementation, measurement, and outcomes of an enduring population-based approach of surveillance of medication management for HCV. The foundation of the population approach to HCV medication management used by the Department of Veterans Affairs (VA) relied upon a basic framework of (a) providing data for effective regional and local management, (b) education and training, (c) real-time oversight and feedback from a higher organization level, and (d) prompt outcome sharing. These population-based processes spanned across the continuum of the direct-acting antiviral oversight process. We used the VA's HCV Clinical Case Registry-which includes pharmacy, laboratory, and diagnosis information for all HCV-infected veterans from all VA facilities-to assess DAA treatment eligibility, DAA uptake and timing, appropriate use of DAAs including HCV RNA monitoring and medication possession ratios (MPR), nonconcordance with guidance for adjunct erythropoiesis-stimulating agent (ESA) and granulocyte colony-stimulating factor (GCSF) use, hematologic adverse effects, discontinuation rates, and early and sustained virologic responses. Training impact was assessed via survey and change in pharmacist scope of practice. One year after FDA approval, DAAs had been prescribed at 120 of 130 VA facilities. Over 680 VA providers participated in live educational training programs including 380 pharmacists, and pharmacists with a scope of practice for HCV increased from 59 to 110 pharmacists (86%). HCV RNA futility testing improved such that only 1%-3% of veterans did not have appropriate testing compared with 15%-17% 6

Evaluation of RayXpert® for shielding design of medical facilities

Science.gov (United States)

Derreumaux, Sylvie; Vecchiola, Sophie; Geoffray, Thomas; Etard, Cécile

2017-09-01

In a context of growing demands for expert evaluation concerning medical, industrial and research facilities, the French Institute for radiation protection and nuclear safety (IRSN) considered necessary to acquire new software for efficient dimensioning calculations. The selected software is RayXpert®. Before using this software in routine, exposure and transmission calculations for some basic configurations were validated. The validation was performed by the calculation of gamma dose constants and tenth value layers (TVL) for usual shielding materials and for radioisotopes most used in therapy (Ir-192, Co-60 and I-131). Calculated values were compared with results obtained using MCNPX as a reference code and with published values. The impact of different calculation parameters, such as the source emission rays considered for calculation and the use of biasing techniques, was evaluated.

Management of radioactive material safety programs at medical facilities. Final report

Energy Technology Data Exchange (ETDEWEB)

Camper, L.W.; Schlueter, J.; Woods, S. [and others

1997-05-01

A Task Force, comprising eight US Nuclear Regulatory Commission and two Agreement State program staff members, developed the guidance contained in this report. This report describes a systematic approach for effectively managing radiation safety programs at medical facilities. This is accomplished by defining and emphasizing the roles of an institution`s executive management, radiation safety committee, and radiation safety officer. Various aspects of program management are discussed and guidance is offered on selecting the radiation safety officer, determining adequate resources for the program, using such contractual services as consultants and service companies, conducting audits, and establishing the roles of authorized users and supervised individuals; NRC`s reporting and notification requirements are discussed, and a general description is given of how NRC`s licensing, inspection and enforcement programs work.

77 FR 60746 - Proposed Information Collection (VA/DOD Joint Disability Evaluation Board Claim) Activity...

Science.gov (United States)

2012-10-04

... burden of the collection of information on respondents, including through the use of automated collection techniques or the use of other forms of information technology. Title: VA/DOD Joint Disability Evaluation... War on Terror Heroes, VA and the Department of Defense (DOD) have agreed to develop a joint process in...

78 FR 77204 - Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys...

Science.gov (United States)

2013-12-20

... AGENCY: Office of Public & Intergovernmental Affairs, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of Public Affairs (OPA), Department of Veterans Affairs (VA), is announcing an... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Proposed Information Collection (VA...

Access to mental health care among women Veterans: is VA meeting women's needs?

Science.gov (United States)

Kimerling, Rachel; Pavao, Joanne; Greene, Liberty; Karpenko, Julie; Rodriguez, Allison; Saweikis, Meghan; Washington, Donna L

2015-04-01

Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

76 FR 38302 - Safety Zone; Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA

Science.gov (United States)

2011-06-30

... the Town of Cape Charles will sponsor a fireworks display on the shoreline of the navigable waters of...-AA00 Safety Zone; Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA AGENCY: Coast Guard... navigable waters of Cape Charles City Harbor in Cape Charles, VA in support of the Fourth of July Fireworks...

76 FR 27970 - Safety Zone; Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA.

Science.gov (United States)

2011-05-13

... Charles will sponsor a fireworks display on the shoreline of the navigable waters of Cape Charles City...[deg]01'30'' W (NAD 1983). This safety zone will be established in the vicinity of Cape Charles, VA...-AA00 Safety Zone; Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA. AGENCY: Coast Guard...

Design of small-animal thermal neutron irradiation facility at the Brookhaven Medical Research Reactor

International Nuclear Information System (INIS)

Liu, H.B.

1996-01-01

The broad beam facility (BBF) at the Brookhaven Medical Research Reactor (BMRR) can provide a thermal neutron beam with flux intensity and quality comparable to the beam currently used for research on neutron capture therapy using cell-culture and small-animal irradiations. Monte Carlo computations were made, first, to compare with the dosimetric measurements at the existing BBF and, second, to calculate the neutron and gamma fluxes and doses expected at the proposed BBF. Multiple cell cultures or small animals could be irradiated simultaneously at the so-modified BBF under conditions similar to or better than those individual animals irradiated at the existing thermal neutron irradiation Facility (TNIF) of the BMRR. The flux intensity of the collimated thermal neutron beam at the proposed BBF would be 1.7 x 10 10 n/cm 2 ·s at 3-MW reactor power, the same as at the TNIF. However, the proposed collimated beam would have much lower gamma (0.89 x 10 -11 cGy·cm 2 /n th ) and fast neutron (0.58 x 10 -11 cGy·cm 2 /n th ) contaminations, 64 and 19% of those at the TNIF, respectively. The feasibility of remodeling the facility is discussed

Intra-Operative Indocyanine Green-Videoangiography (ICG-VA) in ...

African Journals Online (AJOL)

Methods: Fifteen consecutive patients with anterior circulation aneurysms who underwent craniotomy and clipping of the aneurysms were included in this study. Intraoperative ICG-VA was performed in all cases after exposure of the aneurysm and the branches in the vicinity of the aneurysm or the parent vessel before ...

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey (.).

Science.gov (United States)

Young, J Christopher; Roper, Brad L; Arentsen, Timothy J

2016-05-01

A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias. Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams. Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported. Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

KiVa Anti-Bullying Program in Italy: Evidence of Effectiveness in a Randomized Control Trial.

Science.gov (United States)

Nocentini, Annalaura; Menesini, Ersilia

2016-11-01

The present study aims to evaluate the effectiveness of the KiVa anti-bullying program in Italy through a randomized control trial of students in grades 4 and 6. The sample involved 2042 students (51 % female; grade 4, mean age = 8.85; ds = 0.43; grade 6, mean age = 10.93; ds = 0.50); 13 comprehensive schools were randomly assigned into intervention (KiVa) or control (usual school provision) conditions. Different outcomes (bullying, victimization, pro-bullying attitudes, pro-victim attitudes, empathy toward victims), analyses (longitudinal mixed model with multiple-item scales; longitudinal prevalence of bullies and victims using Olweus' single question), and estimates of effectiveness (Cohen's d; odds ratios) were considered in order to compare the Italian results with those from other countries. Multilevel models showed that KiVa reduced bullying and victimization and increased pro-victim attitudes and empathy toward the victim in grade 4, with effect sizes from 0.24 to 0.40. In grade 6, KiVa reduced bullying, victimization, and pro-bullying attitudes; the effects were smaller as compared to grade 4, yet significant (d ≥ 0.20). Finally, using Olweus dichotomous definition of bullies and victims, results showed that the odds of being a victim were 1.93 times higher for a control student than for a KiVa student in grade 4. Overall, the findings provide evidence of the effectiveness of the program in Italy; the discussion will focus on factors that influenced successfully the transportability of the KiVa program in Italy.

Payment or Reimbursement for Certain Medical Expenses for Camp Lejeune Family Members. Final rule.

Science.gov (United States)

2017-05-05

The Department of Veterans Affairs (VA) adopts as final an interim final rule addressing payment or reimbursement of certain medical expenses for family members of Camp Lejeune veterans. Under this rule, VA reimburses family members, or pays providers, for medical expenses incurred as a result of certain illnesses and conditions that may be associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune (Camp Lejeune), North Carolina, from August 1, 1953, to December 31, 1987. Payment or reimbursement is made within the limitations set forth in statute and Camp Lejeune family members receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans. The statutory authority has since been amended to also include certain veterans' family members who resided at Camp Lejeune, North Carolina, for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953, and December 31, 1987. This final rule will reflect that statutory change and will address public comments received in response to the interim final rule.

Applying Lean Six Sigma to improve medication management.

Science.gov (United States)

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health

77 FR 74279 - Agency Information Collection (VA/DOD Joint Disability Evaluation Board Claim): Activity under...

Science.gov (United States)

2012-12-13

... Joint Disability Evaluation Board Claim): Activity under OMB Review AGENCY: Veterans Benefits... . Please refer to ``OMB Control No. 2900-0704.'' SUPPLEMENTARY INFORMATION: Title: VA/DOD Joint Disability Evaluation Board Claim, VA Form 21- 0819. OMB Control Number: 2900-0704. Type of Review: Extension of a...

Study on patient-induced radioactivity during proton treatment in hengjian proton medical facility

International Nuclear Information System (INIS)

Wu, Qingbiao; Wang, Qingbin; Liang, Tianjiao; Zhang, Gang; Ma, Yinglin; Chen, Yu; Ye, Rong; Liu, Qiongyao; Wang, Yufei; Wang, Huaibao

2016-01-01

At present, increasingly more proton medical facilities have been established globally for better curative effect and less side effect in tumor treatment. Compared with electron and photon, proton delivers more energy and dose at its end of range (Bragg peak), and has less lateral scattering for its much larger mass. However, proton is much easier to produce neutron and induced radioactivity, which makes radiation protection for proton accelerators more difficult than for electron accelerators. This study focuses on the problem of patient-induced radioactivity during proton treatment, which has been ignored for years. However, we confirmed it is a vital factor for radiation protection to both patient escort and positioning technician, by FLUKA’s simulation and activation formula calculation of Hengjian Proton Medical Facility (HJPMF), whose energy ranges from 130 to 230 MeV. Furthermore, new formulas for calculating the activity buildup process of periodic irradiation were derived and used to study the relationship between saturation degree and half-life of nuclides. Finally, suggestions are put forward to lessen the radiation hazard from patient-induced radioactivity. - Highlights: • A detailed study on patient-induced radioactivity was conducted by adopting Monte Carlo code FLUKA and activation formula. • New formulas for calculating the activity build-up process of periodic irradiation were derived and extensively studied. • Patient induced radioactivity, which has been ignored for years, is confirmed as a vital factor for radiation protection. • The induced radioactivity from single short-time treatment and long-time running (saturation) were studied and compared. • Some suggestions on how to reduce the hazard of patient’s induced radioactivity were given.

Productivity of Veterans Health Administration laboratories: a College of American Pathologists Laboratory Management Index Program (LMIP) study.

Science.gov (United States)

Valenstein, Paul N; Wang, Edward; O'Donohue, Tom

2003-12-01

The Veterans Health Administration (VA) operates the largest integrated laboratory network in the United States. To assess whether the unique characteristics of VA laboratories impact efficiency of operations, we compared the productivity of VA and non-VA facilities. Financial and activity data were prospectively collected from 124 VA and 131 non-VA laboratories enrolled in the College of American Pathologists Laboratory Management Index Program (LMIP) during 2002. In addition, secular trends in 5 productivity ratios were calculated for VA and non-VA laboratories enrolled in LMIP from 1997 through 2002. Veterans Health Administration and non-VA facilities did not differ significantly in size. Inpatients accounted for a lower percentage of testing at VA facilities than non-VA facilities (21.7% vs 37.3%; P benefits; P depreciation, and maintenance than their non-VA counterparts (all P <.001), resulting in lower overall cost per on-site test result (2.64 dollars vs 3.40 dollars; P <.001). Cost per referred (sent-out) test did not differ significantly between the 2 groups. Analysis of 6-year trends showed significant increases in both VA (P <.001) and non-VA (P =.02) labor productivity (on-site tests/total FTE). Expenses at VA laboratories for labor per test, consumables per test, overall expense per test, and overall laboratory expense per discharge decreased significantly during the 6-year period (P <.001), while in non-VA facilities the corresponding ratios showed no significant change. Overall productivity of VA laboratories is superior to that of non-VA facilities enrolled in LMIP. The principal advantages enjoyed by the VA are higher-than-average labor productivity (tests/FTE) and lower-than-average consumable expenses.

Conformational determination of [Leu]enkephalin based on theoretical and experimental VA and VCD spectral analyses

DEFF Research Database (Denmark)

Abdali, Salim; Jalkanen, Karl J.; Cao, X.

2004-01-01

Conformational determination of [Leu]enkephalin in DMSO-d6 is carried out using VA and VCD spectral analyses. Conformational energies, vibrational frequencies and VA and VCD intensities are calculated using DFT at B3LYP/6-31G* level of theory. Comparison between the measured spectra...

78 FR 55777 - Proposed Information Collection (VA, National Veterans Sports Programs and Special Events, Event...

Science.gov (United States)

2013-09-11

... techniques or the use of other forms of information technology. Titles: a. National Disabled Veterans Winter... Form 0928h. m. Surfing Personnel Application, VA Form 0928i. n. Venue Personnel Application, VA Form... Creative Arts Festival, National Veterans TEE Tournament, National Disabled Veterans Winter Sports Clinic...

Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans.

Science.gov (United States)

Karel, Michele J; Teri, Linda; McConnell, Eleanor; Visnic, Stephanie; Karlin, Bradley E

2016-02-01

Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention. One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact. Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably. This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

A real-time positron monitor for the estimation of stack effluent releases from PET medical cyclotron facilities

International Nuclear Information System (INIS)

Mukherjee, Bhaskar.

2002-01-01

Large activities of short-lived positron emitting radiopharmaceuticals are routinely manufactured by modern Medical Cyclotron facilities for positron emission tomography (PET) applications. During radiochemical processing, a substantial fraction of the volatile positron emitting radiopharmaceuticals are released into the atmosphere. An inexpensive, fast response positron detector using a simple positron-annihilation chamber has been developed for real-time assessment of the stack release of positron emitting effluents at the Australian National Medical Cyclotron. The positron detector was calibrated by using a 3.0 ml (1.50 MBq) aliquot of 18 FDG and interfaced to an industrial standard datalogger for the real-time acquisition of stack release data

78 FR 32124 - Community Residential Care

Science.gov (United States)

2013-05-29

..., heating and air conditioning, interior building plans, laundry service, size and furnishing requirements..., Home and Community Based Services (10P4G), Veterans Health Administration, 810 Vermont Avenue NW... for placement in a CRC facility if VA is furnishing outpatient medical services or hospital...

Medical Applications

OpenAIRE

Biscari, C.; Falbo, L.

2016-01-01

The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on ...

48 CFR 852.219-72 - Evaluation factor for participation in the VA mentor-protégé program.

Science.gov (United States)

2010-10-01

... participation in the VA mentor-protégé program. 852.219-72 Section 852.219-72 Federal Acquisition Regulations... Texts of Provisions and Clauses 852.219-72 Evaluation factor for participation in the VA mentor-protégé... the VA Mentor-Protégé Program (DEC2009) This solicitation contains an evaluation factor or sub-factor...

Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI screen.

Science.gov (United States)

Fortier, Catherine Brawn; Amick, Melissa M; Kenna, Alexandra; Milberg, William P; McGlinchey, Regina E

2015-01-01

Mild traumatic brain injury is the signature injury of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), yet its identification and diagnosis is controversial and fraught with challenges. In 2007, the Department of Veterans Affairs (VA) implemented a policy requiring traumatic brain injury (TBI) screening on all individuals returning from deployment in the OEF/OIF/OND theaters of operation that lead to the rapid and widespread use of the VA TBI screen. The Boston Assessment of TBI-Lifetime (BAT-L) is the first validated, postcombat semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span, including prior to, during, and post-military service. Community-dwelling convenience sample of 179 OEF/OIF/OND veterans. BAT-L, VA TBI screen. Based on BAT-L diagnosis of military TBI, the VA TBI screen demonstrated similar sensitivity (0.85) and specificity (0.82) when administered by research staff. When BAT-L diagnosis was compared with historical clinician-administered VA TBI screen in a subset of participants, sensitivity was reduced. The specificity of the research-administered VA TBI screen was more than adequate. The sensitivity of the VA TBI screen, although relatively high, suggests that it does not oversample or "catch all" possible military TBIs. Traumatic brain injuries identified by the BAT-L, but not identified by the VA TBI screen, were predominantly noncombat military injuries. There is potential concern regarding the validity and reliability of the clinician administered VA TBI screen, as we found poor correspondence between it and the BAT-L, as well as low interrater reliability between the clinician-administered and research-administered screen.

78 FR 31840 - Safety Zone; USO Patriotic Festival Air Show, Atlantic Ocean; Virginia Beach, VA

Science.gov (United States)

2013-05-28

...-AA00 Safety Zone; USO Patriotic Festival Air Show, Atlantic Ocean; Virginia Beach, VA AGENCY: Coast... provide for the safety of life on navigable waters during the USO Patriotic Festival Air Show. This action... Patriotic Festival Air Show, Atlantic Ocean; Virginia Beach, VA. (a) Regulated Area. The following area is a...

Cloning, Characterization, and Functional Investigation of VaHAESA from Vitis amurensis Inoculated with Plasmopara viticola

Directory of Open Access Journals (Sweden)

Shaoli Liu

2018-04-01

Full Text Available Plant pattern recognition receptors (PRRs are essential for immune responses and establishing symbiosis. Plants detect invaders via the recognition of pathogen-associated molecular patterns (PAMPs by PRRs. This phenomenon is termed PAMP-triggered immunity (PTI. We investigated disease resistance in Vitis amurensis to identify PRRs that are important for resistance against downy mildew, analyzed the PRRs that were upregulated by incompatible Plasmopara viticola infection, and cloned the full-length cDNA of the VaHAESA gene. We then analyzed the structure, subcellular localization, and relative disease resistance of VaHAESA. VaHAESA and PRR-receptor-like kinase 5 (RLK5 are highly similar, belonging to the leucine-rich repeat (LRR-RLK family and localizing to the plasma membrane. The expression of PRR genes changed after the inoculation of V. amurensis with compatible and incompatible P. viticola; during early disease development, transiently transformed V. vinifera plants expressing VaHAESA were more resistant to pathogens than those transformed with the empty vector and untransformed controls, potentially due to increased H2O2, NO, and callose levels in the transformants. Furthermore, transgenic Arabidopsis thaliana showed upregulated expression of genes related to the PTI pathway and improved disease resistance. These results show that VaHAESA is a positive regulator of resistance against downy mildew in grapevines.

Power Factor Improvement Using Automatic Power Factor Compensation (APFC) Device for Medical Industries in Malaysia

OpenAIRE

Zaidi Maryam Nabihah; Ali Adlan

2018-01-01

This paper present the project designed to correcting power factor for medical industries in Malaysia automatically. Which with hope to make the cost and energy usage efficient, because the energy source are depleting due to increase in population. Power factor is the ratio of real power and apparent power. This definition is mathematically represented as kW/kVA where kW is active power and kVA is apparent power (active + reactive). Reactive power is the non-working power generated by the mag...

Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process.

Science.gov (United States)

Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

2013-05-01

Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding

Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

Science.gov (United States)

Johnson, Ralph Jay

2015-01-01

Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

VA Construction: Improved Processes Needed to Monitor Contract Modifications, Develop Schedules, and Estimate Costs

Science.gov (United States)

2017-03-01

the Handbook.36 VA headquarters officials told us that regional CFM offices monitor change- order - processing time frames for projects in their...visited collected different types of data on change orders. Because VA lacks the data on the change order processing timeframes required by the Handbook...goals of processing change orders in a timelier manner, especially given our previous findings that change- order - processing time frames caused

Small RNA sequence analysis of adenovirus VA RNA-derived miRNAs reveals an unexpected serotype-specific difference in structure and abundance.

Directory of Open Access Journals (Sweden)

Wael Kamel

Full Text Available Human adenoviruses (HAds encode for one or two highly abundant virus-associated RNAs, designated VA RNAI and VA RNAII, which fold into stable hairpin structures resembling miRNA precursors. Here we show that the terminal stem of the VA RNAs originating from Ad4, Ad5, Ad11 and Ad37, all undergo Dicer dependent processing into virus-specific miRNAs (so-called mivaRNAs. We further show that the mivaRNA duplex is subjected to a highly asymmetric RISC loading with the 3'-strand from all VA RNAs being the favored strand, except for the Ad37 VA RNAII, where the 5'-mivaRNAII strand was preferentially assembled into RISC. Although the mivaRNA seed sequences are not fully conserved between the HAds a bioinformatics prediction approach suggests that a large fraction of the VA RNAII-, but not the VA RNAI-derived mivaRNAs still are able to target the same cellular genes. Using small RNA deep sequencing we demonstrate that the Dicer processing event in the terminal stem of the VA RNAs is not unique and generates 3'-mivaRNAs with a slight variation of the position of the 5' terminal nucleotide in the RISC loaded guide strand. Also, we show that all analyzed VA RNAs, except Ad37 VA RNAI and Ad5 VA RNAII, utilize an alternative upstream A start site in addition to the classical +1 G start site. Further, the 5'-mivaRNAs with an A start appears to be preferentially incorporated into RISC. Although the majority of mivaRNA research has been done using Ad5 as the model system our analysis demonstrates that the mivaRNAs expressed in Ad11- and Ad37-infected cells are the most abundant mivaRNAs associated with Ago2-containing RISC. Collectively, our results show an unexpected variability in Dicer processing of the VA RNAs and a serotype-specific loading of mivaRNAs into Ago2-based RISC.

Interactive radiopharmaceutical facility between Yale Medical Center and Brookhaven National Laboratory. Progress report, October 1976-June 1979

Energy Technology Data Exchange (ETDEWEB)

Gottschalk, A.

1979-01-01

DOE Contract No. EY-76-S-02-4078 was started in October 1976 to set up an investigative radiochemical facility at the Yale Medical Center which would bridge the gap between current investigation with radionuclides at the Yale School of Medicine and the facilities in the Chemistry Department at the Brookhaven National Laboratory. To facilitate these goals, Dr. Mathew L. Thakur was recruited who joined the Yale University faculty in March of 1977. This report briefly summarizes our research accomplishments through the end of June 1979. These can be broadly classified into three categories: (1) research using indium-111 labelled cellular blood components; (2) development of new radiopharmaceuticals; and (3) interaction with Dr. Alfred Wolf and colleagues in the Chemistry Department of Brookhaven National Laboratory.

Interactive radiopharmaceutical facility between Yale Medical Center and Brookhaven National Laboratory. Progress report, October 1976-June 1979

International Nuclear Information System (INIS)

Gottschalk, A.

1979-01-01

DOE Contract No. EY-76-S-02-4078 was started in October 1976 to set up an investigative radiochemical facility at the Yale Medical Center which would bridge the gap between current investigation with radionuclides at the Yale School of Medicine and the facilities in the Chemistry Department at the Brookhaven National Laboratory. To facilitate these goals, Dr. Mathew L. Thakur was recruited who joined the Yale University faculty in March of 1977. This report briefly summarizes our research accomplishments through the end of June 1979. These can be broadly classified into three categories: (1) research using indium-111 labelled cellular blood components; (2) development of new radiopharmaceuticals; and (3) interaction with Dr. Alfred Wolf and colleagues in the Chemistry Department of Brookhaven National Laboratory

BMP-2 Overexpression Augments Vascular Smooth Muscle Cell Motility by Upregulating Myosin Va via Erk Signaling

Directory of Open Access Journals (Sweden)

Ming Zhang

2014-01-01

Full Text Available Background. The disruption of physiologic vascular smooth muscle cell (VSMC migration initiates atherosclerosis development. The biochemical mechanisms leading to dysfunctional VSMC motility remain unknown. Recently, cytokine BMP-2 has been implicated in various vascular physiologic and pathologic processes. However, whether BMP-2 has any effect upon VSMC motility, or by what manner, has never been investigated. Methods. VSMCs were adenovirally transfected to genetically overexpress BMP-2. VSMC motility was detected by modified Boyden chamber assay, confocal time-lapse video assay, and a colony wounding assay. Gene chip array and RT-PCR were employed to identify genes potentially regulated by BMP-2. Western blot and real-time PCR detected the expression of myosin Va and the phosphorylation of extracellular signal-regulated kinases 1/2 (Erk1/2. Immunofluorescence analysis revealed myosin Va expression locale. Intracellular Ca2+ oscillations were recorded. Results. VSMC migration was augmented in VSMCs overexpressing BMP-2 in a dose-dependent manner. siRNA-mediated knockdown of myosin Va inhibited VSMC motility. Both myosin Va mRNA and protein expression significantly increased after BMP-2 administration and were inhibited by Erk1/2 inhibitor U0126. BMP-2 induced Ca2+ oscillations, generated largely by a “cytosolic oscillator”. Conclusion. BMP-2 significantly increased VSMCs migration and myosin Va expression, via the Erk signaling pathway and intracellular Ca2+ oscillations. We provide additional insight into the pathophysiology of atherosclerosis, and inhibition of BMP-2-induced myosin Va expression may represent a potential therapeutic strategy.

CERN-MEDICIS (MEDical Isotopes Collected from ISOLDE): A new facility

CERN Document Server

Augusto, Ricardo Manuel dos Santos; Lawson, Zoe; Marzari, Stefano; Stachura, Monika; Stora, Thierry; CERN. Geneva. ATS Department

2014-01-01

About 50% of the 1.4GeV CERN’s protons are sent onto targets to produce radioactive beams by online mass separation at ISOLDE, for a wide range of studies in fundamental and applied physics. CERN-MEDICIS is a spin-off dedicated to R&D in life sciences and medical applications. It is located in an extension of the Class A building presently under construction. It will comprise laboratories to receive the irradiated targets from a new station located at the dump position behind the ISOLDE production targets. An increasing range of innovative isotopes will thus progressively become accessible from the start-up of the facility in 2015 onward; for fundamental studies in cancer research, for new imaging and therapy protocols in cell and animal models and for pre-clinical trials, possibly extended to specific early phase clinical studies up to phase I trials. 500 MBq isotope batches purified by electromagnetic mass separation combined with chemical methods will be collected on a weekly basis. Possible future u...

A collaborative effort of medical and educational facilities for radiation safety training of nurses

International Nuclear Information System (INIS)

Matsuda, Naoki; Yoshida, Masahiro; Takao, Hideaki

2005-01-01

The proper understanding of radiation safety by nursing staffs in hospitals are essential not only for radiation protection of themselves against occupational radiation exposure but for quality nursing for patients who receive medical radiation exposure. The education program on radiation in nursing schools in Japan is, however, rather limited, and is insufficient for nurses to acquire basic knowledge of radiation safety and protection. Therefore, the radiation safety training of working nurses is quite important. A hospital-based training needs assignment of radiation technologists and radiologists as instructors, which may result in temporary shortage of these staffs for patients' services. Additionally, the equipments and facilities for radiation training in a hospital might not be satisfactory. In order to provide an effective education regarding radiation for working nurses, the radiation safety training course has been conducted for nurse of the university hospital by the collaboration of medical and educational staffs in Nagasaki University. This course was given for 6 hours in Radioisotope Research Center, a research and education facility for radiation workers using radioisotopes. The curriculum of this course included basics of radiation, effects of radiation on human health, procedures in clinical settings for radiation protection and practical training by using survey meters, which were mainly based on the radiation safety training for beginners according to the Japanese law concerning radiation safety with a modification to focus on medical radiation exposure. This course has been given to approximately 25 nurses in a time, and held 13 times in May 2000 through October 2003 for 317 nurse overall. The pre-instruction questionnaire revealed that 60% of nurses felt fears about radiation diagnosis or therapy, which reduced to less than 15% in the post-instruction surveillance. The course also motivated nurses to give an answer to patients' questions about

Relocation consequences on an ophthalmology consultation service from an inpatient to outpatient facility

Directory of Open Access Journals (Sweden)

Singh JS

2015-10-01

Full Text Available Jorawer S Singh,1 Vincent M Imbrogno,2 Mary K Howard,3 Amandip S Cheema,3 Ausra D Selvadurai,4 Surbhi Bansal5 1Department of Ophthalmology, George Washington University, Washington, DC, 2Contemporary Ophthalmology of Erie, Erie, PA, 3Department of Ophthalmology, University at Buffalo, Buffalo, NY, 4OcuSight Eye Care Center, Rochester, NY, 5Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Importance: This study shows that relocation of an academic ophthalmology residency program from an inpatient to an outpatient setting in western New York does not affect the consult volume but affects management patterns and follow-up rates.Objective: To investigate the effects on the ophthalmology consultation service of an academic program with relocation from a Regional Level-1 Trauma center to an outpatient facility.Design: Consultation notes from 3 years before and 3 years after the University at Buffalo’s (UB Department of Ophthalmology relocation from a Regional Level-1 Trauma center (Erie County Medical Center to an outpatient facility (Ross Eye Institute were obtained from hospital electronic medical records and analyzed.Setting: Hospitalized care and institutional practice.Participants: All inpatient or Emergency Room Ophthalmology consultation patients from the Department of Ophthalmology at UB from 2004 to 2010 (1,379 patients.Exposures: None, this was a retrospective chart review.Main outcome measures: Patient demographics, reason for consult, diagnoses, and ophthalmic procedures performed by the UB Department of Ophthalmology before and after its relocation.Results: Relocation to the outpatient facility did not affect consult volume (P=0.15. The number of consults focusing on ophthalmic conditions, as a percentage of the yearly total, rose 460% (P=0.0001, while systemic condition consults with ocular manifestations fell 83% (P=0.0001. Consults for ocular trauma decreased 65% (P=0.0034. Consults ending with a

GeVaDSs – decision support system for novel Genetic Vaccine development process

Directory of Open Access Journals (Sweden)

Blazewicz Jacek

2012-05-01

Full Text Available Abstract Background The lack of a uniform way for qualitative and quantitative evaluation of vaccine candidates under development led us to set up a standardized scheme for vaccine efficacy and safety evaluation. We developed and implemented molecular and immunology methods, and designed support tools for immunization data storage and analyses. Such collection can create a unique opportunity for immunologists to analyse data delivered from their laboratories. Results We designed and implemented GeVaDSs (Genetic Vaccine Decision Support system an interactive system for efficient storage, integration, retrieval and representation of data. Moreover, GeVaDSs allows for relevant association and interpretation of data, and thus for knowledge-based generation of testable hypotheses of vaccine responses. Conclusions GeVaDSs has been tested by several laboratories in Europe, and proved its usefulness in vaccine analysis. Case study of its application is presented in the additional files. The system is available at: http://gevads.cs.put.poznan.pl/preview/(login: viewer, password: password.

Value at risk (VaR in uncertainty: Analysis with parametric method and black & scholes simulations

Directory of Open Access Journals (Sweden)

Humberto Banda Ortiz

2014-07-01

Full Text Available VaR is the most accepted risk measure worldwide and the leading reference in any risk management assessment. However, its methodology has important limitations which makes it unreliable in contexts of crisis or high uncertainty. For this reason, the aim of this work is to test the VaR accuracy when is employed in contexts of volatility, for which we compare the VaR outcomes in scenarios of both stability and uncertainty, using the parametric method and a historical simulation based on data generated with the Black & Scholes model. VaR main objective is the prediction of the highest expected loss for any given portfolio, but even when it is considered a useful tool for risk management under conditions of markets stability, we found that it is substantially inaccurate in contexts of crisis or high uncertainty. In addition, we found that the Black & Scholes simulations lead to underestimate the expected losses, in comparison with the parametric method and we also found that those disparities increase substantially in times of crisis. In the first section of this work we present a brief context of risk management in finance. In section II we present the existent literature relative to the VaR concept, its methods and applications. In section III we describe the methodology and assumptions used in this work. Section IV is dedicated to expose the findings. And finally, in Section V we present our conclusions.

RİSK ÖLÇÜMÜNDE ALTERNATİF YAKLAŞIMLAR: RİSKE MARUZ DEĞER (VaR ve BEKLENEN KAYIP (ES UYGULAMALARI

Directory of Open Access Journals (Sweden)

SEZER BOZKUŞ

2013-06-01

Full Text Available This article shows that Value-at-Risk (VaR, the most popular risk measure in practice, has a considerable positive bias when used for a portfolio with fat-tail distribution. Numerical examples, i.e. USD/Euro daily prices and ISE-100 Index monthly returns, are given to demonstrate the use of our method. In the search for a suitable alternative to VaR, Expected Shortfall (ES or conditional VaR has been characterized as the coherent risk measure to dominate VaR. We discuss properties of VaR and ES and compare them in terms of consistency with elimination of tail risk, strengths and weaknesses. We conclude that ES is more applicable than VaR since ES is free of tail risk and consistent under more lenient conditions than VaR is.

Phenomenology of MaVaN’s Models in Reactor Neutrino Data

Directory of Open Access Journals (Sweden)

M. F. Carneiro

2013-01-01

Full Text Available Mass Varying Neutrinos (MaVaN’s mechanisms were proposed to link the neutrino mass scale with the dark energy density, addressing the coincidence problem. In some scenarios, this mass can present a dependence on the baryonic density felt by neutrinos, creating an effective neutrino mass that depends both on the neutrino and baryonic densities. In this work, we study the phenomenological consequence of MaVaN’s scenarios in which the matter density dependence is induced by Yukawa interactions of a light neutral scalar particle which couples to neutrinos and matter. Under the assumption of one mass scale dominance, we perform an analysis of KamLAND neutrino data which depends on 4 parameters: the two standard oscillation parameters, Δm0,212 and tan2θ12, and two new coefficients which parameterize the environment dependence of neutrino mass. We introduce an Earth’s crust model to compute precisely the density in each point along the neutrino trajectory. We show that this new description of density does not affect the analysis with the standard model case. With the MaVaN model, we observe a first order effect in lower density, which leads to an improvement on the data description.

75 FR 34934 - Safety Zone; Fireworks for the Virginia Lake Festival, Buggs Island Lake, Clarksville, VA

Science.gov (United States)

2010-06-21

...-AA00 Safety Zone; Fireworks for the Virginia Lake Festival, Buggs Island Lake, Clarksville, VA AGENCY... Fireworks for the Virginia Lake Festival event. This action is intended to restrict vessel traffic movement... Virginia Lake Festival, Buggs Island Lake, Clarksville, VA (a) Regulated Area. The following area is a...

Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.

Science.gov (United States)

Jump, Robin L P; Olds, Danielle M; Seifi, Nasim; Kypriotakis, Georgios; Jury, Lucy A; Peron, Emily P; Hirsch, Amy A; Drawz, Paul E; Watts, Brook; Bonomo, Robert A; Donskey, Curtis J

2012-12-01

We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. A 160-bed VA LTCF. Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series. Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (Peffective means to achieve antimicrobial stewardship.

30 CFR 57.22208 - Auxiliary fans (I-A, II-A, III, and V-A mines).

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Auxiliary fans (I-A, II-A, III, and V-A mines... fans (I-A, II-A, III, and V-A mines). (a) Auxiliary fans, except fans used in shops and other areas... applicable requirements of 30 CFR part 18, and be operated so that recirculation is minimized. Auxiliary fans...

Adenovirus Vector-Derived VA-RNA-Mediated Innate Immune Responses

Directory of Open Access Journals (Sweden)

Hiroyuki Mizuguchi

2011-07-01

Full Text Available The major limitation of the clinical use of replication-incompetent adenovirus (Ad vectors is the interference by innate immune responses, including induction of inflammatory cytokines and interferons (IFN, following in vivo application of Ad vectors. Ad vector-induced production of inflammatory cytokines and IFNs also results in severe organ damage and efficient induction of acquired immune responses against Ad proteins and transgene products. Ad vector-induced innate immune responses are triggered by the recognition of Ad components by pattern recognition receptors (PRRs. In order to reduce the side effects by Ad vector-induced innate immune responses and to develop safer Ad vectors, it is crucial to clarify which PRRs and which Ad components are involved in Ad vector-induced innate immune responses. Our group previously demonstrated that myeloid differentiating factor 88 (MyD88 and toll-like receptor 9 (TLR9 play crucial roles in the Ad vector-induced inflammatory cytokine production in mouse bone marrow-derived dendritic cells. Furthermore, our group recently found that virus associated-RNAs (VA-RNAs, which are about 160 nucleotide-long non-coding small RNAs encoded in the Ad genome, are involved in IFN production through the IFN-β promoter stimulator-1 (IPS-1-mediated signaling pathway following Ad vector transduction. The aim of this review is to highlight the Ad vector-induced innate immune responses following transduction, especially VA-RNA-mediated innate immune responses. Our findings on the mechanism of Ad vector-induced innate immune responses should make an important contribution to the development of safer Ad vectors, such as an Ad vector lacking expression of VA-RNAs.

Medical Terminology of the Circulatory System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Developed as a result of an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis…

Medical Terminology of the Respiratory System. Medical Records. Instructional Unit for the Medical Transcriptionist.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for…

Medical Terminology of the Musculoskeletal System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for a…

Current status of collaborative relationships between dialysis facilities and dental facilities in Japan: results of a nationwide survey.

Science.gov (United States)

Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko

2015-02-12

Recent studies have reported an association between periodontal disease and mortality among dialysis patients. Therefore, preventive dental care should be considered very important for this population. In Japan, no systematic education has been undertaken regarding the importance of preventive dental care for hemodialysis patients--even though these individuals tend to have oral and dental problems. The aim of this study was to investigate the current state of collaborative relationships between hemodialysis facilities and dental services in Japan and also to identify strategies to encourage preventive dental visits among hemodialysis outpatients. A nationwide questionnaire on the collaborative relationship between dialysis facilities and dental facilities was sent by mail to all medical facilities in Japan offering outpatient hemodialysis treatment. Responses were obtained from 1414 of 4014 facilities (35.2%). Among the 1414 facilities, 272 (19.2%) had a dental service department. Approximately 100,000 dialysis outpatients were receiving treatment at these participating facilities, which amounts to one-third of all dialysis patients in Japan. Of those patients, 82.9% received hemodialysis at medical facilities without dental departments. Only 87 of 454 small clinics without in-house dental departments (19.2%) had collaborative registered dental clinics. Medical facilities with registered dental clinics demonstrated a significantly more proactive attitude to routine collaboration on dental matters than facilities lacking such clinics. Our nationwide survey revealed that most dialysis facilities in Japan have neither an in-house dental department nor a collaborative relationship with a registered dental clinic. Registration of dental clinics appears to promote collaboration with dental facilities on a routine basis, which would be beneficial for oral health management in hemodialysis patients.

Implementing and evaluating a regional strategy to improve testing rates in VA patients at risk for HIV, utilizing the QUERI process as a guiding framework: QUERI Series.

Science.gov (United States)

Goetz, Matthew B; Bowman, Candice; Hoang, Tuyen; Anaya, Henry; Osborn, Teresa; Gifford, Allen L; Asch, Steven M

2008-03-19

We describe how we used the framework of the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) to develop a program to improve rates of diagnostic testing for the Human Immunodeficiency Virus (HIV). This venture was prompted by the observation by the CDC that 25% of HIV-infected patients do not know their diagnosis - a point of substantial importance to the VA, which is the largest provider of HIV care in the United States. Following the QUERI steps (or process), we evaluated: 1) whether undiagnosed HIV infection is a high-risk, high-volume clinical issue within the VA, 2) whether there are evidence-based recommendations for HIV testing, 3) whether there are gaps in the performance of VA HIV testing, and 4) the barriers and facilitators to improving current practice in the VA.Based on our findings, we developed and initiated a QUERI step 4/phase 1 pilot project using the precepts of the Chronic Care Model. Our improvement strategy relies upon electronic clinical reminders to provide decision support; audit/feedback as a clinical information system, and appropriate changes in delivery system design. These activities are complemented by academic detailing and social marketing interventions to achieve provider activation. Our preliminary formative evaluation indicates the need to ensure leadership and team buy-in, address facility-specific barriers, refine the reminder, and address factors that contribute to inter-clinic variances in HIV testing rates. Preliminary unadjusted data from the first seven months of our program show 3-5 fold increases in the proportion of at-risk patients who are offered HIV testing at the VA sites (stations) where the pilot project has been undertaken; no change was seen at control stations. This project demonstrates the early success of the application of the QUERI process to the development of a program to improve HIV testing rates. Preliminary unadjusted results show that the coordinated use of

Color perception differentiates Alzheimer's Disease (AD) from Vascular Dementia (VaD) patients.

Science.gov (United States)

Arnaoutoglou, N A; Arnaoutoglou, M; Nemtsas, P; Costa, V; Baloyannis, S J; Ebmeier, K P

2017-08-01

Alzheimer's Disease (AD) and Vascular Dementia (VaD) are the most common causes of dementia in older people. Both diseases appear to have similar clinical symptoms, such as deficits in attention and executive function, but specific cognitive domains are affected. Current cohort studies have shown a close relationship between αβ deposits and age-related macular degeneration (Johnson et al., 2002; Ratnayaka et al., 2015). Additionally, a close link between the thinning of the retinal nerve fiber (RNFL) and AD patients has been described, while it has been proposed that AD patients suffer from a non-specific type of color blindness (Pache et al., 2003). Our study included 103 individuals divided into three groups: A healthy control group (n = 35), AD (n = 32) according to DSM-IV-TR, NINCDS-ADRDA criteria, and VaD (n = 36) based on ΝΙΝDS-AIREN, as well as Magnetic Resonance Imaging (MRI) results. The severity of patient's cognitive impairment, was measured with the Mini-Mental State Examination (MMSE) and was classified according to the Reisberg global deterioration scale (GDS). Visual perception was examined using the Ishihara plates: "Ishihara Color Vision Test - 38 Plate." The three groups were not statistically different for demographic data (age, gender, and education). The Ishihara color blindness test has a sensitivity of 80.6% and a specificity of 87.5% to discriminate AD and VaD patients when an optimal (32.5) cut-off value of performance is used. Ishihara Color Vision Test - 38 Plate is a promising potential method as an easy and not time-consuming screening test for the differential diagnosis of dementia between AD and VaD.

76 FR 27381 - Proposed Information Collection (Notice of Waiver of VA Compensation or Pension To Receive...

Science.gov (United States)

2011-05-11

... waive VA benefits for the number of days equal to the number of days in which they received training pay... of Waiver of VA Compensation or Pension To Receive Military Pay and Allowances) Activity; Comment... currently approved collection, and allow 60 days for public comment in response to the notice. This notice...

Social safety and medical maintenance of the labour pool in surveillance areas of the nuclear power plants.

Science.gov (United States)

Prylipko, V A; Ozerova, Yu Yu; Kotsubinskij, O V; Morozova, M M; Petrychenko, O O; Bondarenko, I V

2017-12-01

To study the contentment of population of NPP surveillance areas i.e. monitoring zones with specific components of quality of life, namely the social security, medical care, and socio economic compensation of risk. A sociological study of public opinion about the specific components of quality of life has been conducted in population of the NPP monitoring zone. A questionnaire with independent question blocks was developed. A non repeatable probabilistic selection was applied in population opinion poll. The sampled population was calculated on the basis of the total population living in the NPP monitoring zone. Sample error not exceeded 7.0%. A comparative assessment of the responses of various groups of the able bodied population on issues of social security, medical care, socio economic compensation of risk and analysis of statistical data for 2011-2015 on the resource potential of medical facility of the nuclear power plant overspill town has been conducted. The safety and security status is rated at below the average. Documents regulating the life safety of pop ulation of NPP monitoring zone provide them no confidence in their security. Probability estimates of man made accidents are higher in urban population and depend on education level. The socialized health care is assessed on low and average levels according to the studied parameters. Among the types of medical care the providing of nec essary medical goods, preventive examinations, scheduled medical examination service, ambulance activity, and medical psychological aid need to be improved. There was no significant change in resource potential of special ized healthcare infirmary of NPP overspill town for the last 5 years. Low rating by the monitoring zone population of work efficiency of health facilities is determined by a set of factors, some of which lies in the plane of state socio economic problems. Choice priority of the direct sub ventions in population of monitoring zone depends on the place of

Medical Applications

CERN Document Server

Biscari, C.

2014-12-19

The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field.

Medical Applications

International Nuclear Information System (INIS)

Biscari, C; Falbo, L

2014-01-01

The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field

Tagline: Information Extraction for Semi-Structured Text Elements in Medical Progress Notes

Science.gov (United States)

Finch, Dezon Kile

2012-01-01

Text analysis has become an important research activity in the Department of Veterans Affairs (VA). Statistical text mining and natural language processing have been shown to be very effective for extracting useful information from medical documents. However, neither of these techniques is effective at extracting the information stored in…

QCD sum-rules for V-A spectral functions

International Nuclear Information System (INIS)

Chakrabarti, J.; Mathur, V.S.

1980-01-01

The Borel transformation technique of Shifman et al is used to obtain QCD sum-rules for V-A spectral functions. In contrast to the situation in the original Weinberg sum-rules and those of Bernard et al, the problem of saturating the sum-rules by low lying resonances is brought under control. Furthermore, the present sum-rules, on saturation, directly determine useful phenomenological parameters

Waves from the Sun: to the 100th anniversary of V.A. Troitskaya's birth

Science.gov (United States)

Guglielmi, Anatol; Potapov, Alexander

2017-09-01

It has been one hundred years since the birth of the outstanding scientist Professor V.A. Troitskaya. Her remarkable achievements in solar-terrestrial physics are widely known. For many years, Valeria A. Troitskaya was the President of the International Association of Geomagnetism and Aeronomy. This article deals with only one aspect of the multifaceted creative activity of V.A. Troitskaya. It relates to the problem of sources of ultra-low frequency (ULF) electromagnetic oscillations and waves outside Earth’s magnetosphere. We were fortunate to work under the leadership of V.A. Troitskaya on this problem. In this paper, we briefly describe the history from the emergence of the idea of the extramagnetospheric origin of dayside permanent ULF oscillations in the late 1960s to the modern quest made by ground and satellite means for ULF waves excited by solar surface oscillations propagating in the interplanetary medium and reaching Earth.

Scholar and teacher: V.A. Kitaev at the history department of Volgograd State University

Directory of Open Access Journals (Sweden)

Kuznetsov Oleg Viktorovich

2013-11-01

Full Text Available Vladimir A. Kitaev was born 1941. He was the first dean of the Faculty of History and the first head of the Department of History of the USSR (now the Department of History of Russia of Volgograd State University, reputable scientist, recognized expert in the history of the Russian social thought. The article shows the role of V.A. Kitaev in the formation and development of the faculty and the department. A characteristic of V.A. Kitaev’ sresearch and teaching activities is given. Kitaev’s featuresas a scholar and teacher such as great erudition, science scrupulosity, exactingness to himself andto his disciples, are marked. V.A. Kitaev worked at Volgograd State University for 16 years. All the while, he headed the Department andwas the dean for the first four years. The main thing is what he wanted in those positions – along with their colleagues was to lay and develop the traditions of the classical university, university atmosphere of the faculty and the university. The major scientific issues that are developed by V.A. Kitaev were: the history of liberalism and the fate of liberal reforms (modernization in Russia, the history of the Russian conservative thought, the problem of revolutionary violence as an inevitable result of the practical realization of socialist ideas. As an advocate of “establishing full-fledged liberal order”, V.A. Kitaev had, in essence, to ascertain: in Russia XIX – early XX century did not yet develop the historical conditions for the triumph of liberal ideas. The weakness and indecision of Russian liberals and their fear of the revolutionary movement, the constant fluctuation between the reform and reaction did not allow them to become independent of the political force that would determine the fate of the country in the end.

Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013

Directory of Open Access Journals (Sweden)

Shubash Shander Ganapathy

2017-08-01

Full Text Available Abstract Background Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study. Methods A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR available for a sample of the overall study deaths. Results Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75% for transport accidents and certain cancers. Moderate sensitivity (50% - 75% was obtained for ischaemic heart disease (64% and cerebrovascular disease (72%. The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good. Conclusion We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill

Validation of the Monte Carlo Criticality Program KENO V.a for highly-enriched uranium systems

International Nuclear Information System (INIS)

Knight, J.R.

1984-11-01

A series of calculations based on critical experiments have been performed using the KENO V.a Monte Carlo Criticality Program for the purpose of validating KENO V.a for use in evaluating Y-12 Plant criticality problems. The experiments were reflected and unreflected systems of single units and arrays containing highly enriched uranium metal or uranium compounds. Various geometrical shapes were used in the experiments. The SCALE control module CSAS25 with the 27-group ENDF/B-4 cross-section library was used to perform the calculations. Some of the experiments were also calculated using the 16-group Hansen-Roach Library. Results are presented in a series of tables and discussed. Results show that the criteria established for the safe application of the KENO IV program may also be used for KENO V.a results

Le CERN va supprimer 600 postes d'ici a 2007

CERN Multimedia

2002-01-01

"Le Laboratoire europeen pour la physique des particules (CERN), qui doit economiser quelque 340 millions d'euros jusqu'en 2008, va reduire ses effectifs de 600 postes d'ici a 2007, a annonce jeudi son porte-parole, James Gillies" (1/2/ page).

Military and Veteran Support: DOD and VA Programs That Address the Effects of Combat and Transition to Civilian Life

Science.gov (United States)

2014-11-01

servicemembers to civilian life. For its part, VA’s agency priority goals are to (1) ensure access to VA benefits and services, (2) eliminate the disability...transfer their benefits to dependents. VA – Veterans Benefit Administration ( VBA ) Spinal Cord Injury and Disorders Centers Disability; Physical...who are temporarily residing in a home owned by a family member to help adapt the home to meet his or her special needs. VA - VBA Yellow Ribbon

77 FR 29929 - Safety Zone; Town of Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA

Science.gov (United States)

2012-05-21

... section of this notice. Basis and Purpose On July 4, 2012 the Town of Cape Charles will sponsor a...-AA00 Safety Zone; Town of Cape Charles Fireworks, Cape Charles Harbor, Cape Charles, VA AGENCY: Coast... temporary safety zone on the waters of Cape Charles City Harbor in Cape Charles, VA in support of the Fourth...

75 FR 44720 - Safety Zone; Live-Fire Gun Exercise, M/V Del Monte, James River, VA

Science.gov (United States)

2010-07-29

... DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Part 165 [Docket No. USCG-2010-0585] RIN 1625-AA00 Safety Zone; Live-Fire Gun Exercise, M/V Del Monte, James River, VA AGENCY: Coast Guard, DHS... follows: Sec. 165.T05-0585 Safety Zone; Live-Fire Gun Exercise, M/V Del Monte, James River, VA (a...

Mental illness and intensification of diabetes medications: an observational cohort study.

Science.gov (United States)

Frayne, Susan M; Holmes, Tyson H; Berg, Eric; Goldstein, Mary K; Berlowitz, Dan R; Miller, Donald R; Pogach, Leonard M; Laungani, Kaajal J; Lee, Tina T; Moos, Rudolf

2014-10-22

Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians' decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medications in response to an elevated Hemoglobin A1c (HbA1c) value is longer for patients with MHC than for those without MHC, and whether any such effect varies by specific MHC type. In this observational study of diabetic Veterans Health Administration (VA) patients on oral antiglycemics with poor glycemic control (HbA1c ≥8) (N =52,526) identified from national VA databases, we applied Cox regression analysis to examine time to intensification of antiglycemics after an elevated HbA1c value in 2003-2004, by MHC status. Those with MHC were no less likely to receive intensification: adjusted Hazard Ratio [95% CI] 0.99 [0.96-1.03], 1.13 [1.04-1.23], and 1.12 [1.07-1.18] at 0-14, 15-30 and 31-180 days, respectively. However, patients with substance use disorders were less likely than those without substance use disorders to receive intensification in the first two weeks following a high HbA1c, adjusted Hazard Ratio 0.89 [0.81-0.97], controlling for sex, age, medical comorbidity, other specific MHCs, and index HbA1c value. For most MHCs, diabetic patients with MHC in the VA health care system do not appear to receive less aggressive antiglycemic management. However, the subgroup with substance use disorders does appear to have excess likelihood of non-intensification; interventions targeting this high risk subgroup merit attention.

A Case Study on TRICARE Online Web-enabled Appointing: Improving Utilization Rates at Navy Medical Treatment Facilities

Science.gov (United States)

2009-10-20

Low usage volume raised concerns about the effectiveness of TOL. In 2004, the eHealth Division of TMA Information Management conducted a study to...Case Study 31 (Version 15.8). Falls Church, VA: Department of Defense, TRICARE Management Activity, Information Management eHealth Division

VA Disability Benefits: Additional Planning Would Enhance Efforts to Improve the Timeliness of Appeals Decisions

Science.gov (United States)

2017-03-01

must manually review and correct most incoming cases due to issues with labeling, mismatched dates, and missing files. Via an internal study, VA...individuals acclimate to their jobs —and factored this into the modeling assumptions used to project the number of Board staff needed. More...Needed to Promote Increased User Satisfaction . GAO-15-582 (Washington, D.C.: September 1, 2015). Page 29 GAO-17-234 VA Disability

Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center.

Science.gov (United States)

Tsan, Grace L; Hoban, Keely L; Jun, Weon; Riedel, Kevin J; Pedersen, Amy L; Hayes, John

2015-01-01

We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

Activation of air and concrete in medical isotope production facilities

Science.gov (United States)

Dodd, Adam C.; Shackelton, R. J.; Carr, D. A.; Ismail, A.

2017-05-01

Medical isotope facilities operating in the 10 to 25 MeV proton energy range have long been used to generate radioisotopes for medical diagnostic imaging. In the last few years the beam currents available in commercially available cyclotrons have increased dramatically, and so the activation of the materials within cyclotron vaults may now pose more serious radiological hazards. This will impact the regulatory oversight of cyclotron operations, cyclotron servicing and future decommissioning activities. Air activation could pose a hazard to cyclotron staff. With the increased cyclotron beam currents it was necessary to examine the issue more carefully. Therefore the ways in which radioactivity may be induced in air by neutron reactions and neutron captures were considered and it was found that the dominant mechanism is neutron capture on Ar-40. A study of the activation of the air by neutron capture on Ar-40 within a cyclotron vault was performed using the MCNP Monte Carlo code. The neutron source energy spectrum used was from the production of the widely used F-18 PET isotope. The results showed that the activation of the air within a cyclotron vault does not pose a significant radiological hazard at the beam intensities currently in use and shows how ventilation affects the results. A second MCNP study on the activation of ordinary concrete in cyclotron vaults by neutron capture was made with a view to determining the optimum thickness of borated polyethylene to reduce neutron activation on both the inner surfaces of the vault and around production targets. This is of importance in decommissioning cyclotrons and therefore in the design of new cyclotron vaults. The distribution of activation on the walls as a function of the source position was also studied. Results are presented for both borated and regular polyethylene, and F-18 and Tc-99 neutron spectra.

Visual symptomatology and referral patterns for Operation Iraqi Freedom and Operation Enduring Freedom veterans with traumatic brain injury.

Science.gov (United States)

Bulson, Ryan; Jun, Weon; Hayes, John

2012-01-01

Advances in protective armor technology and changes in the "patterns of war" have created a population of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with traumatic brain injury (TBI) that provide a unique challenge to Department of Veterans Affairs (VA) healthcare practitioners. The purpose of the study was to determine the frequency of symptomatic ocular and visual sequelae of TBI in OIF/OEF veterans at the Portland VA Medical Center, a Polytrauma Support Clinic Team site. A retrospective analysis of 100 OIF/OEF veterans with TBI was conducted to determine the prevalence of ocular and visual complaints. Referral patterns were also investigated. Visual symptoms were reported in approximately 50% of veterans with TBI. Loss of consciousness, but not number of deployments or number of blast exposures, was found to have a statistically significant association with severity of reported visual symptoms. The most commonly reported symptoms included blurred vision (67%), photosensitivity (50%), and accommodative problems (40%). Visual symptoms of OIF/OEF veterans at the Portland VA Medical Center are reported at slightly lower rates than similar studies conducted at the Palo Alto and Edward Hines Jr VA facilities.

Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

Science.gov (United States)

Comer, Rachel; Lizer, Mitsi

2017-10-01

A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

Beyond "medical tourism": Canadian companies marketing medical travel.

Science.gov (United States)

Turner, Leigh

2012-06-15

Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross

76 FR 78569 - Medical Benefits for Newborn Children of Certain Woman Veterans

Science.gov (United States)

2011-12-19

... conform to amendments made by the enactment of the Caregivers and Veteran Omnibus Health Services Act of... the Caregivers and Veterans Omnibus Health Services Act of 2010, Public Law 111-163. Section 206 of... in what is known as the VA ``medical benefits package.'' This rulemaking amends Sec. 17.38(a) to...

VaProS: a database-integration approach for protein/genome information retrieval

KAUST Repository

Gojobori, Takashi; Ikeo, Kazuho; Katayama, Yukie; Kawabata, Takeshi; Kinjo, Akira R.; Kinoshita, Kengo; Kwon, Yeondae; Migita, Ohsuke; Mizutani, Hisashi; Muraoka, Masafumi; Nagata, Koji; Omori, Satoshi; Sugawara, Hideaki; Yamada, Daichi; Yura, Kei

2016-01-01

Life science research now heavily relies on all sorts of databases for genome sequences, transcription, protein three-dimensional (3D) structures, protein–protein interactions, phenotypes and so forth. The knowledge accumulated by all the omics research is so vast that a computer-aided search of data is now a prerequisite for starting a new study. In addition, a combinatory search throughout these databases has a chance to extract new ideas and new hypotheses that can be examined by wet-lab experiments. By virtually integrating the related databases on the Internet, we have built a new web application that facilitates life science researchers for retrieving experts’ knowledge stored in the databases and for building a new hypothesis of the research target. This web application, named VaProS, puts stress on the interconnection between the functional information of genome sequences and protein 3D structures, such as structural effect of the gene mutation. In this manuscript, we present the notion of VaProS, the databases and tools that can be accessed without any knowledge of database locations and data formats, and the power of search exemplified in quest of the molecular mechanisms of lysosomal storage disease. VaProS can be freely accessed at http://p4d-info.nig.ac.jp/vapros/.

VaProS: a database-integration approach for protein/genome information retrieval

KAUST Repository

Gojobori, Takashi

2016-12-24

Life science research now heavily relies on all sorts of databases for genome sequences, transcription, protein three-dimensional (3D) structures, protein–protein interactions, phenotypes and so forth. The knowledge accumulated by all the omics research is so vast that a computer-aided search of data is now a prerequisite for starting a new study. In addition, a combinatory search throughout these databases has a chance to extract new ideas and new hypotheses that can be examined by wet-lab experiments. By virtually integrating the related databases on the Internet, we have built a new web application that facilitates life science researchers for retrieving experts’ knowledge stored in the databases and for building a new hypothesis of the research target. This web application, named VaProS, puts stress on the interconnection between the functional information of genome sequences and protein 3D structures, such as structural effect of the gene mutation. In this manuscript, we present the notion of VaProS, the databases and tools that can be accessed without any knowledge of database locations and data formats, and the power of search exemplified in quest of the molecular mechanisms of lysosomal storage disease. VaProS can be freely accessed at http://p4d-info.nig.ac.jp/vapros/.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

Directory of Open Access Journals (Sweden)

Tariq Amina

2012-11-01

Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

Science.gov (United States)

2012-01-01

Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes. PMID:23122411

Medical team training and coaching in the Veterans Health Administration; assessment and impact on the first 32 facilities in the programme.

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Neily, Julia; Mills, Peter D; Lee, Pamela; Carney, Brian; West, Priscilla; Percarpio, Katherine; Mazzia, Lisa; Paull, Douglas E; Bagian, James P

2010-08-01

Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities. Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1='no impact' and 5='significant impact.' We used logistic regression to examine implementation of briefing/debriefing. Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p=0.03). Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.

A configurational and conformational study of aframodial and its diasteriomers via experimental and theoretical VA and VCD spectroscopies

DEFF Research Database (Denmark)

Jalkanen, Karl J.; Gale, J.D.; Lassen, Peter Rygaard

2008-01-01

In this work we present the experimental and theoretical vibrational absorption (VA) and the theoretical vibrational circular dichroism (VCD) spectra for aframodial. In addition, we present the theoretical VA and VCD spectra for the diasteriomers of aframodial. Aframodial has four chiral centers ...

Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

Science.gov (United States)

Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

2013-01-01

To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back

76 FR 44086 - Agency Information Collection (Notice of Waiver of VA Compensation or Pension To Receive Military...

Science.gov (United States)

2011-07-22

... number of days equal to the number of days in which they received training pay. An agency may not conduct... of Waiver of VA Compensation or Pension To Receive Military Pay and Allowances) Activity Under OMB....'' SUPPLEMENTARY INFORMATION: Title: Notice of Waiver of VA Compensation or Pension to Receive Military Pay and...

KiVa Antibullying Program: Overview of Evaluation Studies Based on a Randomized Controlled Trial and National Rollout in Finland

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Christina Salmivalli

2012-12-01

Full Text Available The effects of a Finnish national school-based antibullying program (KiVa were evaluated in a randomized controlled trial (2007–2009 and during nationwide implementation (since 2009. The KiVa program is been found to reduce bullying and victimization and increase empathy towards victimized peers and self-efficacy to support and defend them. KiVa increases school liking and motivation and contributes to significant reductions in anxiety, depression, and negative peer perceptions. Somewhat larger reductions in bullying and victimization were found in the randomized controlled trial than in the broad rollout, and the largest effects were obtained in primary school (grades 1–6. The uptake of the KiVa program is remarkable, with 90 percent of Finnish comprehensive schools currently registered as program users.

Myosin Va Plays a Role in Nitrergic Smooth Muscle Relaxation in Gastric Fundus and Corpora Cavernosa of Penis

Science.gov (United States)

Carew, Josephine A.; Goyal, Raj K.; Sullivan, Maryrose P.

2014-01-01

The intracellular motor protein myosin Va is involved in nitrergic neurotransmission possibly by trafficking of neuronal nitric oxide synthase (nNOS) within the nerve terminals. In this study, we examined the role of myosin Va in the stomach and penis, proto-typical smooth muscle organs in which nitric oxide (NO) mediated relaxation is critical for function. We used confocal microscopy and co-immunoprecipitation of tissue from the gastric fundus (GF) and penile corpus cavernosum (CCP) to localize myosin Va with nNOS and demonstrate their molecular interaction. We utilized in vitro mechanical studies to test whether smooth muscle relaxations during nitrergic neuromuscular neurotransmission is altered in DBA (dilute, brown, non-agouti) mice which lack functional myosin Va. Myosin Va was localized in nNOS-positive nerve terminals and was co-immunoprecipitated with nNOS in both GF and CCP. In comparison to C57BL/6J wild type (WT) mice, electrical field stimulation (EFS) of precontracted smooth muscles of GF and CCP from DBA animals showed significant impairment of nitrergic relaxation. An NO donor, Sodium nitroprusside (SNP), caused comparable levels of relaxation in smooth muscles of WT and DBA mice. These normal postjunctional responses to SNP in DBA tissues suggest that impairment of smooth muscle relaxation resulted from inhibition of NO synthesis in prejunctional nerve terminals. Our results suggest that normal physiological processes of relaxation of gastric and cavernosal smooth muscles that facilitate food accommodation and penile erection, respectively, may be disrupted under conditions of myosin Va deficiency, resulting in complications like gastroparesis and erectile dysfunction. PMID:24516539

Accidental nuclear excursion recuplex operation 234-5 facility: Final medical report

Energy Technology Data Exchange (ETDEWEB)

Fuqua, P. A.

1962-04-07

The April 7, 1962 criticality accident involving human exposures was the first to have occurred in any production facility at Hanford. The accidental nuclear excursion did not result in any mechanical damage or spread of contamination. Three employees received over-exposure to gamma and neutron radiation. None were fatally exposed and in each case the over-exposure was recognized promptly. Following an initial period of medical observation and testing, the men were released to work. They continued to be followed clinically. Clinical studies performed were hematological procedures including leukocyte chromosome aberrations, morphologically aberrant blood cells, bone marrow evaluations, blood chemistry determinations, amino acid excretion studies, seminal fluid, urinary gonadotropins and estrogen excretion studies, testicular biopsies and crystalline lens examinations. These studies, along with a brief description of the accident and of the dosimetry, are summarized in this report by those participating in the studies. In view of the dose ranges received in these cases, both the negative and positive findings are considered to be of unusual interest due to the lack of knowledge of effects following human exposures at these levels.

[Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps].

Science.gov (United States)

Zevallos, Leslie; Pastor, Reyna; Moscoso, Betsy

2011-06-01

To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics.

Science.gov (United States)

Williams, Emily C; Achtmeyer, Carol E; Young, Jessica P; Berger, Douglas; Curran, Geoffrey; Bradley, Katharine A; Richards, Julie; Siegel, Michael B; Ludman, Evette J; Lapham, Gwen T; Forehand, Mark; Harris, Alex H S

2018-03-01

Three medications are FDA-approved and recommended for treating alcohol use disorders (AUD) but they are not offered to most patients with AUD. Primary care (PC) may be an optimal setting in which to offer and prescribe AUD medications, but multiple barriers are likely. This qualitative study used social marketing theory, a behavior change approach that employs business marketing techniques including "segmenting the market," to describe (1) barriers and facilitators to prescribing AUD medications in PC, and (2) beliefs of PC providers after they were segmented into groups more and less willing to prescribe AUD medications. Qualitative, interview-based study. Twenty-four providers from five VA PC clinics. Providers completed in-person semi-structured interviews, which were recorded, transcribed, and analyzed using social marketing theory and thematic analysis. Providers were divided into two groups based on consensus review. Barriers included lack of knowledge and experience, beliefs that medications cannot replace specialty addiction treatment, and alcohol-related stigma. Facilitators included training, support for prescribing, and behavioral staff to support follow-up. Providers more willing to prescribe viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective "tool" or "foot in the door" for treating AUD, and believed that providing AUD medications in PC might catalyze change while reducing stigma and addressing other barriers to specialty treatment. Those less willing believed that medications could not effectively treat AUD, and that treating AUD was the role of specialty addiction treatment providers, not PC providers, and would require time and expertise they do not have. We identified barriers to and facilitators of prescribing AUD medications in PC, which, if addressed and/or capitalized on, may increase provision of AUD medications. Providers more willing to prescribe may be the optimal target of a

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

In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in

VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association.

Science.gov (United States)

Tsai, Jack; Rosenheck, Robert A

2015-06-01

There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs. Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development-Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted. About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs. A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.

Implementing and evaluating a regional strategy to improve testing rates in VA patients at risk for HIV, utilizing the QUERI process as a guiding framework: QUERI Series

Directory of Open Access Journals (Sweden)

Osborn Teresa

2008-03-01

Full Text Available Abstract Background We describe how we used the framework of the U.S. Department of Veterans Affairs (VA Quality Enhancement Research Initiative (QUERI to develop a program to improve rates of diagnostic testing for the Human Immunodeficiency Virus (HIV. This venture was prompted by the observation by the CDC that 25% of HIV-infected patients do not know their diagnosis – a point of substantial importance to the VA, which is the largest provider of HIV care in the United States. Methods Following the QUERI steps (or process, we evaluated: 1 whether undiagnosed HIV infection is a high-risk, high-volume clinical issue within the VA, 2 whether there are evidence-based recommendations for HIV testing, 3 whether there are gaps in the performance of VA HIV testing, and 4 the barriers and facilitators to improving current practice in the VA. Based on our findings, we developed and initiated a QUERI step 4/phase 1 pilot project using the precepts of the Chronic Care Model. Our improvement strategy relies upon electronic clinical reminders to provide decision support; audit/feedback as a clinical information system, and appropriate changes in delivery system design. These activities are complemented by academic detailing and social marketing interventions to achieve provider activation. Results Our preliminary formative evaluation indicates the need to ensure leadership and team buy-in, address facility-specific barriers, refine the reminder, and address factors that contribute to inter-clinic variances in HIV testing rates. Preliminary unadjusted data from the first seven months of our program show 3–5 fold increases in the proportion of at-risk patients who are offered HIV testing at the VA sites (stations where the pilot project has been undertaken; no change was seen at control stations. Discussion This project demonstrates the early success of the application of the QUERI process to the development of a program to improve HIV testing rates

Status of RIB facilities in Asia

International Nuclear Information System (INIS)

Tanihata, Isao

1998-01-01

Radioactive Ion Beam Facilities in Asia are presented. In China, in-flight separation type facilities are in operation at the Institute of Modern Physics in Lanzhou and the other at Tandem facility in China Institute of Atomic Energy in Beijing. The storage-ring facility is proposed and approved in Lanzhou. In India, the Variable Energy Cyclotron Facility in Calcutta start to construct an ISOL-type facility. In Japan, in-flight separation type facilities are working at Research Center for Nuclear Physics in Osaka, and at RIKEN. Also a separator start its operation in medical facility in Chiba. In RIKEN, the construction of RI Beam Factory has been started. An ISOL-type facility is proposed in the Japan Hadron Facility in KEK. Table I summarize these facilities

Contribution of soil-32P, fertilizer-32P and VA mycorrhizal fungi to phosphorus nutrition of corn plant

International Nuclear Information System (INIS)

Feng Gu; Yang Maoqiu; Bai Dengsha; Huang Quansheng

1997-01-01

32 P labelled fertilizer and five synthetic phosphates (dicalcium phosphate, octocalcium phosphate, iron phosphate, aluminium phosphate and apatite), which were used to simulate inorganic phosphates such as Ca 2 -P, Ca 8 -P, Fe P , Al-P and Ca 10 -P in calcareous soil, were applied to corn plants inoculating with and without vesicular-arbuscular (VA) mycorrhizal fungi in a calcareous soil. The results showed that VA mycorrhizal fungi and dicalcium phosphate, octocalcium phosphate, iron phosphate, aluminium phosphate promoted growth and increased phosphorus content of corn plant. The four synthetic phosphates except apatite had higher contributions to corn plant growth than VA mycorrhizal fungi. Contributions of fertilizer-P, soil-P and synthetic phosphates to phosphorus nutrition of corn plant were in order of synthetic phosphates (except apatite) > soil- P > fertilizer-P. Inoculating with VA mycorrhizal fungi increased the contribution of soil-P and decreased the contribution of synthetic phosphates, but did not affect the contribution of fertilizer-P

Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

Directory of Open Access Journals (Sweden)

Benjamin A. Bouvier

2017-02-01

Full Text Available Abstract Background Supervised injection facilities (SIFs are legally sanctioned environments for people to inject drugs under medical supervision. SIFs currently operate in ten countries, but to date, no SIF has been opened in the USA. In light of increasing overdose mortality in the USA, this study evaluated willingness to use a SIF among youth who report non-medical prescription opioid (NMPO use. Methods Between January 2015 and February 2016, youth with recent NMPO use were recruited to participate in the Rhode Island Young Adult Prescription Drug Study (RAPiDS. We explored factors associated with willingness to use a SIF among participants who had injected drugs or were at risk of initiating injection drug use (defined as having a sex partner who injects drugs or having a close friend who injects. Results Among 54 eligible participants, the median age was 26 (IQR = 24–28, 70.4% were male, and 74.1% were white. Among all participants, when asked if they would use a SIF, 63.0% answered “Yes”, 31.5% answered “No”, and 5.6% were unsure. Among the 31 participants reporting injection drug use in the last six months, 27 (87.1% reported willingness to use a SIF; 15 of the 19 (78.9% who injected less than daily reported willingness, while all 12 (100.0% of the participants who injected daily reported willingness. Compared to participants who were unwilling or were unsure, participants willing to use a SIF were also more likely to have been homeless in the last six months, have accidentally overdosed, have used heroin, have used fentanyl non-medically, and typically use prescription opioids alone. Conclusions Among young adults who use prescription opioids non-medically and inject drugs or are at risk of initiating injection drug use, more than six in ten reported willingness to use a SIF. Established risk factors for overdose, including homelessness, history of overdose, daily injection drug use, heroin use, and fentanyl misuse, were

A Study of the Utility of a Participative Approach to Employee Attitude Surveys as a Management Tool at the Audie L. Murphy Memorial VA Hospital in San Antonio, Texas

Science.gov (United States)

1979-05-01

Classification) A Study of the Utility of a Participative Approach to Employee Attitude Surveys as a Management Tool at the Audie L. Murphy Memoria VA...Engineering-49, Medical-38, Laboratory-32, Social Work-23, and RMS-19.) The responses of employees in all other services would be collectively identified...Laboratory 47 Social Work 78 All Others 50 TABLE 3 Positive Responses to Question Thirteen By Service Comparing responses by salary level the average positive

Aerosol Vacuum-Assisted Plasma Ionization (Aero-VaPI) Coupled to Ion Mobility-Mass Spectrometry

Science.gov (United States)

Blair, Sandra L.; Ng, Nga L.; Zambrzycki, Stephen C.; Li, Anyin; Fernández, Facundo M.

2018-02-01

In this communication, we report on the real-time analysis of organic aerosol particles by Vacuum-assisted Plasma Ionization-Mass Spectrometry (Aero-VaPI-MS) using a home-built VaPI ion source coupled to a Synapt G2-S HDMS ion mobility-mass spectrometry (IM-MS) system. Standards of organic molecules of interest in prebiotic chemistry were used to generate aerosols. Monocaprin and decanoic acid aerosol particles were successfully detected in both the positive and negative ion modes, respectively. A complex aerosol mixture of different sizes of polymers of L-malic acid was also examined through ion mobility (IM) separations, resulting in the detection of polymers of up to eight monomeric units. This noncommercial plasma ion source is proposed as a low cost alternative to other plasma ionization platforms used for aerosol analysis, and a higher-performance alternative to more traditional aerosol mass spectrometers. VaPI provides robust online ionization of organics in aerosols without extensive ion activation, with the coupling to IM-MS providing higher peak capacity and excellent mass accuracy. [Figure not available: see fulltext.

Planning of emergency medical treatment in nuclear power plant

International Nuclear Information System (INIS)

Kusama, Tomoko

1989-01-01

Medical staffs and health physicists have shown deep concerning at the emergency plans of nuclear power plants after the TMI nuclear accident. The most important and basic countermeasure for accidents was preparing appropriate and concrete organization and plans for treatment. We have planed emergency medical treatment for radiation workers in a nuclear power plant institute. The emergency medical treatment at institute consisted of two stages, that is on-site emergency treatment at facility medical service. In first step of planning in each stage, we selected and treatment at facility medical service. In first step of planning in each stage, we selected and analyzed all possible accidents in the institute and discussed on practical treatments for some possible accidents. The manuals of concrete procedure of emergency treatment for some accidents were prepared following discussion and facilities and equipment for medical treatment and decontamination were provided. All workers in the institute had periodical training and drilling of on-site emergency treatment and mastered technique of first aid. Decontamination and operation rooms were provided in the facillity medical service. The main functions at the facility medical service have been carried out by industrial nurses. Industrial nurses have been in close co-operation with radiation safety officers and medical doctors in regional hospital. (author)

Medical equipment in government health facilities: Missed opportunities

OpenAIRE

Pardeshi Geeta

2005-01-01

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

Technical Note: A proposal of air ventilation system design criteria for a clinical room in a heavy-ion medical facility.

Science.gov (United States)

Kum, Oyeon

2018-04-16

An optimized air ventilation system design for a treatment room in Heavy-ion Medical Facility is an important issue in the aspects of nuclear safety because the activated air produced in a treatment room can directly affect the medical staff and the general public in the radiation-free area. Optimized design criteria of air ventilation system for a clinical room in 430 MeV/u carbon ion beam medical accelerator facility was performed by using a combination of MCNPX2.7.0 and CINDER'90 codes. Effective dose rate and its accumulated effective dose by inhalation and residual gamma were calculated for a normal treatment scenario (2 min irradiation for one fraction) as a function of decay time. Natural doses around the site were measured before construction and used as reference data. With no air ventilation system, the maximum effective dose rate was about 3 μSv/h (total dose of 90 mSv/y) and minimum 0.2 μSv/h (total dose of 6 mSv/y), which are over the legal limits for medical staff and for the general public. Although inhalation dose contribution was relatively small, it was considered seriously because of its long-lasting effects in the body. The integrated dose per year was 1.8 mSv/y in the radiation-free area with the 20-min rate of air ventilation system. An optimal air ventilation rate of 20 min is proposed for a clinical room, which also agrees with the best mechanical design value. © 2018 American Association of Physicists in Medicine.

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs).

Science.gov (United States)

Edwards, Samuel T; Helfrich, Christian D; Grembowski, David; Hulen, Elizabeth; Clinton, Walter L; Wood, Gordon B; Kim, Linda; Rose, Danielle E; Stewart, Greg

2018-01-01

Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean ± standard deviation composite delegation score, 2.97± 0.64 [range, 1-4]; nurse composite reliance score, 3.26 ± 0.50 [range, 1-4]). Approximately 48% of PCPs and 35% of nurses reported burnout. PCPs who reported more task delegation reported less burnout (odds ratio [OR], 0.62 per unit of delegation; 95% confidence interval [CI], 0.49-0.78), whereas nurses who reported being relied on more reported more burnout (OR, 1.83 per unit of reliance; 95% CI, 1.33-2.5). Task delegation was associated with less burnout for PCPs, whereas task reliance was associated with greater burnout for nurses. Strategies to improve work life in primary care by increasing PCP task delegation must consider the impact on nurses. © Copyright 2018 by the American Board of Family Medicine.

Beyond "medical tourism": Canadian companies marketing medical travel

Science.gov (United States)

2012-01-01

Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other

EFFECTS OF VARIOUS SOIL ENVIRONMENTAL STRESSES ON THE OCCURRENCE, DISTRIBUTION AND EFFECTIVENESS OF VA MYCORRHIZAE

Directory of Open Access Journals (Sweden)

A.G. KHAN

1995-01-01

Full Text Available The vesicular - arbuscular (VA mycorrhizal fungi are geographically ubiquitous soil inhabitants and form universal symbiotic relationship with plants from every phylum. These fungi link host plants with host soils and their biota in the mycorrhizosphere and play an important role in plant health, productivity and soil structure. Although VA mycorrhizal fungi do not show any host specificity, there is increasing evidence that various climatic and edaphic environmental factors such as land use and management practices, physical, chemical and biological properties of host soils and host plant characteristics influence their occurrence, taxonomic distribution and effectiveness. The interaction of these factors with vesicular-arbuscular mycorrhizae (VAM is poorly understood except in a few cases. It is now very clear that VA mycorrhizal associations are ecologically significant factors that require more attention than previously accorded. This paper discusses the occurrence, distribution and significance of VAM in environmentally stressed soil conditions that limit plant growth such as drought, waterlogging and salinity.

Waves from the Sun: to the 100th anniversary of V.A. Troitskaya’s birth

Directory of Open Access Journals (Sweden)

Guglielmi A.V.

2017-09-01

Full Text Available It has been one hundred years since the birth of the outstanding scientist Professor V.A. Troitskaya. Her remarkable achievements in solar-terrestrial physics are widely known. For many years, Valeria A. Troitskaya was the President of the International Association of Geomagnetism and Aeronomy. This article deals with only one aspect of the multifaceted creative activity of V.A. Troitskaya. It relates to the problem of sources of ultra-low frequency (ULF electromagnetic oscillations and waves outside Earth’s magnetosphere. We were fortunate to work under the leadership of V.A. Troitskaya on this problem. In this paper, we briefly describe the history from the emergence of the idea of the extramagnetospheric origin of dayside permanent ULF oscillations in the late 1960s to the modern quest made by ground and satellite means for ULF waves excited by solar surface oscillations propagating in the interplanetary medium and reaching Earth.

Modeling of Mean-VaR portfolio optimization by risk tolerance when the utility function is quadratic

Science.gov (United States)

Sukono, Sidi, Pramono; Bon, Abdul Talib bin; Supian, Sudradjat

2017-03-01

The problems of investing in financial assets are to choose a combination of weighting a portfolio can be maximized return expectations and minimizing the risk. This paper discusses the modeling of Mean-VaR portfolio optimization by risk tolerance, when square-shaped utility functions. It is assumed that the asset return has a certain distribution, and the risk of the portfolio is measured using the Value-at-Risk (VaR). So, the process of optimization of the portfolio is done based on the model of Mean-VaR portfolio optimization model for the Mean-VaR done using matrix algebra approach, and the Lagrange multiplier method, as well as Khun-Tucker. The results of the modeling portfolio optimization is in the form of a weighting vector equations depends on the vector mean return vector assets, identities, and matrix covariance between return of assets, as well as a factor in risk tolerance. As an illustration of numeric, analyzed five shares traded on the stock market in Indonesia. Based on analysis of five stocks return data gained the vector of weight composition and graphics of efficient surface of portfolio. Vector composition weighting weights and efficient surface charts can be used as a guide for investors in decisions to invest.

30 CFR 57.22205 - Doors on main fans (I-A, II-A, III, and V-A mines).

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Doors on main fans (I-A, II-A, III, and V-A... main fans (I-A, II-A, III, and V-A mines). In mines ventilated by multiple main fans, each main fan... reversal through the fan. The doors shall be located so that they are not in direct line with explosive...

Study of waste acceptance criteria for low-level radioactive waste from medical, industrial, and research facilities (Contract research)

International Nuclear Information System (INIS)

Koibuchi, Hiroto; Dohi, Terumi; Ishiguro, Hideharu; Hayashi, Masaru; Senda, Masaki

2008-12-01

Japan Atomic Energy Agency (JAEA) is supposed to draw up the plan for the disposal program of the very low-level radioactive waste and low-level radioactive waste generated from medical, industrial and research facilities. For instance, there are these facilities in JAEA, universities, private companies, and so on. JAEA has to get to know about the waste and its acceptance of other institutions described above because it is important for us to hold the licenses for the disposal program regarding safety assessment. This report presents the basic data concerning radioactive waste of research institutes etc. except RI waste, domestic and foreign information related to acceptance criteria for disposal of the low-level radioactive waste, the current status of foreign medical waste management, waste acceptance, and such. In this report, Japan's acceptance criteria were summarized on the basis of present regulation. And, the criteria of foreign countries, United States, France, United Kingdom and Spain, were investigated by survey of each reference. In addition, it was reported that the amount of waste from laboratories etc. for near-surface disposal and their characterization in our country. The Subjects of future work: the treatment of hazardous waste, the problem of the double-regulation (the Nuclear Reactor Regulation Law and the Law Concerning Prevention from Radiation Hazards due to Radioisotopes and Others) and the possession of waste were discussed here. (author)

Etno parks in the function of cultural tourism development in the Mačva, Šabačka Posavina and Pocerina

Directory of Open Access Journals (Sweden)

Grčić Ljiljana

2010-01-01

Full Text Available The monuments of folk architecture have its historical, artistic and tourist value. They illustrate the characteristics of local culture and way of life, and therefore should be preserved for the future. The main touristic functions in them can be cognitive, educational, fun, and also vacation and recreation. If we would like to keep the traditional folk architecture, it is necessary to protect vulnerable areas at the source or in the open air museums. This paper presents an overview of the ethno-parks and other facilities in the Mačva, Šabac, Šabačka Pocerina and Posavina, which seems preserved examples of folk architecture and architecture from the nineteenth and early twentieth century, are part of the cultural heritage not only of these areas, but also the whole of Serbia.

78 FR 27882 - VA Veteran-Owned Small Business (VOSB) Verification Guidelines

Science.gov (United States)

2013-05-13

... Verification Self-Assessment Tool that walks the veteran through the regulation and how it applies to the...) Verification Guidelines AGENCY: Department of Veterans Affairs. ACTION: Advanced notice of proposed rulemaking... regulations governing the Department of Veterans Affairs (VA) Veteran-Owned Small Business (VOSB) Verification...

Factors influencing readiness to deploy in disaster response: findings from a cross-sectional survey of the Department of Veterans Affairs Disaster Emergency Medical Personnel System.

Science.gov (United States)

Zagelbaum, Nicole K; Heslin, Kevin C; Stein, Judith A; Ruzek, Josef; Smith, Robert E; Nyugen, Tam; Dobalian, Aram

2014-07-19

The Disaster Emergency Medical Personnel System (DEMPS) program provides a system of volunteers whereby active or retired Department of Veterans Affairs (VA) personnel can register to be deployed to support other VA facilities or the nation during national emergencies or disasters. Both early and ongoing volunteer training is required to participate. This study aims to identify factors that impact willingness to deploy in the event of an emergency. This analysis was based on responses from 2,385 survey respondents (response rate, 29%). Latent variable path models were developed and tested using the EQS structural equations modeling program. Background demographic variables of education, age, minority ethnicity, and female gender were used as predictors of intervening latent variables of DEMPS Volunteer Experience, Positive Attitude about Training, and Stress. The model had acceptable fit statistics, and all three intermediate latent variables significantly predicted the outcome latent variable Readiness to Deploy. DEMPS Volunteer Experience and a Positive Attitude about Training were associated with Readiness to Deploy. Stress was associated with decreased Readiness to Deploy. Female gender was negatively correlated with Readiness to Deploy; however, there was an indirect relationship between female gender and Readiness to Deploy through Positive Attitude about Training. These findings suggest that volunteer emergency management response programs such as DEMPS should consider how best to address the factors that may make women less ready to deploy than men in order to ensure adequate gender representation among emergency responders. The findings underscore the importance of training opportunities to ensure that gender-sensitive support is a strong component of emergency response, and may apply to other emergency response programs such as the Medical Reserve Corps and the American Red Cross.

Comparison of Comet Enflow and VA One Acoustic-to-Structure Power Flow Predictions

Science.gov (United States)

Grosveld, Ferdinand W.; Schiller, Noah H.; Cabell, Randolph H.

2010-01-01

Comet Enflow is a commercially available, high frequency vibroacoustic analysis software based on the Energy Finite Element Analysis (EFEA). In this method the same finite element mesh used for structural and acoustic analysis can be employed for the high frequency solutions. Comet Enflow is being validated for a floor-equipped composite cylinder by comparing the EFEA vibroacoustic response predictions with Statistical Energy Analysis (SEA) results from the commercial software program VA One from ESI Group. Early in this program a number of discrepancies became apparent in the Enflow predicted response for the power flow from an acoustic space to a structural subsystem. The power flow anomalies were studied for a simple cubic, a rectangular and a cylindrical structural model connected to an acoustic cavity. The current investigation focuses on three specific discrepancies between the Comet Enflow and the VA One predictions: the Enflow power transmission coefficient relative to the VA One coupling loss factor; the importance of the accuracy of the acoustic modal density formulation used within Enflow; and the recommended use of fast solvers in Comet Enflow. The frequency region of interest for this study covers the one-third octave bands with center frequencies from 16 Hz to 4000 Hz.

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War.

Science.gov (United States)

Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R

2016-05-01

The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

Estimating Value at Risk with the Generalized Kalman Filter%基于Generalized Kalman Filter的VaR估计

Institute of Scientific and Technical Information of China (English)

赵利锋; 张崇岐

2009-01-01

在应用Kalman Filter方法估计时变风险β系数的基础上,引入Generalized Kalman Filter方法来估计时变卢系数,再通过Sharp对角线模型计算投资组合的VaR,并运用Backtesting检验判断两方法估计VaR的精确度.

Operational and safety requirement of radiation facility

International Nuclear Information System (INIS)

Zulkafli Ghazali

2007-01-01

Gamma and electron irradiation facilities are the most common industrial sources of ionizing radiation. They have been used for medical, industrial and research purposes since the 1950s. Currently there are more than 160 gamma irradiation facilities and over 600 electron beam facilities in operation worldwide. These facilities are either used for the sterilization of medical and pharmaceutical products, the preservation of foodstuffs, polymer synthesis and modification, or the eradication of insect infestation. Irradiation with electron beam, gamma ray or ultra violet light can also destroy complex organic contaminants in both liquid and gaseous waste. EB systems are replacing traditional chemical sterilization methods in the medical supply industry. The ultra-violet curing facility, however, has found more industrial application in printing and furniture industries. Gamma and electron beam facilities produce very high dose rates during irradiation, and thus there is a potential of accidental exposure in the irradiation chamber which can be lethal within minutes. Although, the safety record of this industry has been relatively very good, there have been fatalities recorded in Italy (1975), Norway (1982), El Salvador (1989) and Israel (1990). Precautions against uncontrolled entry into irradiation chamber must therefore be taken. This is especially so in the case of gamma irradiation facilities those contain large amounts of radioactivity. If the mechanism for retracting the source is damaged, the source may remain exposed. This paper will, to certain extent, describe safety procedure and system being installed at ALURTRON, Nuclear Malaysia to eliminate accidental exposure of electron beam irradiation. (author)

Validation of KENO V.a for criticality safety calculations involving WR-1 fast-neutron fuel arrangements

Energy Technology Data Exchange (ETDEWEB)

Gauld, I. C.

1991-07-15

The KENO V.a criticality safety code, used with the SCALE 27-energy-group ENDF/B-IV-based cross-section library, has been validated for low-enriched uranium carbide (UC) WR-1 fast-neutron (FN) fuel arrangements. Because of a lack of relevant experimental data for UC fuel in the published literature, the validation is based primarily on calculational comparisons with critical experiments for fuel types with a range of enrichments and densities that cover those of the FN UC fuel. The ability of KENO V.a to handle the unique annular pin arrangement of the WR-1 FN fuel bundle was established using a comparison with the MCNP3B code used with a continuous-energy ENDF/B-V-based cross-section library. This report is part of the AECL--10146 report series documenting the validation of the KENO V.a criticality safety code.

Magnetic resonance image examinations in emergency medical care

International Nuclear Information System (INIS)

Yamashiro, Takanobu; Yoshizumi, Tohru; Ogura, Akio; Hongou, Takaharu; Kikumoto, Rikiya

2006-01-01

There is a growing consensus in terms of the need for effective use of magnetic resonance imaging (MRI) diagnostic devices in emergency medical care. However, a thorough assessment of risk management in emergency medical care is required because of the high magnetic field in the MRI room. To understand the conditions required for the execution of emergency MRI examinations in individual medical facilities, and to prepare guidelines for emergency MRI examinations, we carried out a questionnaire survey concerning emergency MRI examinations. We obtained responses from 71% of 230 medical facilities and used this information in considering a system of emergency MRI examinations. Moreover, some difficulties were experienced in half of the facilities where emergency MRI examinations had been enacted, the main cause of which was the medics. Based on the results of the questionnaire, guidelines are necessary to maintain an urgent system for MRI examinations. Moreover, we were able to comprehend the current state of emergency MRI examinations in other medical facilities through this investigation, and we are preparing a system for the implementation of emergency MRI examinations. (author)

38 CFR 58.17 - VA Form 10-0144A-Statement of Assurance of Compliance with Equal Opportunity Laws.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA Form 10-0144A-Statement of Assurance of Compliance with Equal Opportunity Laws. 58.17 Section 58.17 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) FORMS § 58.17 VA Form 10-0144A—Statement of Assurance of Compliance with Equal...

30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a) Provided...

Drug prescription based on WHO indicators: Tehran university of medical sciences facilities with pharmacy

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Mosleh A.

2007-11-01

Full Text Available Background: Rationalize of drug use in societies is one of the main responsibilities of health policy makers. In our country irrational use of dugs has increased in the recent years, for example one study in 1998 has shown that average number of medicines per prescription was 3.6, percentage of prescriptions containing antibiotics was 43% and percentage of prescriptions containing Injections was 39%. One of the best tools for evaluation of drug use is the WHO guideline for calculating prescribing indicators. In this study, we had an assessment about prescribing patterns in South of Tehran, Islamshahr and Rey Health Centers.Methods: In order to evaluating prescribing indicators in Tehran University of Medical Sciences region 35 facilities which had pharmacy were selected according to WHO gridline and 4190 prescription from these facilities were studied. Indicators were calculated according to formulas has explained in article. Results: The average number of drug per prescription was 2.58, percentage of drug prescribed by generic name: 99.8%, percentage of encounters prescribed Antibiotics: 62.39% percentage of encounters prescribed Injection: 28.96% & the percentage of drugs prescribed from PHC formulary 99.46%. These findings were almost similar in the three Health Centers.Conclusions: Health facilities are one of the most important bases to improve rational use of Drugs and general practitioners are the major chain in RUD cycle. Results show that we need to design intervention especially educational interventions to improve two WHO prescribing indicators, percentage of encounters prescribed Antibiotics & Injections in this region. For reaching this goals we need to design educational programs for physicians, pharmacists and people too. These educations can be as workshops, seminars, conferences or printed materials such as books, leaflets and etc.

Characterization of the interaction between the heavy and light chains of bovine factor Va.

Science.gov (United States)

Walker, F J

1992-10-05

Bovine factor Va has been previously been shown to consist of heavy (M(r) = 94,000) and light chains (M(r) = 81,000), that interact in a manner dependent upon the presence of either calcium or manganese ions. In an attempt to understand the mechanism of subunit interaction we have studied the effects of temperature and ions on factor Va stability. The rates of formation of factor Va from isolated chains and dissociation were temperature-dependent with an energy of activation of 6.2 and 1.3 kcal mol-1, respectively. The yield of factor Va from isolated chains was inversely related to the amount of time the chains were incubated at 4 degrees C. Incubation of individual chains revealed that the heavy chain is cold-labile, an effect that is reversible. Manganese ion was observed to prevent the conversion to the inactive form. High salt tends to stabilize the two-chain structure of factor Va, but is inhibitory to its formation from isolated chains. High concentrations of either manganese or calcium ions also inhibited reconstitution of activity. The light chain, in particular, was sensitive to the presence of manganese or calcium ion. Heavy chain that had been cleaved by activated protein C had a weakened interaction with the light chain, and the resulting complex had no procoagulant activity. Cooling of the heavy chain to 4 degrees C enhanced its intrinsic fluorescence. Manganese ion prevented some of this enhancement. The heavy chain fluorescence returned to the room temperature value with a half-life of approximately 10 min. In the presence of manganese ion relaxation was accelerated. The intrinsic fluorescence of activated protein C-cleaved heavy chain was not increased when the temperature was decreased. These data suggest that the heavy chain can exist in two forms. Elevated temperature converts it to a form that can bind ions and have a productive interaction with the light chain. However, conditions that prevent the heavy chain from combining with the light

ASSESSMENT OF MEDICAL WASTE MANAGEMENT IN EDUCATIONAL HOSPITALS OF TEHRAN UNIVERSITY MEDICAL SCIENCES

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M. H. Dehghani, K. Azam, F. Changani, E. Dehghani Fard

2008-04-01

Full Text Available The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past, medical waste was often mixed with municipal solid waste and disposed in residential waste landfills or improper treatment facilities in Iran. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better managing the wastes from healthcare facilities. This study was carried in 12 educational hospitals of Tehran University of Medical Sciences. The goals of this study were to characterize solid wastes generated in healthcare hospitals, to report the current status of medical waste management and to provide a framework for the safe management of these wastes at the considered hospitals. The methodology was descriptive, cross-sectional and consisted of the use of surveys and interviews with the authorities of the healthcare facilities and with personnel involved in the management of the wastes. The results showed that medical wastes generated in hospitals were extremely heterogeneous in composition. 42% of wastes were collected in containers and plastic bags. In 75% of hospitals, the stay-time in storage sites was about 12-24h. 92% of medical wastes of hospitals were collected by covered-trucks. In 46% of hospitals, transferring of medical wastes to temporary stations was done manually. The average of waste generation rates in the hospitals was estimated to be 4.42kg/bed/day.