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After revamping agency operations, this agency was able to devise a voluntary incentive bonus program to address recruitment, retention, and quality concerns while controlling costs.
Rapid voluntary limb movements are accompanied by a triphasic electromyogram (EMG): the agonist muscle discharges briefly to generate the initial limb displacement and then, in sequence, an antagonist and second agonist burst occur. The origins of these bursts of EMG have been attributed to both peripheral and central sources. We attempted to determine in human subjects whether somesthetic afferent inputs related to passive muscle stretch or joint rotation were necessary for the appearance of the three bursts. EMGs were recorded while subjects performed rapid isotonic movements before and after forearm afferent function was blocked by ischemia. EMG patterns were also studied during phasic and sustained isometric contractions of forearm muscles. When the forearm was ischemically deafferented the triphasic EMG pattern persisted though the amplitudes of the three bursts were modified. In separate experiments, a similar three burst pattern was also observed while phasic isometric contractions were performed but not when rapid-onset sustained isometric contractions were executed. These data support the view that somesthetic afferent information related to muscle length or joint rotation is not necessary for the occurrence of the three burst pattern during rapid motor behaviors. Since bursts of EMG activity were observed when torque rose and fell quickly during fast isotonic movements and phasic isometric contractions, the triphasic pattern appears to be a fundamental property of the central program underlying such rapid motor behaviors.
Because the inhalation of asbestos, a naturally occurring, inorganic fibrous material, is associated with lung fibrosis and thoracic cancers, concerns have been raised about the possible health effects of synthetic vitreous fibers (SVFs). SVFs include a very broad variety of inorganic fibrous materials with an amorphous molecular structure. Traditionally, SVFs have been divided into three subcategories based on composition: fiberglass, mineral wool (rock, stone, and slag wools), and refractory ceramic fiber. For more than 50 years, the toxicologic potential of SVFs has been researched extensively using human epidemiology and a variety of laboratory studies. Here we review the research and its impact on hazard classification and regulation of SVFs. Large, ongoing epidemiology studies of SVF manufacturing workers have provided very little evidence of harmful effects in humans. Several decades of research using rodents exposed by inhalation have confirmed that SVF pulmonary effects are determined by the "Three D's", fiber dose (lung), dimension, and durability. Lung dose over time is determined by fiber deposition and biopersistence in the lung. Deposition is inversely related to fiber diameter. Biopersistence is directly related to fiber length and inversely related to fiber dissolution and fragmentation rates. Inhaled short fibers are cleared from the lung relatively quickly by mobile phagocytic cells, but long fibers persist until they dissolve or fragment. In contrast to asbestos, most of the SVFs tested in rodent inhalation studies cleared rapidly from the lung (were nonbiopersistent) and were innocuous. However, several relativley biopersistent SVFs induced chronic inflammation, lung scarring (fibrosis), and thoracic neoplasms. Thus, biopersistence of fibers is now generally recognized as a key determinant of the toxicologic potential of SVFs. In vitro dissolution of fibers in simulated extracellular fluid correlates fairly well with fiber biopersistence in the lung and pulmonary toxicity, but several exceptions suggest that biopersistence involves more than dissolution rate. Research demonstrating the relationship between biopersistence and SVF toxicity has provided a scientific basis for hazard classification and regulation of SVFs. For a nonhazardous classification, legislation recently passed by the European Union requires a respirable insulation wool to have a low lung-biopersistence or be noncarcinogenic in laboratory rats. U.S. fiberglass and mineral wool industries and the Occupational Health and Safety Administration (OSHA) have formed a voluntary Health and Safety Partnership Program (HSPP) that include: a voluntary permissible exposure level (PEL) in the workplace of 1 fiber/cc, a respiratory protection program for specified tasks, continued workplace air monitoring, and, where possible, the development of fiber formulations that do not persist in the lung. RCF manufacturers have implemented a Product Stewardship Program that includes: a recommended exposure guideline of 0.5 fibers/cc; a 5-year workplace air monitoring program; and research into the development of high-temperature-resistant, biosoluble fibers.
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Caregiving for aging parents or other disabled family members takes a heavy toll on work and family life, as well as the company bottom line. Research reveals that the two primary responses to elder-care issues in the workplace are employer-paid consultation and referral programs, and employee-paid long-term care insurance (LTCI) plans.
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This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician's role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.
The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.
A major thrust of health professionals now is the development of continuing education programs needed to maintain excellence in the services they render to the public. The question arises whether these new programs should remain voluntary or be mandatory. Radiologic technologists have a responsibility to develop their own quality programs that are reasonably inexpensive, diverse, comprehensive, accessible, and give the learner satisfaction in personal fulfillment. If it is not already too late, the profession should be sure that it uses education to the fullest possible extent.
The epidemic of infection with the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) poses a major ethical question: How can we control the epidemic and the harm that it causes without unjustly discriminating against particular social groups and without unnecessarily infringing on the freedom of individuals? This question pertains to three spheres of public policy in the United States: public health, the delivery of health care, and research. In the public health sphere, vigorous educational efforts will be required, as will modified approaches to intravenous drug use, prostitution, and homosexual and bisexual sexual activity. Carefully targeted, voluntary testing and screening programs should be coupled with counseling and with guarantees of confidentiality and nondiscrimination where these are appropriate. Both health care workers and the health care system have a moral obligation to provide care to people with HIV infection, but heroic self-sacrifice should not be required provided that infection control precautions are observed. Patients with neurological involvement and terminally ill patients will benefit from statutes allowing recognition of advance directives about preferred modes of care or nontreatment. There is a moral imperative to perform intensive research directed toward the understanding, treatment, and prevention of HIV infection and AIDS. The research process will raise challenging ethical questions.
We studied three patients: two with voice and hand tremor, and one with voice tremor. Voice tremor was associated with synchronous rhythmic contraction of cricothyroid and rectus abdominis muscles, but not always vocalis muscle. Voice tremor was manifested only in voluntary phonation or expiration, not in involuntary phonation, voluntary inspiration, or involuntary expiration and inspiration (breathing at rest). Impaired regulation of the CNS programs innervating the voluntary expiratory muscles probably causes voice tremor. Clonazepam and propranolol were helpful in blinded studies.
In summary, the HGM program is a voluntary, multicenter, prospective study of the SEOPF that is open to all transplant centers. The program extends mandatory sharing beyond the UNOS zero-antigen mismatch obligation, and uses preliminary crossmatching via ROP trays to try to facilitate transplantation of the highly sensitized patient. The program encompasses less than 7% of the cadaver kidney transplant activity of the participating centers, so it does not impact the majority of recipients. After 49 months of operation, it has significantly improved access to transplantation for blood group O patients, patients awaiting re-grafts, and those who are highly sensitized (PRA > or = 40%). Additionally, 92% of the HGM recipients have received an allograft with 2 or less antigens mismatched. Enrollment will continue until there is sufficient power to test the null hypothesis of equality of HGM and non-HGM transplants.
Nonhuman primate (NHP) species used in biomedical research may be infected with a variety of retroviruses including simian immunodeficiency virus (SIV), simian spumaviruses (i.e., simian foamy viruses [SPV]), simian T-lymphotrophic viruses (STLV), and/or simian type D retroviruses. All of these retroviruses cause life-long infections in NHPs, and some are transmissible through sexual contact, blood, or breast-feeding. Following the detection of SIV infection in a worker with occupational exposure to SIV, in 1993 CDC and the National Institutes of Health conducted an anonymous serosurvey using stored specimens collected from U.S. workers with similar exposures. SIV seroreactivity was present in three (0.6%) of 427 stored serum samples. As a result of this finding, in 1993 CDC implemented a voluntary testing and counseling surveillance program to link specific exposures or health outcomes with the SIV serostatus of persons with potential occupational exposure to SIV. In 1995, the linked surveillance program was expanded to include voluntary testing and counseling for exposure to SFV, STLV and simian type D retroviruses. As of November 20, 1996, samples from 231 of the participating volunteer workers had been tested for SFV; infection was documented in three (1.3%). This report presents laboratory findings and case descriptions of these three infections, which indicate that SFV from NHPs can persistently infect exposed humans and may or may not cause disease or be transmitted among humans.
The Canadian Society of Clinical Chemists (CSCC) and the Canadian Academy of Clinical Biochemistry (CACB) have recently implemented a new professional development program for its 400 members. The program's goals are: to evaluate and recognize professional development based on self-determined needs, interests, and learning preferences; and to ensure that qualified professionals directing clinical biochemistry laboratories have adequate basic and current knowledge to function competently in their profession. Involvement in the program is currently voluntary and based on a 3-year cycle during which time participants must earn a minimum of 150 credits from at least 3 of 8 categories' learning activities. Of these activities: four are related to updating knowledge (Formal Group Learning related to Laboratory Medicine, Other Formal Group Learning, Self-Directed Learning, Self-Assessment); three are related to the maintenance and implementation of practice skills (Service Associated Learning, Teaching, Change in Practice); and one is related to the advancement of knowledge (Publications and Presentations). One credit is defined as one hour of continuing professional development activity. At the end of each year, members document their activities by submitting a 4 page Annual Summary of Activities (ASA) form. The cost of coordinating the program is minimal as it is administered by a steering committee and smaller working committees, all of whom are voluntary. A basic assumption of our program is that self-management of professional development (PD) is an important prerequisite and indicator of maintenance of competence. By recognizing learning through a number of activities and outcomes, it is anticipated that our program will promote an overall improvement in the quality of Laboratory Medicine throughout Canada.
There are numerous pesticides and toxic chemicals in the environment that have yet to be evaluated for potential to cause developmental neurotoxicity. Recent legislation and testing initiatives provide an impetus to generating more information about potential hazards to children. In the United States, the 1996 Food Quality Protection Act (FQPA) required the U.S. Environmental Protection Agency (U.S. EPA) to make a finding that a pesticide food use is safe for children. In addition, the law requires U.S. EPA to incorporate an additional 10-fold factor in risk assessments for pesticide residue tolerances to take into account the special sensitivities of infants and children as well as incomplete data with respect to toxicity and exposures. The potential of chemicals in food and drinking water to cause endocrine disruption will also be examined via the Endocrine Disruptor Screening and Testing Program required by the FQPA and the 1996 Safe Drinking Water Act. In addition, a new voluntary chemical information program will provide screening-level information for the some 2,800 high-volume chemicals in commerce in the United States. These initiatives will need to be accompanied by research focused on developmental toxicity for children, including developmental disabilities. Developmental disabilities exact a large toll on children's health in the United States. Three major developmental disabilities--autism, cerebral palsy, and severe mental retardation--each affect substantial numbers of children. We know very little about the etiology of these conditions. A number of priority areas for research are suggested, including a large environmental prospective study of developmental neurotoxicity.