Funding the utilization of community health workers in Texas

Community health workers (CHWs) are volunteers or paid members of communities that perform outreach, patient assistance, health education, and assist in navigation of healthcare system amongst other duties. The utilization of CHWs in hospital and community setting provides health benefits to their communities while reducing cost to the overall healthcare system. ^ The general population of Texas lacks adequate access to primary care. An important indicator of such a crisis is excessive usage of emergency department services in Texas, especially by the large minority population within the state. Also, unmanaged chronic diseases have been shown to be correlated with the excessive usage of emergency services. According to a recent survey of 25 Houston metropolitan area hospitals, almost 54% of the ER visits could have been resolved in primary care settings. A Galveston based study also indicated that the ER usage was higher amongst African-Americans and Latinos. Meanwhile, 28.5% of the total ER visits were made by Latinos from the surrounding areas (Begley et al., 2007). There is substantial evidence present which indicates enormous cost-savings that CHWs have produced in Texas and nationwide through reduction in unnecessary ER visits along with better management of chronic diseases (Fedder et al, 2003). ^ This paper provides an analysis regarding the need and importance for sustainable and stable sources of funding for Community health workers (CHWs) in Texas utilizing Kingdon's model of Agenda Setting as framework. The policy analysis is also aimed at reporting on the policy process and actions taken by Children at Risk to address this critical issue. Children at Risk, a Houston based advocacy organization, has created a legislative proposal that calls on the Texas Health and Human Commission to apply for a Medicaid §§1115 waiver to provide sustainable sources of funding for CHWs, Rep. John Zerwas sponsored HB 2244 bill and it was filed on March 3, 2011. The bill would affect the use of CHWs in Texas in two ways: 1) through the establishment and operation of a program designed to train and educate CHWs 2) by creating a statewide training and certification advisory committee. The advisory committee is required in the bill to submit recommendations for providing sustainable funding and employment for CHWs. The HB 2244 failed to move out of the House Public Health committee. However, HB2244 was amended into HB 2610 introduced by Representative Guillen. The House Bill 2610 is geared towards establishing a community-based navigator program in order to assist individuals applying for public assistance through the Internet. The House Bill 2610 was signed by the Governor and will be effective September 1, 2011.^

Development and implementation of a dynamic heterogeneous proton equivalent anthropomorphic thorax phantom for the assessment of scanned proton beam therapy

DEVELOPMENT AND IMPLEMENTATION OF A DYNAMIC HETEROGENEOUS PROTON EQUIVALENT ANTHROPOMORPHIC THORAX PHANTOM FOR THE ASSESSMENT OF SCANNED PROTON BEAM THERAPY by James Leroy Neihart, B.S. APPROVED: ______________________________David Followill, Ph.D. ______________________________Peter Balter, Ph.D. ______________________________Narayan Sahoo, Ph.D. ______________________________Kenneth Hess, Ph.D. ______________________________Paige Summers, M.S. APPROVED: ____________________________ Dean, The University of Texas Graduate School of Biomedical Sciences at Houston DEVELOPMENT AND IMPLEMENTATION OF A DYNAMIC HETEROGENEOUS PROTON EQUIVALENT ANTHROPOMORPHIC THORAX PHANTOM FOR THE ASSESSMENT OF SCANNED PROTON BEAM THERAPY A THESIS Presented to the Faculty of The University of Texas Health Science Center at Houston andThe University of TexasMD Anderson Cancer CenterGraduate School of Biomedical Sciences in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE by James Leroy Neihart, B.S. Houston, Texas Date of Graduation August, 2013 Acknowledgments I would like to acknowledge my advisory committee members, chair David Followill, Ph.D., Peter Balter, Ph.D, Narayan Sahoo, Ph.D., Kenneth Hess, Ph.D., Paige Summers M.S. and, for their time and effort contributed to this project. I would additionally like to thank the faculty and staff at the PTC-H and the RPC who assisted in many aspects of this project. Falk Pӧnisch, Ph.D. for his breath hold proton therapy treatment expertise, Matt Palmer and Jaques Bluett for proton dosimetry assistance, Matt Kerr for verification plan assistance, Carrie Amador, Nadia Hernandez, Trang Nguyen, Andrea Molineu, Lynda McDonald for TLD and film dosimetry assistance. Finally, I would like to thank my wife and family for their support and encouragement during my research and studies. Development and implementation of a dynamic heterogeneous proton equivalent anthropomorphic thorax phantom for the assessment of scanned proton beam therapy By: James Leroy Neihart, B.S. Chair of Advisory Committee: David Followill, Ph.D Proton therapy has been gaining ground recently in radiation oncology. To date, the most successful utilization of proton therapy is in head and neck cases as well as prostate cases. These tumor locations do not suffer from the resulting difficulties of treatment delivery as a result of respiratory motion. Lung tumors require either breath hold or motion tracking, neither of which have been assessed with an end-to-end phantom for proton treatments. Currently, the RPC does not have a dynamic thoracic phantom for proton therapy procedure assessment. Additionally, such a phantom could be an excellent means of assessing quality assurance of the procedures of proton therapy centers wishing to participate in clinical trials. An eventual goal of this phantom is to have a means of evaluating and auditing institutions for the ability to start clinical trials utilizing proton therapy procedures for lung cancers. Therefore, the hypothesis of this study is that a dynamic anthropomorphic thoracic phantom can be created to evaluate end-to-end proton therapy treatment procedures for lung cancer to assure agreement between the measured and calculated dose within 5% / 5 mm with a reproducibility of 2%. Multiple materials were assessed for thoracic heterogeneity equivalency. The phantom was designed from the materials found to be in greatest agreement. The phantom was treated in an end-to-end treatment four times, which included simulation, treatment planning and treatment delivery. Each treatment plan was delivered three times to assess reproducibility. The dose measured within the phantom was compared to that of the treatment plan. The hypothesis was fully supported for three of the treatment plans, but failed the reproducibility requirement for the most aggressive treatment plan.

Table 1 of experts and representatives interviewed

In a modern society it is generally accepted that the major cause for environmental problems is the current consumption pattern in industrialized countries, thus it is crucial to understand underlying processes and search for solutions in order to consciously progress towards sustainable consumption. In this paper the exclusive role of municipalities in promoting sustainable consumption is recognized. By analyzing the example of the situation of municipalities in Latvia, the reason for focusing on local level when dealing with sustainable consumption issues, as well as main obstacles and possibilities for municipalities' progress towards sustainability are revealed. Promotion of sustainable consumption cannot be based solely on eco-efficiency. Sufficiency strategy plays a crucial role. Since positive social environment for sufficiency dimension is vitally important, local level holds exclusively crucial role for its implementation - the potential of municipalities here is unbounded. Although local authorities already have many tools available, they are insufficiently discovered. Insufficiently exploited tools are property tax relief as support mechanism, establishment of advisory boards, green procurement, promotion of social entrepreneurship and collaborative consumption, as well as delegation of municipalities' functions to NGOs, thus encouraging nonmaterial wellbeing by strengthening social ties and community activities.

Contexto de las políticas agrarias en los proyectos de desarrollo para Patagonia : El "Informe Altimir" en la provincia de Chubut (1970)

El "Informe Altimir" es un trabajo solicitado por el Consejo Federal de Inversiones (CFI) a un equipo de investigadores dirigido por Oscar Altimir, para ser entregado a la Asesoría de Desarrollo de Chubut en 1970.Su objetivo era planificar las acciones para la instalación del modelo de "polos de desarrollo" así como analizar las políticas a seguir en las otras áreas económicas. A través de una revisión exhaustiva de esta fuente, y de su cruce con otros aportes, mostramos cuáles fueron las políticas agrarias que se impulsaron en Chubut.Se dividió la provincia en regiones, para impulsar un proyecto que buscara asegurar el suministro de alimentos a las áreas urbanas, la provisión de mano de obra para las industrias a instalarse y la concentración de la propiedad en el resto de Chubut.

Contexto de las políticas agrarias en los proyectos de desarrollo para Patagonia : El "Informe Altimir" en la provincia de Chubut (1970)

El "Informe Altimir" es un trabajo solicitado por el Consejo Federal de Inversiones (CFI) a un equipo de investigadores dirigido por Oscar Altimir, para ser entregado a la Asesoría de Desarrollo de Chubut en 1970.Su objetivo era planificar las acciones para la instalación del modelo de "polos de desarrollo" así como analizar las políticas a seguir en las otras áreas económicas. A través de una revisión exhaustiva de esta fuente, y de su cruce con otros aportes, mostramos cuáles fueron las políticas agrarias que se impulsaron en Chubut.Se dividió la provincia en regiones, para impulsar un proyecto que buscara asegurar el suministro de alimentos a las áreas urbanas, la provisión de mano de obra para las industrias a instalarse y la concentración de la propiedad en el resto de Chubut.

Contexto de las políticas agrarias en los proyectos de desarrollo para Patagonia : El "Informe Altimir" en la provincia de Chubut (1970)

El "Informe Altimir" es un trabajo solicitado por el Consejo Federal de Inversiones (CFI) a un equipo de investigadores dirigido por Oscar Altimir, para ser entregado a la Asesoría de Desarrollo de Chubut en 1970.Su objetivo era planificar las acciones para la instalación del modelo de "polos de desarrollo" así como analizar las políticas a seguir en las otras áreas económicas. A través de una revisión exhaustiva de esta fuente, y de su cruce con otros aportes, mostramos cuáles fueron las políticas agrarias que se impulsaron en Chubut.Se dividió la provincia en regiones, para impulsar un proyecto que buscara asegurar el suministro de alimentos a las áreas urbanas, la provisión de mano de obra para las industrias a instalarse y la concentración de la propiedad en el resto de Chubut.

Organic geochemical studies of DSDP Leg 64 Holes

Twenty-six core samples from Leg 64, Holes 474, 474A, 477, 478, 479, and 481A in the Gulf of California, were provided by the Joint Oceanographic Institutions for Deep Earth Sampling (JOIDES) Advisory Panel on Organic Geochemistry for analysis. The high heat flow characteristic of the basin provides an opportunity to study the effect of temperature on the diagenesis of organic matter. The contents and carbon isotope compositions of the organic matter and bitumen fractions of different polarity, isoprenoid and normal alkane distributions, and the nature of tetrapyrrole pigments were studied. Relative contents of hydrocarbons and bitumens depend on the thermal history of the deposits. Among other criteria, the nature and content of tetrapyrrole pigments appear to be most sensitive to thermal stress. Whereas only chlorins are present in the immature samples, porphyrins, including VO-porphyrins, appear in the thermally altered deposits, despite the shallow burial depth. Alkane distributions in thermally changed samples are characterized by low values of phytane to 2-C18 ratios and an odd/even carbon preference index close to unity. The thermally altered samples show unusual carbon isotope distributions of the bitumen fractions. The data also provide some evidence concerning the source of the organic matter and the degree of diagenesis.

Geochemistry of carbon at DSDP Legs 56-57 Holes

Forty-three core sections from Sites 434, 435, 438, 439, and 440 on the landward side and six core sections from Site 436 on the seaward side of the Japan Trench were obtained through the JOIDES Organic Geochemistry Advisory Panel for study of the origin and state of genesis of the organic matter associated with these continental slope, accretionary wedge, and outer trench slope sediments of the Japan Trench. The lipid fraction of these sediments is derived primarily from terrigenous organic matter and thus is allochthonous to the area. The associated kerogen fraction is of mixed allochthonous and autochthonous origin. The total organic carbon content seaward of the trench is less than that on the landward side. The composition of this organic matter is similar but not identical to that found in the landward side sediments. The organic matter within these sediments is in a diagenetic state in which geopolymerization of biogenic organic matter is nearly complete, but microbial alteration is still occurring.

Literature review of elasmobranch bycatch and retention rate

To address growing concern over the effects of fisheries non-target catch on elasmobranchs worldwide, the accurate reporting of elasmobranch catch is essential. This requires data on a combination of measures, including reported landings, retained and discarded non-target catch, and post-discard survival. Identification of the factors influencing discard vs. retention is needed to improve catch estimates and to determine wasteful fishing practices. To do this we compared retention rates of elasmobranch non-target catch in a broad subset of fisheries throughout the world by taxon, fishing country, and gear. A regression tree and random forest analysis indicated that taxon was the most important determinant of retention in this dataset, but all three factors together explained 59% of the variance. Estimates of total elasmobranch removals were calculated by dividing the FAO global elasmobranch landings by average retention rates and suggest that total elasmobranch removals may exceed FAO reported landings by as much as 400%. This analysis is the first effort to directly characterize global drivers of discards for elasmobranch non-target catch. Our results highlight the importance of accurate quantification of retention and discard rates to improve assessments of the potential impacts of fisheries on these species.

Una propuesta y un etiquetador de codificación morfosintáctica para corpus de referencia en lengua española

Este trabajo presenta una propuesta de codificación morfosintáctica para corpus de referencia en lengua española basada en los estándares de la Text Encoding Initiative (TEI), The Network of European Reference Corpora (NERC) y The Expert Advisory Group on Language Engineering Standards (EAGLES) tal y como se presenta en (Martín de Santa Olalla, 1994). Presentamos también el trabajo de creación de etiquetador morfosintáctico que utiliza el conjunto de etiquetas que ésta contiene.

Knowledge Management and Leadership in the Higher Education: A First Approach

Today, it is more and more important to develop competences in the learning process of the university students (that is to say, to acquire knowledge but also skills, abilities, attitudes and values). This is because professional practice requires that the future graduates design and market products, defend the interests of their clients, be introduced in the Administration or, even, in the Politics. Universities must form professionals that become social and opinion leaders, consultants, advisory, entrepreneurs and, in short, people with capacity to solve problems. This paper offers a tool to evaluate the application for the professor of different styles of management in the process of the student’s learning. Its main contribution consists on advancing toward the setting in practice of a model that overcomes the limitations of the traditional practices based on the masterful class, and that it has been applied in Portugal and Spain.

Training organization of a middle-size company engaged in information technology services: theory and practice

In order to establish an active internal know-how -reserve~ in an information processing and engineering services . company, a training architecture tailored to the company as an whole must be defined. When a company' s earnings come from . advisory services dynamically structured i.n the form of projects, as is the case at hand, difficulties arise that must be taken into account in the architectural design. The first difficulties are of a psychological nature and the design method proposed here begjns wi th the definition of the highest training metasystem, which is aimed at making adjustments for the variety of perceptions of the company's human components, before the architecture can be designed. This approach may be considered as an application of the cybernetic Law of Requisita Variety (Ashby) and of the Principle of Conceptual Integrity (Brooks) . Also included is a description of sorne of the results of the first steps of metasystems at the level of company organization.

Algunas impresiones para el próximo milenio

Con un intervalo de algunos días he tenido la ocasión de participar en la reunión de dos comités de carácter —un tanto— diferente. Uno era el técnico de la Conferencia de Comunicaciones Ópticas que tendrá lugar en Suiza el próximo mes de septiembre. El otro era uno de los habituales del Esprit Advisory Board en el que, entre otras cosas, se informó de cuál había sido el resultado de la evaluación de los proyectos presentados. Aunque el fin de ambas reuniones era, en contenido y objetivos, diferente, tenían algo en común: estaban relacionados con el mismo entorno tecnológico. Y, lo que para mí es más importante, de las dos extraje la misma consecuencia: el inicio de una vuelta a la realidad, tras el espejismo que supuso en los últimos años la idealización de las "nuevas tecnologías", y el inicio de un nuevo planteamiento basado en ellas

Diretrizes regulatórias aplicáveis à cadeia dos produtos para saúde

A ciência e a tecnologia cada vez mais vêm proporcionando avanços em produtos inovadores. Particularmente na área da saúde nota-se eminente sinergismo entre os materiais utilizados, suas propriedades de biocompatibilidade, biofuncionalidade, processabilidade, esterilidade e a área de aplicabilidade no organismo humano. O setor farmacêutico por apresentar grande complexidade exige conhecimentos multidisciplinares, atualizados e em conformidade às tendências internacionais. A Agência Nacional de Vigilância Sanitária (ANVISA) tem sob sua responsabilidade extensa diversidade de bens, serviços e produtos, dentre eles estão os correlatos, que também compreende os produtos para saúde. Os produtos para saúde são classificados conforme o seu risco, no Brasil podendo apresentar até quatro classes, sendo as classes III e IV as que caracterizam maior risco. Para alguns produtos, devido seu risco sanitário, é compulsório a Certificação de Conformidade pelo Instituto Nacional de Metrologia, Qualidade e Tecnologia (INMETRO) previamente a concessão de seu registro sanitário pela ANVISA. Dentre as normas técnicas aplicáveis pelo INMETRO estão as normas da Associação Brasileira de Normas Técnicas (ABNT) e na sua ausência, as normas da International Organization for Standardization (ISO). Outros requisitos técnicos e regulatórios devem ser contemplados com o propósito de comprovação da segurança e eficácia dos produtos. Entretanto, as regulamentações sanitárias inerentes a essa categoria de produtos ainda se encontram incipientes no país. A desenvoltura do setor produtivo nesse segmento pode ser evidenciada pelo aumento de novas solicitações na ANVISA e de seu crescimento na balança comercial. No entanto, observa-se pouco estudo e entendimento do setor regulado e regulador referente à relação mútua entre ANVISA, INMETRO e ABNT e quanto à regulação sanitária aplicável para obtenção da anuência do produto ao consumo. Na conjuntura das demandas apontadas o objetivo deste estudo foi avaliar o processo regulatório aplicável à cadeia produtiva dos produtos para saúde com a finalidade de compreender a relação entre ANVISA, INMETRO e ABNT na garantia da qualidade, segurança e eficácia dos produtos. A metodologia aplicada neste trabalho foi à pesquisa qualitativa. Com o auxílio da pesquisa documental constatou-se que o processo regulatório brasileiro é complexo, específico e robusto e apresenta estrutura e exigências semelhantes dos Estados Unidos e União Europeia. A fiscalização pós-uso é uma tendência internacional e a ANVISA vem adotando com frequência com intuito de acompanhar a qualidade dos produtos comercializados. As três instituições apresentam competências definidas e regulamentadas, bem como mecanismos de inter-relação por meio de conselhos consultivos. O estudo de caso caracterizou que o perfil dos profissionais do setor regulado apresenta em grande percentual formação na área da saúde e nível de pós-graduação, porém o nível de conhecimento dos principais conceitos relativos aos produtos para saúde é parcial, reforçando a necessidade de incentivos de capacitação de recursos humanos em regulação em saúde.