Leveraging Federal Policies to Prevent and Respond to Communicable Disease Outbreaks

Leveraging Federal Policies to Prevent and Respond to Communicable Disease Outbreaks in Skilled Nursing Facilities Objective: The coronavirus (COVID-19) pandemic significantly impacted the health, safety and well-being of patients and healthcare workers in skilled nursing facilities (SNFs) across the United States (US), resulting in approximately 1.2 million confirmed cases, and 134,000 deaths as of May 30, 2021. The purpose of this study was to apply principles of legal research to identify federal policies aimed at preventing and responding to communicable disease outbreaks in SNFs, to assess these policies based on current evidence and expert opinions, and to provide policy proposals to address identified gaps. Methods: An environmental scan of the Library of Congress, Google Scholar, the Federal Register, Centers for Medicare and Medicaid Services (CMS), and Westlaw Edge databases was conducted to identify federal policies relevant to the prevention and response to communicable disease outbreaks in SNFs. Results were reviewed against study inclusion and exclusion criteria to identify policies to be included in the final analysis. The CDC’s Policy Analysis Framework was then used to assess current policies relative to current evidence as well as their overall public health impact, feasibility of implementation, and the economic impact. Gaps in existing policies were identified and policy proposals were made based on the analysis. Results: The environmental scan identified 571 policies across the five databases. Application of inclusion and exclusion criteria resulted in the elimination of 563, leaving a total of eight policies for review and analysis. Policies were categorized as preventative, responsive, or both. Nursing services (preventative) and Infection Prevention and Control/Training Requirements (responsive and preventative) were identified as policies needing modification to better improve patient care and safety. Conclusion: While there are many federal policies to prevent and respond to communicable disease outbreaks in SNFs, some of those policies do not reflect the best available scientific evidence. To improve the quality of care and safety for patients in these facilities, changes are needed to existing policies to ensure the appropriate prevention and response to communicable disease outbreaks such as COVID-19, among this vulnerable population

The Validity of Health-Related Quality of Life Instruments in Patients With Late-Stage Parkinson's Disease

OBJECTIVE: To examine the validity of health-related quality of life (Hr-QoL) measures in patients with late-stage Parkinson's disease (PD). METHODS: We analysed data from patients with late-stage PD and their carers who were assessed with a range of clinical measures and the EQ-5D-3 L. The DEMQOL-Proxy was completed for 157 patients with a diagnosis of dementia and the PDQ-8 by 401 patients without dementia. Convergent validity was assessed using correlations with measures of Parkinson's severity, independence and cognitive function, and construct validity using correlations with patients' own EQ-5D-3 L scores. In addition, we assessed divergent validity using correlations with carers' own EQ-5D index, EQ-VAS and Zarit caregiver burden scores. RESULTS: In patients without dementia, both the PDQ-8 and EQ-5D-3 L correlated with measures of disease severity, dependence and carer burden scores, and PDQ-8 scores moderately with EQ-5D-3 L and EQ-5D-3 L VAS scores. In patients with dementia, EQ-5D-3 L scores correlated with disease severity, cognition and dependence scores, but DEMQOL-Proxy scores were moderately associated only with patients' dependence and carers' own EQ-5D-3 L scores but not patients' disease severity, EQ-5D-3 L or cognitive scores. CONCLUSIONS: The PDQ-8 and EQ-5D-3 L have adequate validity in late stage PD without dementia, but in those with PD and dementia the EQ-5D-3 L may be preferable to the DEMQOL-Proxy

The late stage of Parkinson's –results of a large multinational study on motor and non-motor complications

INTRODUCTION: There is little information on the late stages of parkinsonism. METHODS: We conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less. RESULTS: Average disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment. CONCLUSION: These data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients

Characteristics of Patients with Late-Stage Parkinsonism who are Nursing Home Residents Compared with those Living at Home

OBJECTIVES: To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES: Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS: Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS: These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder

Software security requirements management as an emerging cloud computing service

© 2016 Elsevier Ltd. All rights reserved.Emerging cloud applications are growing rapidly and the need for identifying and managing service requirements is also highly important and critical at present. Software Engineering and Information Systems has established techniques, methods and technology over two decades to help achieve cloud service requirements, design, development, and testing. However, due to the lack of understanding of software security vulnerabilities that should have been identified and managed during the requirements engineering phase, we have not been so successful in applying software engineering, information management, and requirements management principles that have been established for the past at least 25 years, when developing secure software systems. Therefore, software security cannot just be added after a system has been built and delivered to customers as seen in today's software applications. This paper provides concise methods, techniques, and best practice requirements engineering and management as an emerging cloud service (SSREMaaES) and also provides guidelines on software security as a service. This paper also discusses an Integrated-Secure SDLC model (IS-SDLC), which will benefit practitioners, researchers, learners, and educators. This paper illustrates our approach for a large cloud system Amazon EC2 service

Communication rehabilitation in sub-Saharan Africa: A workforce profile of speech and language therapists.

BACKGROUND: There is an urgent global need to strengthen rehabilitation services for people with disabilities. In sub-Saharan Africa, rehabilitation services for people with communication disabilities continue to be underdeveloped. A first step in strengthening services for people with a communication disabilities is to understand the composition and conditions of the current workforce. OBJECTIVES: This research describes a sample of the speech and language therapists (SLTs) working in SSA (excluding South Africa). This study explores the characteristics of this workforce, including their demographics, education, experience and geographical stability. METHOD: A mixed-methods survey was used to collect data from SLTs within Anglophone countries of SSA. Completed surveys were received from 33 respondents working in 44 jobs across nine countries. Analysis included descriptive and non-parametric inferential statistics. This study reports on a subset of descriptive and quantitative data from the wider survey. RESULTS: A background profile of SLTs across the region is presented. Results indicated that the workforce of SLTs comprised a mix of local and international SLTs, with university-level education. Local SLTs were educated both within and outside of Africa, with more recent graduates trained in Africa. These data reflected the local emergence of speech and language therapy training in SSA. CONCLUSION: This sample comprised a mix of African and international SLTs, with indications of growing localisation of the workforce. Workforce localisation offers potential advantages of linguistic diversity and stability. Challenges including workforce support and developing culturally and contextually relevant SLT practices are discussed

Quantifying Lighting Benefits under the RoHS Directive: Calculating the Cost of Lost Time

This report quantifies the cost of delayed action by the European commission in delaying the phase out of mercury-based lighting

1995 - Award Recipient: Frances Temple

The Consortium of Latin American Studies Programs (CLASP) founded the Américas Award in 1993 to encourage and commend authors, illustrators and publishers who produce quality children’s and young adult books that portray Latin America, the Caribbean, or Latinos in the United States, and to provide teachers with recommendations for classroom use. For more information on the Américas Award, visit the CLASP website: http://claspprograms.org/pages/detail/37/Americas-Award. The 1995 Américas Award titles were honored at a ceremony held in 1996 at the Library of Congress in Washington, D.C. Award Winner Tonight, by Sea by Frances Temple (Orchard, 1995

1996 - Award Recipients: Carmen Lomas Garza and Victor Martínez

The Consortium of Latin American Studies Programs (CLASP) founded the Américas Award in 1993 to encourage and commend authors, illustrators and publishers who produce quality children’s and young adult books that portray Latin America, the Caribbean, or Latinos in the United States, and to provide teachers with recommendations for classroom use. For more information on the Américas Award, visit the CLASP website: http://claspprograms.org/pages/detail/37/Americas-Award. The 1996 Américas Award titles were honored at a ceremony held in 1997 at the Library of Congress in Washington, D.C. Award Winners In My Family/En mi familia by Carmen Lomas Garza (Children’s Book Press, 1996) Parrot in the Oven by Victor Martínez (HarperCollins, 1996