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By: V. Rozhov, M.A., M.D., M.P.H.

Assistant Professor, Harvard Medical School

Final Report from the Centre on Global Health Security Working Group on Health Governance diabetes mellitus retinopathy buy repaglinide 1 mg cheap. Better coordination and standardization between health and humanitarian sectors diabetes medications pharmacology buy discount repaglinide 0.5 mg, development of mutual accountability principles diabetes diet underweight purchase repaglinide discount, and integration of a human rights perspective would improve human security outcomes in future global responses diabetes mellitus type 2 incidence cheap repaglinide 1 mg overnight delivery. From the perspective of humanitarian governance, the global response to the Ebola outbreak exposed both deep inadequacies in the global systems tasked with safeguarding global public health, and opportunities for developing better tools of global governance. A well-noted inadequacy was the inability of the global system to quickly diagnose and react to the outbreak. I begin by differentiating between national and human security approaches to humanitarian-health crises using four guiding questions: security for whom, from what, by whom and how? Using this lens, I show that the Ebola emergency constitutes a threat to human security. Most notably, a national security approach requires isolating, containing and eradicating a specific pathogen to stabilize a crisis situation, while a human security approach prescribes a dual-pronged approach that both contains the disease and addresses the underlying sources of insecurity. This section compares national to human security using four guiding questions: (1) Security for whom? Following Paris, I view human security as a broad category of research that is a distinct branch of security studies and not a concept intended to usurp or replace national security. I show that security by whom and how supply important insights for global policymaking on humanitarian-health crises. Traditional definitions of national security are state-centered where the main objective is the protection of the state from real or perceived external security threats. National security requires the protection of national borders, populations, and territories from external threats; the state is most often, but not always, the principal actor that provides and ensures national security. Since the end of the Cold War, the field of security studies has both broadened to consider nonmilitary security threats, and deepened to include the security of groups other than the state. How human security identifies the source of a threat is both its most defining and contested feature. First, the broad definition generates a litany of possible threats, which diminishes its analytic value and makes prioritizing political action challenging. Take the example of Ebola, political and economic factors like state incapacity and uneven development created conditions conducive to the spread of the disease and the pandemic impacted multiple areas of human security beyond health. A final defining characteristic is vulnerability, defined by King and Murray as the number of years of future life spent outside a state of "generalized poverty;" security is based on the risk of severe deprivation and thus depends heavily on the concept of poverty. The question security by whom might be understood in two ways, who securitizes and who provides security? If security remains dominated by states and associated with their self-interested motivations, then who labels an issue a security concern matters because it determines which issues appear on the global agenda. For example, in the case of health, threats to the security of developed countries and their citizens are frequently prioritized in the international agenda. Securitization of infectious diseases such as H1N1 has also backfired, incentivizing non-cooperative behavior based on narrow calculations of national interest over international collaboration on health. Traditional views of security focus on using the military to ensure the territorial integrity of sovereign states and thus securitization is often associated with militarization. Human security therefore suggests that multiple actors provide security based on a moral and legal obligation to uphold and protect human rights. While critical of human security, Howard-Hassman offers that "insofar as human security identifies new threats to well-being, new victims of those threats, new duties of states, or new mechanisms of dealing with threats at the inter-state level" it can add to the human rights regime. Axworthy articulates, "our own security is increasingly indivisible from that of our neighbors-at home and abroad. Globalization has made individual human suffering an irrevocable universal concern. Table 1 summarizes the discussion of the four guiding questions in this section and reflects general understandings of national and human security approaches to humanitarian-health crises. A human security approach to humanitarian-health crises requires a systemslevel response which coordinates the efforts-particularly information sharing, project planning, and needs assessment-of multiple actors based on actual human needs and human rights; encourages consideration and protection of the most vulnerable parts of the population-women, children, the disabled and the elderly- and emphasizes empowerment, which suggests a bottom-up approach that enables people and communities to act on their own behalf. A representative model of accountability, which requires elected officials to answer to their constituents and to adhere to legal standards, informs accountability systems in a national security approach. Table 1: Humanitarian Action Viewed through National and Human Security Lenses Security for whom?

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No current hospital membership or privilege restrictions and no history of hospital membership or privilege restrictions diabetes symptoms blurred vision one eye order 1 mg repaglinide. No history of or current use of illegal drugs or history of or current alcoholism blood glucose levels in pregnancy purchase genuine repaglinide on-line. Submission of complete recredentialing application and required attachments that must not contain intentional misrepresentations 2 diabetes type 2 news order on line repaglinide. Current diabetes diet chart purchase repaglinide 0.5mg overnight delivery, valid, unrestricted license to practice in each state in which the practitioner provides care to covered individuals 7. No new (since previous credentialing review) history of or current use of illegal drugs or alcoholism 14. No impairment or other condition which would negatively impact the ability to perform the essential functions in their professional field 15. No new (since previous credentialing review) history of criminal/felony convictions including a plea of no contest 16. A practitioner credentialed by the National Register of Health Service Providers in Psychology with an area of expertise in neuropsychology may be considered. Must meet minimum supervised experience requirement for licensure as a psychoanalyst as determined by the licensing state and examination requirements for licensure as determined by the licensing state. Practitioners will be credentialed as a licensed psychoanalyst if they are not otherwise credentialed as a practitioner type detailed in Credentialing Policy. Verification of this will occur either via verification of the licensure status from the state licensing agency provided that that agency verifies the education or from the certification board if that board provides documentation that it performs primary verification of the professional education and training. If the licensing agency or certification board does not verify highest level of education, the education will be primary source verified in accordance with policy. The institution must have been accredited within 3 years of the time the practitioner graduates. Additionally, this license must be active, unencumbered, unrestricted and not subject to probation, terms or conditions. Any applicants whose licensure status does not meet these criteria or who have in force adverse actions regarding Medicare or Medicaid will be notified of this and the applicant will be administratively denied. If the applicant is not certified or if his/her certification has expired, the application will be submitted for individual review. As with all providers, this listing will accurately reflect their specific licensure designation and these providers will be subject to the audit process. Verification of this education and training will occur either via primary source verification of the license provided that state licensing agency performs verification of the education or from the certification board if that board provides documentation that it performs primary verification of the professional education and training. If the state licensing agency or the certification board does not verify education, the education will be primary source verified in accordance with policy. Any applicant whose licensure status does not meet these criteria or who have in force adverse actions regarding Medicare or Medicaid will be notified of this and the applicant will be administratively denied. If the state licensing board primary source verifies one of these certifications as a requirement for licensure, additional verification by the company is not required. If the applicant is not certified or if their certification has expired, the application will be submitted for individual review by the geographic Credentialing Committee. On notification to network services and to the provider database must be active and primary source verified. If the state licensing board primary sources verifies this certification as a requirement for licensure, additional verification by the company is not required. Verification of this will occur via verification of the licensure status from the state licensing agency provided that that agency verifies the education. If the state licensing agency does not verify education, the education will be primary source verified in accordance with policy. The Chair/Vice Chair will serve as a voting member(s) and provide support to the credentialing/recredentialing process as needed. A committee member will disclose and abstain from voting on a practitioner if the committee member (i) believes there is a conflict of interest such as direct economic competition with the practitioner; or (ii) feels his or her judgment might otherwise be compromised.

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Given the obstacles to implementation diabetes symptoms blood in urine purchase repaglinide 0.5 mg free shipping, improvements in performance measures may not initially be evident diabetes definition article cheap repaglinide 0.5mg online. Even with good implementation diabetic quick bread order repaglinide uk, fall rates may appear to trend upward initially due to better reporting diabetes puppy signs purchase repaglinide 0.5 mg overnight delivery. To address this barrier, ensure that orientation for new clinical staff is modified to include a focus on fall prevention and that new staff are appropriately integrated into their unit`s fall prevention program. This will help to maintain a unit culture that is positively oriented toward fall prevention. Section 6: Sustain 84 this article describes strategies to reinforce desired outcomes: Weinberg J, Proske D, Szerszen A. Key points from this article include: Importance of continued leadership support and staff dedication at all levels. Ongoing monthly fall meetings attended by the hospital fall committee cochairs, managers, and clinical staff to address root causes of falls. To reinforce desired results, you also need to be aware of obstacles to sustaining your fall prevention program. This tendency supports the need for ongoing refresher training in the context of each unit`s needs. Practices that had become accepted may suddenly be more difficult to perform or the availability of needed resources may change. For example, budget cuts may limit the number of sitters/safety attendants available to monitor very high risk patients for falls. We chose an example of a mobility program, because mobility programs have been shown to decrease hospital length of stay and costs and to increase the likelihood that a patient is discharged home rather than to a nursing home or rehabilitation facility. The hospital (an academic medical center) was concerned about patients` decline in mobility during inpatient stays, a factor that puts patients at risk for falls, but did not have enough physical therapy staff to provide sufficient mobility training. Readiness for change: Although senior leadership and medical staff had several discussions about the importance of maintaining patient mobility, the hospital lacked a strong promobility culture. One particular clinical event helped create urgency for implementing a mobility program. A transporter had difficulty transferring one patient into his car and the patient was concerned about how he would get out of the car when he got home. This was a wake-up call to staff because they realized the patient had not been out of bed since admission but needed to be able to get out of his car and into his home on his own after discharge. However, the mobility program did not begin until a newly hired individual within the Nursing Department was tasked with implementing the change. This new individual was committed to the program`s goals and was able to pull together the right team to initiate the mobility program. Best practices and planned implementation: the mobility program was based on the principle that bed rest should not be the default for patients and uses a nurse-driven plan of care. As long as a physician has not set the patient to restricted mobility, the nurse follows the default electronic order set and progressively moves the patient through a mobility scale from 1 (turn patient) to 6 (ambulation with assist as needed). Nurses and patient care technicians take primary responsibility for patient mobility, with physical therapy or medical staff directing the mobility plan if there is a skilled need and/or weight-bearing limitations. Implementation: the implementation efforts were led by an interdisciplinary team that included physical therapy, nursing, and medical staff. The team implemented the program in two pilot units (medical intensive care and trauma/orthopedics), followed by a hospitalwide launch. Initial education included general computer training on the order set and a 2-hour nurse training on how to achieve each level of the mobility scale. The units use a status board to present key patient information, including the mobility score, and physicians can quickly see and check where patients are on the scale. When at the bedside with residents and nurses, one physician often talks to patients about their mobility score and encourages them to progress. The implementation of the mobility program had positive benefits in creating more opportunities for discussion about patient mobility between physicians, nurses, and patients. It was difficult for some staff to change from assuming patients should be on bed rest to encouraging progressive increases in mobility. Nursing staff remembered previous experiences with patients falling and worried that fall rates would increase with increased ambulation.

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We would really appreciate you letting (Peer to Peer Support Students Name) participate in the case conference blood sugar numbers for diabetics quality 2 mg repaglinide. We do understand that as the general education teacher you reserve the right to deny (Peer to peer support student name) from attending the case conference diabetes test york purchase 0.5mg repaglinide overnight delivery. We do understand that as parents/guardians diabetes mellitus type 2 management pdf purchase repaglinide online pills, you reserve the right to deny (Peer to peer support student name) from attending the case conference diabetes in dogs how to inject cheap 0.5mg repaglinide mastercard. This is an information sharing sheet used to enhance the information presented during this case conference Please answer the following questions as openly and honestly as possible. If you do not have an answer or if you have an answer but it is hard to put into words just do your best. The biggest accomplishment that I have made being a (Peer to Peer Support) is 6. Are you interested in continuing to be a (Peer to Peer Supporter) Yes No If yes, which student would you like to support: 7. Please fill out the form below and put in the Peer to Peer Support Student of the Week box. Access to qualified counselors, appropriate transition services, academic remediation, and accommodations may make a difference to whether or not students are able to achieve postsecondary success. Educators, counselors and community service providers are currently attempting to understand and define their roles, certification requirements, and obligations under changing and sometimes conflicting Federal regulations. How are these high risk students able to pursue postsecondary education successfully when there are so many undefined variables? According to the National Association for College Admission Counseling, between 1988 and 1994, the fastest growing category of disability among students was `learning disabilities. This increase may not represent the additional unknown number of students who transfer from one postsecondary college to another, part-time students, adults with learning disabilities, students who choose not to identify themselves, or those freshmen who may be entering college with an undiagnosed learning disability (Mangrum and Strichart, 1988). Sittlington and Frank (1990) found that one year after graduation from high school only 6. Ellis and Cramer (1995) stated that 62% of learning disabled students were unemployed one year after high school graduation. The authors also reported other statistics listed below which demonstrate the extent of the problem and the subsequent cost to society if better solutions are not found: x 50% of juvenile delinquents tested were found to have undetected learning disabilities; x Up to 60% of adolescents in treatment for substance abuse have learning disabilities; x 31% of adolescents with learning disabilities will be arrested 3-5 years out of high school; x Learning disabilities and substance abuse are the most common impediments to keeping welfare clients from becoming and remaining employed, according to the 1992 report from the Office of the Inspector General (pp. Successful postsecondary college experiences can lead to financial independence and self-sufficiency. Department of Education, Commerce, and Labor, the Small Business Administration and the National Institute for Literacy state that workers with a college degree earn 77 percent more than those with only a high school diploma. The report also notes that workers with college degrees enjoy greater benefits, experience less unemployment 1 and less difficulty finding new employment if dislocated from their jobs, and have a better chance of obtaining employer-provided training (Stuart and Daham 1999). On the contrary, students with learning disabilities who drop out of school are more likely to experience economic and social difficulties (Barga, 1996). Unemployed adults with disabilities become consumers of public resources instead of contributors (Fass, 1989). Foreness and Sinclair (1990) state that clinical depression and suicide are six times greater in the learning disabled population. Also, since repeated failures and negative feedback from significant others can lead to low sense of self-worth, students with learning problems often enter a self-defeating cycle in which academic failure and self-doubt impact each other (Thompson, 1986; Villa and Thousand (1995). For example, Enright, (1996) compared the relationship between disability status, career beliefs, and career indecision and found that a disability was a significant predictor of career indecision. These services have substantially improved access to postsecondary institutions (Bursuck, Rose, Cowen, and Yahaya, 1989; Jarrow, 1991; Jarrow, 1993; Brinckerhoff, Shaw and McGuire, 1992; Mangrum and Strichart, 1988; Vogel and Adelman, 1992). The author reports postsecondary institutions continue to be confronted with the following questions: 1) What learning disabilities will be considered handicaps or disabilities under the Rehabilitation Act and the Americans with Disabilities Act? Washington University (1990) case in which the court ruled that colleges need to be proactive in advocating on behalf of qualified students with disabilities.

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