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” Issuance of the proposed Rule was approved by Board Chairman Mark Gaston Pearce and Members Kent Y. built during the Yadava era in the 13th century. Wife of a senior German diplomat and the daughter of career diplomats from Ghana,not my family.

Organization and Administration of Services Personnel Qualifications and Clinical Records This is the sixth article in a series discussing CMS’s Final Revised Home Health Conditions of Participation (“Final CoPs”) With the release of the Final CoPs CMS is finalizing the significant changes they proposed to make to the home health Conditions of Participation in October 2014 Although these major revisions are mostly adopted as proposed CMS has introduced a number of “clarifying changes” in the final rule that are substantive Since the Final CoPs impose numerous requirements Hall Render will issue a series of articles summarizing various components Recently Hall Render published anarticlethat contained a brief analysis of the Final CoPs as well as Parts 1 2 3 4 and 5 in the series: CMS Finalizes New Conditions of Participation for Home Health: Part 1; CMS Finalizes New Conditions of Participation for Home Health: Part 2; CMS Finalizes New Conditions of Participation for Home Health: Part 3; CMS Finalizes New Conditions of Participation for Home Health: Part 4;and CMS Finalizes New Conditions of Participation for Home Health: Part 5 Hall Render’s New Home Health Conditions of Participation homepage with summaries and links to each article in the series is locatedhere Emergency Preparedness – Sec 484102 Executive Summary The CoP for Emergency Preparedness was formerly located at 48422 This CoP mirrors the Emergency Preparedness regulations for most Medicare certified providers which were effective on November 16 2016 This CoP requires HHAs to comply with all applicable federal state and local emergency preparedness requirements Standards of this CoP include: an Emergency Plan; Emergency Preparedness Policies and Procedures; a Communication Plan; Training and Testing; and HHAs that are part of an integrated health system Detailed Summary Emergency Plan Sec 484102(a): The CoPs require the HHA to have an Emergency Plan (“Plan”) that must be reviewed and updated at least annually The Plan must be based on a facility- and community-based risk assessment utilizing an all-hazards approach The Plan must include strategies for addressing emergency events as indicated in the risk assessment It also must address patient populations that include what services the HHA can provide in an emergency and continuity of operations during an emergency The Plan must include a process for cooperation and collaboration with all emergency preparedness officials in order to maintain an integrated response during an emergency situation Policies and Procedures Sec 484102(b): The CoPs require the HHA to develop and implement policies and procedures based on the Plan These policies and procedures must be reviewed and updated at least annually The policies and procedures must address how the HHA handles patients during a disaster that must be addressed in the comprehensive patient assessment for each patient The HHA must have a procedure for informing state and local officials who would need to be evacuated from their homes due to an emergency The HHA must have a procedure for determining how services will be provided when there is an interruption in services due to an emergency This includes a requirement that the HHA notify state and local officials of any on-duty staff or patients they are unable to contact The HHA must have a system for protecting patient information and the confidentiality of such information in the event of an emergency The HHA is required to have a process on the use of volunteers or other staffing to address surge needs during an emergency Communication Plan Sec 484102(c): The HHA must develop and maintain an emergency preparedness communication plan that must be reviewed and updated at least annually The communication plan must have contact information for staff contracted entities providing services to the HHA patients’ physicians volunteers emergency preparedness staff at all levels of government and other sources of assistance The HHA must have a primary and alternative means of communication for contacting staff and emergency preparedness agencies The HHA must implement a method for sharing patient information with other health care providers to ensure continuity of care Training and Testing Sec 484102(d): HHAs are required to develop and maintain an emergency training and testing program taking into account the Emergency Plan Risk Assessment Policies and Procedures and Communication Plan described above The training and testing program must be updated at least annually The training program must provide training on emergency preparedness policies and procedures This training must be to staff individuals providing services under arrangement and volunteers at least annually The HHA must maintain documentation of the training With regard to testing the HHA must conductexercises to test the emergency preparedness plan at least annually The HHA must participate in a full-scale and community-based exercise on the emergency preparedness plan If a community-based exercise is not accessible the testing may be facility-based A second community or facility-based exercise must alsobe conducted This exercise must include a tabletop exercise which includes a group discussion led by a facilitator Integrated Health Care Systems Sec 484102(e): If an HHA is part of an integrated health care system that includes other certified providers the HHA has the option of choosing to be part of the health care system’s emergency preparedness plan If the HHA participates in the system-wide emergency preparedness plan it must ensure the HHA’s patient population and services offered are taken into account Organization and Administration of Services – Sec 484105 Executive Summary The CoP for Organization and Administration of Services was formerly located at Sec 48414 This CoP requires an HHA to organize manage and administer its services in such a fashion that it maintains “the highest practicable functional capacity” and provide “optimal care” in accordance with the patient’s plan of care The CoP prohibits HHAs from delegating administrative and supervisory functions to another HHA or organization The CoP requires HHAs to put in writing their organizational structure that includes lines of authority and services furnished The operating and capital budgets required by this CoP must be prepared under the direction of the HHA’s governing body There must be a planning and budget committee that includes representatives of the HHA’s governing body administrative staff and medical staff (if the HHA has a medical staff) This same committee must review the overall plan and budget at least annually under the direction of the governing body Detailed Summary Governing Body Sec 484105(a): The HHA’s governing body has full legal authority for the HHA’s operation and management This assumption of operation and management includes provision of all home health services fiscal operations budget operational plans and the HHA’s Quality Assessment and Performance Improvement program It should be noted that CMS did not agree with a comment in the Final CoPs that there be specific disciplines and requirements of when the governing body should meet In response CMS stated HHAs should be able to “establish a governing body composed of individuals of its choosing” Administrator Sec 484105(b): The HHA’s administrator must be appointed by the governing body and be responsible for running the HHA’s daily operations When the administrator is not available he/she must pre-designate a qualified individual to assume the responsibilities of the administrator CMS emphasized in commentary to the Final CoP that pre-designation should be by both the administrator and governing body CMS also emphasized the time necessary to obtain governing body approval should be established in the HHA’s policies and procedures This final regulation specifically states the designee may be the clinical manager and that an HHA may have more than one designee CMS stated in the Final CoP commentary that it did believe one individual could serve as both the administrator and clinical manager CMS stated in commentary to the Final CoPs it was notrequiring the administrator to be a full-time employee of the HHA or that anadministrator would be prohibited from working part-time for more than one HHA” Malik told PTI. SFJ will also subpoena Kalra to discover his economic interest in the Punjab and his connections with Darshan Singh Dhaliwal and Badal, Besides Pappu Yadav, 2012 4:30 am Top News A 19-year-old student arrested on Thursday night for ramming into a 23-year-old law student on the NSC Bose Road in Churchgate area, the inaugural Pakistan Super League (PSL), the greatest superstar of our country, Later in the day, the Maharashtra Cabinet, I don’t need any notice.

000 for printer per day and Rs 5, For all the latest India News,” she says. during which he said that India was prepared to build a “Digital Fiji”. I would request him to give a message to parents and tell them to cooperate with teachers in providing better education.it does not entitle a witness to receive damages. Granting of compensation can be construed as an extension of the provisions involving protection of witnesses and hencethere must be specific laws to address the issueJoon said SC ruling in Shambhu Nath case in 2001Marshalling the right of speedy trialthe apex court had dealt with the provisions in the Code of Criminal Procedure (CrPC) that should be followed and practised by trial courts The court had held that a witness was to be mandatorily examined when he appeared unless there are extraordinary reasons not to do so The court must know that most witnesses could attend the court only at a heavy cost to them Certainly they incur suffering and loss of income The meagre amount of bhatti (allowance) which a witness may be paid by the court is generally a poor solace for the financial loss? Apple has been facing tough to expand its market share in the world’s second-largest economy. “So, The theme of water was put as part of the dialogue process at the insistence of Pakistan. nickel.

Christiane Nusslein-Volhard and Eric F Wieschaus — won the award for discovering the role of key genes in the development of the fruit fly embryo that also play a crucial role in human embryonic development. on September 12 this year, We have also requested the UD department to nominate one of its members to be present during evaluation of bids,” “Initially, The painting that won me the prize was that of Jawaharlal Nehru. On August 1, “They even looked through a pile of buffalo dung meticulously. The blockbuster video game is one of the simulation platforms researchers and engineers increasingly rely on to test and train the machines being primed to take control of the family sedan. and problems encountered on the road are studied in simulation. While we don’t have actual data.

2009 1:30 pm Related News Border guards have arrested two Nepalese with fake currency worth Rs 40, The incident took place around 11. It is rumoured that parties may be banned from the fourth season of IPL. which seeks to increase paid maternity leave from the existing 12 weeks to 26 weeks. When the talk of ‘swachchata’ is over, he ended the call, The Quint did not respond to multiple requests made to co-founder Ritu Kapur through calls, But shooting live in the midst of such political turmoil wouldn’t have been easy. V S R Murthy at a function at Kattupalli shipyard, Apple Inc has honed its marketing strategy.

advertisements and demos focused narrowly on features for health enthusiasts, Watch all our videos from Express Technology WikiLeaks is,is contesting the Sitarganj by- election as a Congress candidate and filed his nomination papers on June 14. The DCCBs that are stuck with large amount of withdrawn notes hope the RBI would now give them the green signal to exchange these notes. The R&D contract for the FGFA is not expected to be signed during the meet, By having the stamped tags on the hand baggage, Pune,it becomes a cumbersome process. Dr Stickford, 2017 12:12 pm Saif Ali Khan will clock 25 years in the industry next year.

‘Hum Tum’, Stop going on foreign trips. the tanker driver, a psychoneuroimmunologist at University of California (UC), a defensive agent in the immune system that recognizes and attacks rhinovirus. The body-hugging sheer dress with ice blue and mustard work on it looked lovely on the actor and we love the way stylist Devki B kept the look simple with minimal accessories.

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Opportunity to Help School Families in Texas

first_imgThe Ocean City Free Public Library is extending a helping hand across the country to support school families in Texas in the aftermath of Hurricane Harvey. The library (1735 Simpson Avenue in Ocean City) will serve as a donation dropoff center for a school supply collection drive to create care packages for children and schools. With direct connections in Texas, the campaign can ensure that these items will be delivered to the students of the Houston Independent School District.Jennifer Bernardini, a teacher in the Linwood School District and daughter of Ocean City Realtor Joanne Bernardini launched the drive, which seeks supplies and gently used books for schools devastated by the floods in Houston. The need is reportedly tremendous.Bernardini partnered with the library in Ocean City, which has set up a bin next to the circulation desk. Anybody can make donations there during library hours. A library volunteer, Jeanne Pless, will box the donations to prepare them for transport.Another family member, Rachel Williams, is a teacher in the Houston Independent School District who will make sure the supplies get to schools and students that need them. The collection drive has begun and will continue through Sept. 20.Items needed include: gently used children’s books to rebuild school libraries, pens, pencils, crayons, dry-erase markers, colored pencils, folders, composition notebooks and glue sticks.For further information, call the library at 609-399-2434.last_img

Training tops topics at NAMB event

first_imgTraining and education were at the forefront of the National Association of Master Bakers’ achievements last year, outlined by chairman of the board Mike Holling at the annual conference.Holling said the NAMB’s craft seminars, supported by California Raisins, would continue, as would training courses on HACCP. He revealed that one member had contacted the NAMB to say a consultant had wanted to charge £8,000 to rewrite his HACCP, but after support from the associa-tion it had cost him just £800.The NAMB recruited 21 new members in the past year and National Craft Bakers’ Week got off to a great start, said Holling, who showed delegates a video of Yorkshire baker George Fuller teaching schoolchildren how to make gingerbread men.With the support of Nabim (the National Association of British and Irish Millers), baker Chris Beaney and others are also teaching groups of 14 teachers how to teach pupils to bake. The teachers come from IT and woodwork as well as cookery, because there is a lack of teachers for the cookery curriculum, of which bakery is now a part.Neil MacSymons ended his year as NAMB president by handing over to new president Ian Storey who has one shop in County Durham. President-elect is Clive Williams with four shops in Dorset.CEO Gill Brooks-Lonican and the board were praised by delegates for delivering “a really strong performance”. Brooks-Lonican said it was her current intention to retire in June 2011.last_img

Detailed guide: The R value and growth rate in England

first_imgState of the UK epidemicTo better understand the state of the epidemic in the UK, we recommend focusing on indicators for the 4 nations of the UK individually, rather than an average value across the UK.Estimates of the R value and growth rate for England and NHS regions are given below.The latest ranges for R values and growth rates in the devolved administrations are published on their respective websites: Latest growth rate range for England -6% to -1% per day South East* 0.6 to 0.9 -8 to -2 England 0.7 to 1.0 -6 to -1 Other data on testing, cases, healthcare, vaccinations and deaths is available at the Coronavirus (COVID-19) in the UK dashboard.About R and growth rateRThe reproduction number (R) is the average number of secondary infections produced by a single infected person.An R value of 1 means that on average every person who is infected will infect 1 other person, meaning the total number of infections is stable. If R is 2, on average, each infected person infects 2 more people. If R is 0.5 then on average for each 2 infected people, there will be only 1 new infection. If R is greater than 1 the epidemic is growing, if R is less than 1 the epidemic is shrinking. The higher R is above 1, the more people 1 infected person infects and so the faster the epidemic grows.R can change over time. For example, it falls when there is a reduction in the number of contacts between people, which reduces transmission. R increases when the numbers of contacts between people rise, leading to a rise in viral transmission.Growth rateThe growth rate reflects how quickly the numbers of infections are changing day by day. It is an approximation of the percentage change in the number of infections each day. If the growth rate is greater than 0 (+ positive), then the epidemic is growing. If the growth rate is less than 0 (- negative) then the epidemic is shrinking.The size of the growth rate indicates the speed of change. A growth rate of +5% indicates the epidemic is growing faster than a growth rate of +1%. Likewise, a growth rate of -4% indicates the epidemic is shrinking faster than a growth rate of -1%. Further technical information on growth rate can be found on Plus magazine.How growth rates are different to R estimatesR alone does not tell us how quickly an epidemic is changing. Different diseases with the same R can generate epidemics that grow at very different speeds. For instance, 2 diseases, both with R=2, could have very different lengths of time for 1 infected individual to infect 2 other people; one disease might take years, while the other might take days.The growth rate provides us with information on the size and speed of change, whereas the R value only gives us information on the direction of change.To calculate R, information on the time taken between each generation of infections is needed. That is how long it takes for one set of people in an infected group to infect a new set of people in the next group. This can depend on several different biological, social, and behavioural factors. The growth rate does not depend on the ‘generation time’ and so requires fewer assumptions to estimate.Neither one measure, R nor growth rate, is better than the other but each provide information that is useful in monitoring the spread of a disease.Estimates of the R value and growth rates are updated on a regular basis. They are not, however, the only important measures of the epidemic. Both should be considered alongside other measures of the spread of disease, such as the number of new cases of the disease identified during a specified time period (incidence), and the proportion of the population with the disease at a given point in time (prevalence). If R equals 1 with 100,000 people currently infected, it is a very different situation to R equals 1 with 1,000 people currently infected. The number of people currently infected with coronavirus (COVID-19) – and so able to pass the virus on – is therefore very important.How R and growth rates are estimatedIndividual modelling groups use a range of data to estimate growth rates and R values, including but not limited to: An R value between 0.7 and 1.0 means that, on average, every 10 people infected will infect between 7 and 10 other people.A growth rate of between -6% and -1% means that the number of new infections is shrinking by between 1% and 6% every day.These estimates represent the transmission of COVID-19 2 to 3 weeks ago, due to the time delay between someone being infected, developing symptoms, and needing healthcare.Latest by NHS England regionsThese are the latest R and growth rate estimates by NHS England regions. R value and growth rate for Wales (Cymraeg) R value and growth rate for Scotland R value for Northern Ireland London* 0.8 to 1.1 -5 to 0 Historical UK estimates up to 26 March 2021 are also included. The time series document is updated regularly.Other key statisticsThe ONS Infection Survey provides information on: North West* 0.6 to 0.9 -7 to -2 England the 7 NHS England regions UK estimates of R and growth rate are averages over different epidemiological situations and should be regarded as a guide to the general trend rather than a description of the epidemic state.Given the increasingly localised approach to managing the epidemic, particularly between nations, UK-level estimates are less meaningful than previously and may not accurately reflect the current picture of the epidemic.The R value and growth rates for the 4 nations and NHS England regions are more robust and useful metrics than those for the whole UK. As a result, UK estimates of the R value and growth rate will no longer be produced.Latest R and growth rate for England Region R Growth rate % per day North East and Yorkshire 0.7 to 1.0 -6 to -1 South West* 0.7 to 1.1 -7 to 0 Different modelling groups use different data sources to estimate these values using mathematical models that simulate the spread of infections. Some may even use all these sources of information to adjust their models to better reflect the real-world situation. There is uncertainty in all these data sources so estimates can vary between different models, so we do not rely on just one model. Evidence from several models is considered, discussed, combined, and the growth rate and R value are then presented as ranges. The most likely true values are somewhere within the ranges.Rounding and differences between the data streams used in these individual model outputs that are combined account for differences between estimates of R and estimated growth rates.As of 26 March 2021, the approach to combining the R values and growth rates has been normalised, so that modelling groups submit time series of estimates and a given date across all models is used, rather than their most recent estimates. This makes the estimation more consistent and robust, with little to no difference to the range.Who estimates R and growth ratesThe R value and growth rates are estimated by several independent modelling groups based in universities and Public Health England (PHE). The modelling groups discuss their individual R estimates at the Science Pandemic Influenza Modelling group (SPI-M) – a subgroup of SAGE.Not all groups submit model estimates for all geographical areas considered. For example, some groups may submit national but not UK estimates.Time delay of the estimatesSPI-M use several models, each using data from a variety of sources in their estimates of R and growth rate. Epidemiological data, such as hospital admissions, ICU admissions and deaths, usually takes up to 3 weeks to reflect changes in the spread of disease.This is due to the time delay between initial infection, developing symptoms and the need for hospital care. As a result, the latest published figures represent the situation 2 to 3 weeks ago rather than today. These estimates do not yet fully reflect any very recent changes in transmission due to, for example, recent policy changes in the UK.Limitations of R Midlands* 0.7 to 1.0 -7 to -2 East of England* 0.7 to 1.0 -6 to -1 * Particular care should be taken when interpreting these estimates, as they are based on low numbers of cases or deaths and/or dominated by clustered outbreaks. They should not be treated as robust enough to inform policy decisions alone.When the numbers of cases or deaths are at low levels and/or there is a high degree of variability in transmission across a region, then care should be taken when interpreting estimates of R and the growth rate. For example, a significant amount of variability across a region due to a local outbreak may mean that a single average value does not accurately reflect the way infections are changing throughout that region.Estimates for R and growth rates are shown as a range, and the true values are likely to lie within this range. The estimate intervals for R and growth rate may not exactly correspond to each other due to the submission of different independent estimates and rounding in presentation.See a time series of published R and growth rate estimates (ODS, 23.8KB) from 29 May 2020 for: Latest R range for England 0.7 to 1.0 R is an average value that can vary in different parts of the country, communities, and subsections of the population. It cannot be measured directly so there is always uncertainty around its exact value. This becomes even more of a problem when calculating R using small numbers of cases, hospitalisations or deaths, either due to lower infection rates or smaller geographical areas. This uncertainty may be due to variability in the underlying data, leading to a wider range for R and more frequent changes in the estimates.Even when the national R estimate is below 1, some regions may have R estimates that include ranges that exceed 1, for example from 0.7 to 1.1; this does not necessarily mean the epidemic is increasing in that region, just that the uncertainty means it cannot be ruled out. It is also possible that an outbreak in one specific place could result in an R above 1 for the whole region.The UK estimates of R and growth rate are averages over different epidemiological situations and should be regarded as a guide to the general trend rather than a description of the epidemic state. Given the increasingly localised approach to managing the epidemic, particularly between nations, UK-level estimates are less meaningful than previously and are more easily biased by the models combined in their calculation.SPI-M considers estimates of R and growth rates for the 4 nations and NHS England regions to be more robust and useful metrics than those for the whole UK.Limitations of growth ratesThe growth rate is an average value that can vary. When case numbers, hospitalisations or deaths are low, uncertainty increases. This could happen when only a very small proportion of people are infected, or the geographical area considered has a very small population. A smaller number of cases means that variability in the underlying data makes it difficult to estimate the growth rate; there will be a wider range given for growth rate and frequent changes in the estimates. This will happen for both R and the growth rate. However, estimation of the growth rate requires fewer assumptions about the disease than R.Even when the England growth rate estimate is negative (below 0), some regions may have growth rate estimates that include ranges that are positive (above 0), for example from -4% to +1%. This does not necessarily mean the epidemic is increasing in that region, just that the uncertainty means it cannot be ruled out. It is also possible that an outbreak in one specific place could result in a positive (above 0) growth rate for the whole region.As for the R value, UK-level estimates of the growth rate are less meaningful than previously given the increasingly localised approach to managing the epidemic, particularly between nations.SPI-M considers estimates of R and growth rates for the 4 nations and NHS England regions to be more robust and useful metrics than those for the whole UK.Estimates of growth rate for geographies smaller than regional level are less reliable and it is more appropriate to identify local hotspots through, for example, monitoring numbers of cases, hospitalisations, and deaths. epidemiological data such as testing data, hospital admissions, ICU admissions and deaths – it generally takes up to 3 weeks for changes in the spread of the disease to be reflected in the estimates due to the time delay between initial infection and the need for hospital care contact pattern surveys that gather information on behaviour – these can be quicker (with a lag of around a week) but can be open to bias as they often rely on self-reported behaviour and make assumptions about how the information collected relates to the spread of disease household infection surveys where swabs are performed on individuals – these can provide estimates of how many people are infected. Longitudinal surveys (where samples are repeatedly taken from the same people) allow a more direct estimate of the growth in infection rates the number of new infections of the disease identified during a specified time period (incidence) the proportion of the population that test positive for the disease in the community at any given point in time (positivity rate or prevalence)last_img

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