text:
What does it mean when FDA "clears" or "approves" a medical device?
When FDA review is needed prior to marketing a medical device, FDA will either:
- "clear" the device after reviewing a premarket notification, otherwise known as a 510(k) (named for a section in the Food, Drug, and Cosmetic Act), that has been filed with FDA, or
- "approve" the device after reviewing a premarket approval (PMA) application that has been submitted to FDA.
Whether a 510(k) or a PMA application needs to be filed depends on the classification of the medical device.
To acquire clearance to market a device using the 510(k) pathway, the submitter of the 510(k) must show that the medical device is "substantially equivalent" to a device that is already legally marketed for the same use.
To acquire approval of a device through a PMA application, the PMA applicant must provide reasonable assurance of the device's safety and effectiveness.
(Source: fda.gov)
Is There A GROUP PURCHASING ORGANIZATION (GPO) Conspiracy?
Group purchasing organizations (GPOs) play an important role in the provision of health care services in the United States. As hospitals and other health care providers have come under pressure to reduce expenses, they have turned increasingly to GPOs to reduce the costs of the products and services they purchase. Today, virtually every hospital in the U.S. belongs to at least one GPO. More than seventy percent of all hospital purchases are made through GPO contracts, and GPOs contract for purchases with an annual value in the range of $150 billion.
The fundamental purpose of a GPO is to allow its members to join together to leverage their purchasing strength in order to purchase goods and services at lower prices, which in turn should enable them to lower their costs and become more competitive in the provision of their own services. In its basic form, a GPO is a cooperative of buyers. Over time, however, GPOs have evolved significantly to offer other competition-enhancing programs such as networking, bench marking, and educational quality improvement programs. These functions are pro-competitive and consistent with antitrust policy – they offer GPO members increased efficiency, eliminate wasteful administrative duplication, and they increase competition between manufacturers/vendors, and within the hospital members' own markets, which translate into lower prices and higher quality for consumers.
At a time when increasing health care costs are a major policy concern, one would expect GPOs to be seen as a major force in the health care industry for increased efficiency and cost containment. In fact, GPOs currently are under attack from several different directions. On the political front, GPOs have come under attack by some manufacturers of medical devices that claim GPO contracting practices, including "sole-source contracts," percentage of purchase or "market share" discounts, and multi-product or "bundled" discounts, favor large established manufacturers with the result that smaller companies with "innovative" products are effectively foreclosed from selling to a large number of the nation's hospitals. These concerns have attracted the attention of the U.S. Senate, which held hearings last year scrutinizing GPO contracting practices; the Senate may hold additional hearings on GPOs in 2003. Similarly, the Federal Trade Commission (FTC) held a workshop last fall at which GPO contracting practices were a topic of discussion, and the FTC, together with the Antitrust Division of the Department of Justice (DOJ), are holding health care hearings in 2003 at which GPO contracting practices also are being discussed. Finally, a 2002 preliminary study by the General Accounting Office (GAO) raised questions about whether GPO contracts actually save hospitals money. GPO contracts also have been the subject of recent private litigation. In Kinetic Concepts, Inc. v. Hillenbrand Indus., Inc., a jury awarded more than $500 million in treble damages against a manufacturer of hospital beds that allegedly was using GPO contracts to exclude plaintiff, its competitor. In a suit more directly implicating GPO practices, Retractable Technologies, Inc. v. Becton Dickinson, et al., a manufacturer of safety syringes sued the two largest manufacturers of standard and safety syringes along with the two largest GPOs, alleging, among other things, a conspiracy between the GPOs and manufacturers to monopolize the needle and syringe market.
The important role GPOs play in the delivery of health care services, and the criticism that has been directed at them, raise important issues under the antitrust laws. Are GPOs the agents of efficiency they claim to be, or, as their critics charge, have GPOs become a vehicle for dominant manufacturers to achieve and/or maintain monopoly power? This article analyzes GPO contracting practices under the antitrust laws and whether these practices are likely to result in anti-competitive effects. As this analysis will show, in general, GPO contracts promote significant efficiencies and are unlikely to result in sufficient market foreclosure to injure competition. The policy implications of this conclusion are clear: instead of increasing competition, restrictions on GPO contracting practices are likely to result in less competition and higher prices for health care consumers.
I. History and Background of Group Purchasing Organizations Hospital GPOs trace their history back to the late 1800s, though the first known hospital GPO was the Hospital Bureau of New York, which appeared in 1910. Over the next half century, the GPO concept grew slowly and by the early 1970s there were forty hospital GPOs in the United States. The next thirty years witnessed an explosion of GPOs. From 1974 to 1999,the number of GPOs grew from forty to 633. Today, there are over 900 GPOs in the United States. While some of these are "child" GPOs that rely on contracts negotiated by larger "parent" GPOs, it is estimated that approximately 200 GPOs contract directly with suppliers, and that twenty-six of these operate on a national level.
It is not a coincidence that GPOs began to grow in popularity in the late 1970s and early 1980s. During this time, for-profit hospital chains began to expand and buy up not-for-profit hospitals, forcing not-for-profits to find ways to cut costs to remain competitive. In the early 1980s, Medicare instituted the Prospective Payment System through which hospitals were reimbursed a fixed rate based on a defined service rather than the cost to the hospital of providing that service. At the same time, growing pressure in the private sector to reduce health care costs in the form of Health Maintenance Organizations (HMOs) and other types of managed care also reduced hospital reimbursement. These external market factors made it important for hospitals to control costs. Part of this effort included forming or joining a GPO to lower the cost of goods and services that the hospitals purchased.
CONTINUE TO FULL ARTICLE WITH REFERENCES : http://www.ftc.gov/ogc/healthcarehearings/docs/030926bloch.pdf
Robert E. Bloch, Esq.
Scott P. Perlman, Esq,
Jay S. Brown, Esq.*
1909 K Street, N.W.
Washington, D.C. 20006
(202) 263-3000
FDA – Approved SHARPS Disposable Containers
Sharps Disposal Containers – FDA APPROVED
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FDA-Cleared Sharps Containers
The FDA recommends that used needles and other sharps be immediately placed in FDA-cleared sharps disposal containers. FDA-cleared sharps disposal containers are generally available through pharmacies, medical supply companies, health care providers, and online.
The FDA has evaluated the safety and effectiveness of these containers and has cleared them for use by health care professionals and the public to help reduce the risk of injury and infections from sharps.
FDA-cleared sharps disposal containers are made from rigid plastic and come marked with a line that indicates when the container should be considered full, which means it's time to dispose of the container. Below are examples of FDA-cleared sharps containers:
FDA-cleared sharps disposal containers are available in a variety of sizes, including smaller travel sizes to use while away from home.
Alternative Sharps Disposal Containers
If an FDA-cleared container is not available, some organizations and community guidelines recommend using a heavy-duty plastic household container as an alternative. The container should be leak-resistant, remain upright during use and have a tight fitting, puncture-resistant lid, such as a
plastic laundry detergent container.
Household containers should also have the basic features of a good sharps disposal container described below.
All sharps disposal containers should be:
- made of a heavy-duty plastic;
- able to close with a tight-fitting, puncture-resistant lid, without sharps being able to come out;
- upright and stable during use;
- leak-resistant; and
- properly labeled to warn of hazardous waste inside the container.
When your sharps disposal container is about three-quarters (3/4) full, follow your community guidelines for proper disposal methods.
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Low "Dead Space" Syringes Could Save Your Life
Another guest article from Jamie Bridge this week. This time he's writing about some of the work of researcher Dr. William Zule, looking into how the type of syringe someone uses may have an inpact on their risk of getting the HIV virus. I have had this article a few weeks but it was embargoed until the AIDS2010 conference started as its finding are being presented there.
How syringe type effects HIV risk
New research being presented this week at the International AIDS Conference in Vienna has made a strong link between different types of syringe and levels of HIV transmission through sharing.
Every needle-syringe, when the plunger is fully depressed, retains some fluid or blood in what is termed "dead-space". Some syringe designs have more of this "dead space" than others – especially those with detachable needles. Depending on the design, some syringes can retain 84 microlitres of fluid. This is a very, very small amount – but other syringe designs can retain as little as 2 microlitres.
So the hypothesis is simple: if you share a syringe with higher "dead-space", then there will be more blood retained in the syringe and you will be more likely to become infected with blood-borne viruses. If you share a low "dead space" syringe, you are still putting yourself at risk – but perhaps less so, as there is less blood retained when the plunger is fully down.
Previous modelling work by Dr William Zule and colleagues in the USA tried to quantify what this could mean in the real world. The results suggested that injection-related HIV epidemics might not occur when most (95% or more) of injectors use syringes with low "dead space". If everyone uses higher "dead space" syringes, then HIV prevalence can reach 50% among injectors in just seventeen years. When just one in ten sharing events involve high "dead space" syringes, then HIV prevalence can stabilise.
The findings, albeit theoretical, have clear implications for harm reduction programs. However, in Vienna, the research has been taken to the next level. Data from multi-year HIV prevalence studies were gathered from 35 cities in 20 countries, and local needle exchange workers were contacted to find out what types of syringe were mainly used.
In cities where high "dead space" syringes were mainly used, the average HIV prevalence among injectors was 32.6% (and went up as high as 73%). In cities where low "dead space" syringes were mainly used, the average was just 1.4%. When the data were analyzed, the type of syringe was the only factor closely associated with this pattern in HIV.
More research needs to be done on this topic, and expect to hear a lot more about this in the future – this is an important finding which could have a big impact on harm reduction and the advice given to injectors. Of course, the biggest message is that ALL needle-syringe sharing is a risk. However, if we could reduce HIV transmission simply by providing one kind of syringe over another, then this is something that must be rolled out as soon as possible. Do you know what kind of syringe your local exchange supplies?
A big thank you to Dr William Zule for sharing this research.
Jamie Bridge, MSc, currently works in the Technical Publications and Learning Team of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Before moving to Geneva in 2010, he worked for the International Harm Reduction Association in London, coordinating the international harm reduction conferences. Before that, he also worked in a needle and syringe program in Bedford. Jamie also works voluntarily with UKHRA and the NNEF.
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Potentially dangerous needlestick injuries often go unreported
Johns Hopkins research suggests least-skilled providers at risk for life-threatening infections
Medical students are commonly stuck by needles – putting them at risk of contracting potentially dangerous blood-borne diseases – and many of them fail to report the injuries to hospital authorities, according to a Johns Hopkins study published in the December issue of the journal Academic Medicine.
Researchers surveyed surgery residents at 17 medical centers and, of 699 respondents, 415 (or 59 percent) said they had sustained a needlestick injury as a medical student. Many said they were stuck more than once. Of the surgeons-in-training whose most recent needlestick occurred in medical school, nearly half of them did not report their injury to an employee health office, thereby avoiding an evaluation as to whether they needed treatment to prevent HIV or hepatitis C.
It is estimated that 600,000 to 800,000 needlesticks and other similar injuries are reported annually among U.S. health care workers and there is evidence of vast underreporting, says Martin A. Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine and lead researcher for the study."Medical schools are not doing enough to protect their students and hospitals are not doing enough to make medical school safe," he says. "We, as a medical community, are putting our least skilled people on the front lines in the most high-risk situations. Most trainees are still forced to learn to sew and stitch on patients, which puts both providers and patients at risk."
Makary says medical schools should take advantage of advances in simulation technology and do less training on actual human beings until they are more skilled.
The authors of the study believe that needlesticks go unreported due to cumbersome reporting procedures, fears about poor clinical evaluations by their by their superiors, or embarrassment. The most commonly given reason in the study for why the medical students didn't report needle injuries was the amount of time involved in making a report.
The survey did find, however, that medical students were very likely (92 percent) to report the needlestick if the patient was at high risk for having a virus like HIV or hepatitis, compared with 47 percent of injuries involving low-risk patients. Still, prompt reporting of all needlestick injuries is critical to ensuring proper medical prophylaxis, counseling and legal precautions, Makary says. Very few people who follow proper protocol and seek treatment after a needlestick get sick, he says.
"Hospitals are not creating a culture of speaking up," says Makary, who is also the Mark Ravitch Chair of Gastrointestinal Surgery and director of the Johns Hopkins Center for Surgical Outcomes Research. "If people are not speaking up regarding their own safety concerns, it's probably a surrogate marker of people not speaking up about patient safety concerns."
Most of the needlesticks among medical students were self-inflicted and occurred in the operating room when the student felt rushed.
Makary says that needlestick injuries in surgery can infect patients since the providers' blood can enter the patient's wound. He argues that hospitals need to create a culture of reporting errors and stop placing their newest trainees at the greatest risk for infection. He also says that since medical students are at significant risk of personal injury during clinical training, more needs to be done to educate them about the importance of reporting any needlesticks, the value of post-exposure treatment and on how to prevent future injuries.
At The Johns Hopkins Hospital, for example, a hotline has been instituted for all occupational blood exposures. After such a report is received, a rapid response team is activated to deliver appropriate care while preserving confidentiality. The study was supported by the Mr. and Mrs. Chad Richison Foundation and the Lotus Global Health Foundation.
An Act To Amend The Public Health Law, In Relation To Hypodermic Syringes
More than 3,000 pharmacies, health care facilities and practitioners have registered with the Department of Health (DOH) to sell or furnish syringes to those age 18 and over without a prescription under the ESAP.
This program makes syringes available without a prescription and promotes the safe disposal of used syringes. Research has shown this program effectively reduces transmission of blood-borne pathogens as a result of needle sharing and reuse and may increase safe disposal of used syringes. ESAP providers sell two to three million non-prescription syringes a year and the need for unrestricted access to syringes remains high. Only two states, Delaware and New Jersey, do not allow the sale of syringes without a prescription.
In a 2003 report, the New York Academy of Medicine (NYAM) stated that ESAP "has great potential to prevent transmission of blood-borne diseases without any detrimental effect on syringe disposal, drug use or crime." NYAM's recommendation included: (1) enacting legislation to allow the program to continue permanently (which occurred as part of the 2009-10 enacted budget); (2) lifting the restriction on pharmacy advertising; (3) continuing education and outreach; (4) continuing safe syringe disposal education; and (5) expanding disposal options. At the time of the program's extension through 2007, NYAM again noted the importance of syringe access, indicating that expanded syringe access "is critically important to stemming the spread of infectious disease." Numerous studies published in peer-reviewed journals have attested to the value of ESAP in reducing syringe sharing and re-use and preventing disease transmission.
This bill would eliminate two restrictions on the sale of syringes to further the objectives of ESAP. First, the bill would remove the restriction on the number of syringes that may be sold or furnished, leaving the matter to the discretion of the individual ESAP provider. The current limit of 10 syringes per transaction was first implemented when ESAP was a demonstration project. Removing the limitation would better serve individuals who use this program by ensuring that they have enough clean syringes to prevent reusing or sharing syringes. For individuals in rural regions of the State, removing this restriction will facilitate access, particularly when it may be difficult or time-consuming to get to a pharmacy to purchase or dispose of used syringes.
Second, the bill would permit pharmacies to advertise the availability of syringes to the public. Of the 3,300 pharmacies, health care facilities and practitioners that have registered with DOH as part of ESAP, more than 97 percent are pharmacies. The public health function that they serve is compromised if potential customers are unaware of which pharmacies are registered ESAP providers. Appropriate pharmacy advertising can supplement the efforts of DOH to promote ESAP and provide consumers with access to information that they need to make informed choices.
~ S5312-2011: Relates to hypodermic syringes ---------------------- www.QDSyringeSystems.com www.QDSyringe www.Twitter.com/QDSyringe www.Syringes.co
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Bloodborne Pathogens and Needlestick Prevention
Needlestick injuries and other sharps-related injuries which expose workers to bloodborne pathogens continues to be an important public health concern. Workers in many different occupations are at risk of exposure to bloodborne pathogens, including Hepatitis B, Hepatitis C, and HIV/AIDS. First aid team members, housekeeping personnel in some settings, nurses and other healthcare providers are examples of workers who may be at risk of exposure.
Bloodborne Pathogens is addressed in standards specifically for the general industry.
OSHA Standards
This section highlights the OSHA standard requirements, preambles to final rules (background to final rules), directives (instructions for compliance officers), and standard interpretations (official letters of interpretation of the standards) related to bloodborne pathogens and needlestick prevention.
Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.
1910.1030, Bloodborne pathogens.
Revisions to 1910.1030 as a result of the Needlestick Safety and Prevention Act:
Paragraph 1910.1030(d)(2)(i) requires the use of engineering and work practice controls to eliminate or minimize employee exposure to bloodborne pathogens.
Employers must keep a Sharps Injury Log for the recording of percutaneous injuries from contaminated sharps [1910.1030(h)(5)(i)].
The Exposure Control Plan (1910.1030(c)(1)(i)) shall:
Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens [1910.1030(c)(1)(iv)(A)].
Document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure [1910.1030(c)(1)(iv)(B)].
Solicit input from non-managerial employees responsible for direct patient care, who are potentially exposed to injuries from contaminated sharps, in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan [1910.1030(c)(1)(v)].
Appendix A, Hepatitis B vaccine declination (Mandatory).
The following information provides discussion on the revised standard.
Revision to OSHA's Bloodborne Pathogens Standard – Technical Backgr…. OSHA, (2001, April). Includes revised information regarding the identification, evaluation, and selection of effective engineering controls, including safer medical devices.
Most frequently asked questions concerning the bloodborne pathogens…. OSHA Standard Interpretation, (1993, February 1; corrected 2003, August 13). Responses to common questions about the bloodborne pathogens standard.
Frequently Asked Questions. OSHA. Provides questions and answers to some commonly asked questions regarding needlestick hazards and prevention.
Frequently Asked Questions: Bloodborne Pathogens. OSHA. Provides answers and additional information to frequently asked questions regarding bloodborne pathogen hazards.
Frequently Asked Questions: OSHA's Occupational Exposure to Bloodbo…. OSHA. Provides answers to questions concerning the safe administration of vaccines.
Occupational Exposure to Bloodborne Pathogens; Needlestick and Othe…. OSHA Federal Register Final Rules 66:5317-5325, (2001, January 18). Also available as a 450 KB PDF, 9 pages. OSHA revised the Bloodborne Pathogens standard in conformance with the requirements of the Needlestick Safety and Prevention Act.
OSHA's Bloodborne Pathogens Standard [63 KB PDF*, 2 pages]. OSHA Fact Sheet, (2011, January).
Needlestick Legislation
Overview of State Needle Safety Legislation. National Institute for Occupational Safety and Health (NIOSH). As of June 2002, twenty-two states have enacted legislation related to needle safety.
Needlestick Prevention and Safety Act. 106th Congress – Public Law 106-430, (2000). The Needlestick Safety and Prevention Act became Public Law 106-430 on November 6, 2000.
Preambles to Final Rules
Occupational Exposure to Bloodborne Pathogens. (1991)
Search all available preambles to final rules.
Enforcement Procedures for the Occupational Exposure to Bloodborne …. CPL 02-02-069 [CPL 2-2.69], (2001, November 27). Includes revisions mandated by the Needlestick Safety and Prevention Act.
Appendix D, Model Exposure Control Plan. Includes a model exposure control plan that meets the requirements of OSHA's Bloodborne Pathogens Standard and can be tailored to meet the specific requirements of an establishment.
Updated U.S. Public Health Service Guidelines for the Management of…. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) 50(RR11);1-42, (2001, June 29). Also available as a 333 KB PDF, 67 pages. Updates and consolidates recommendations for the management of health-care personnel (HCP). Serves as Appendix E for CPL 02-02-069.
Updated U.S. Public Health Service Guidelines for the Management of…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 54(RR09);1-17, (2005, September 30). Updates US Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain human immunodeficiency virus (HIV).
Rules of agency practice and procedure concerning OSHA access to em…. CPL 02-02-072, (2007, August 22). Provides guidance concerning application of the rules of agency practice and procedure when accessing personally identifible employee medical records.
Multi-Employer Citation Policy. CPL 02-00-124 [CPL 2-0.124], (1999, December 10).
Search all available directives.
Standard Interpretations
Clarification of the use and selection of BBP safety devices. (2008, May 5).
Applicability of OSHA's bloodborne pathogens standard to the contai…. (2008, January 2).
Clarification of PPE requirements for phlebotomists performing veni…. (2007, October 26).
The applicability of OSHA's bloodborne pathogens standards to the u…. (2007, June 14).
Application of OSHA's Bloodborne Pathogens standard to contractors …. (2007, May 22).
Requirements for safety-engineered sharps for stockpiled pandemic i…. (2007, March 2).
The use of safety-engineered devices and work practice controls in …. (2007, January 18).
Use of rapid HIV antibody testing on a source individual after an e…. (2007, January 8).
Periodic serologic testing to monitor antibody concentrations after…. (2005, November 9).
Safety precautions, PPE, and immunizations for workers in waste wat…. (2005, September 13).
Containment and disposal requirements for disposable razors used in…. (2005, March 28).
Needle removal procedures for situations where other methods of dis…. (2004, December 9).
Limiting factors for implementing the use of engineering controls, …. (2004, September 1).
Bloodborne Pathogens Standard application to bifurcated needles; ac…. (2004, May 27).
Employer's responsibility to re-evaluate engineering controls, i.e….. (2004, January 20).
Acceptable use of antiseptic-hand cleansers for bloodborne pathogen…. (2003, March 31).
Needlestick Safety and Prevention Act and the requirement to includ…. (2003, February 20).
Evaluation of sutureless catheter securement devices to prevent nee…. (2003, January 23).
Safer medical devices must be selected based on employee feedback a…. (2002, November 21).
Application of the bloodborne pathogens standard to veterinary clinics. (2002, October 15).
Re-use of blood-tube holders. (2002, June 12).
Search all available standard interpretations.
Hazard Recognition
OSHA estimates that 5.6 million workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and others. All occupational exposure to blood or other potentially infectious materials (OPIM) place workers at risk for infection with bloodborne pathogens. OSHA defines blood to mean human blood, human blood components, and products made from human blood. Other potentially infectious materials (OPIM) means: (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. The following references aid in recognizing workplace hazards associated with bloodborne pathogens.
Bloodborne Pathogens
Hospital. OSHA eTool.
Bloodborne Pathogens
Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B Virus, and He…. National Institute for Occupational Safety and Health (NIOSH) Safety and Health Topic.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. US Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention (CDC).
Viral Hepatitis B
Viral Hepatitis C
Healthcare-associated Infections (HAIs). Centers for Disease Control and Prevention (CDC).
Exposure to Blood: What Healthcare Personnel Need to Know [363 KB PDF, 10 pages]. Centers for Disease Control and Prevention (CDC), National Center for Infectious Diseases, (2003, July).
EPINet Data Reports. University of Virginia, International Health Care Worker Safety Center. The Center has used the Exposure Prevention Information Network (EPINet) since 1992 to collect data from approximately 70 hospitals on sharp object injury and blood and body fluid exposure patterns in the health care setting.
Sharps Injuries among Hospital Workers in Massachusetts, 2008 — F… [213 KB PDF, 32 pages]. Massachusetts Department of Public Health, (2010, March).
Medical & Dental Offices: A Guide to Compliance with OSHA Stand…. OSHA Publication 3187-09R, (2003). Also available as a 787 KB PDF, 2 pages. Provides a glimpse of the most frequently found hazards in medical and dental offices.
Disposal of Contaminated Needles and Blood Tube Holders Used for Ph…. OSHA Safety and Health Information Bulletin (SHIB), (2003, October 15). Also available as a 37 KB PDF, 4 pages. OSHA has concluded that the best practice for prevention of needlestick injuries following phlebotomy procedures is the use of a sharp with engineered sharps injury protection (SESIP), (e.g., safety needle), attached to the blood tube holder and the immediate disposal of the entire unit after each patient's blood is drawn.
Potential for Occupational Exposure to Bloodborne Pathogens From Cl…. OSHA Health Information Bulletin (HIB), (1995, September 21).
Securing Medical Catheters [353 KB PDF*, 2 pages]. OSHA Fact Sheet.
Job Safety and Health Quarterly (JSHQ) [4 MB PDF*, 44 pages]. (2001, Summer).
Fleming, Susan. "Preventing Needlesticks [4 MB PDF*, 44 pages]." New rules affirm the need for safer devices to protect workers.
"Highlights of OSHA's Bloodborne Pathogens Standard Revision [4 MB PDF*, 44 pages]." A toolbox discussion of the revision to OSHA's bloodborne pathogens standard.
Preventing Needlestick Injuries in Health Care Settings. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2000-108 (Alert), (1999, November). NIOSH warns that health care workers who use or may be exposed to needles are at increased risk of needlestick injury.
Selecting, Evaluating, and Using Sharps Disposal Containers. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 97-111, (1998, January). Presents a comprehensive framework for selecting sharps disposal containers and evaluating their efficacy as part of an overall needlestick injury prevention plan, reviews the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard and recommends containers on the basis of a site-specific hazard analysis, and establishes criteria and provides tools for evaluating the performance of sharps disposal containers.
What Every Worker Should Know: How to Protect Yourself From Needles…. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2000-135, (1997, July). Discusses pathogens that pose the most serious health risks.
Possible Solutions
Studies show that nurses sustain the most needlestick injuries and that as many as one-third of all sharps injuries occur during disposal. The Centers for Disease Control and Prevention (CDC) estimates that 62 to 88 percent of sharps injuries can be prevented simply by using safer medical devices. The following references provide information regarding possible solutions for bloodborne pathogens and needlestick hazards.
Please Note: Articles/references that are dated before April 18, 2001 may not reflect the changes of the new Bloodborne Pathogens Standard but still provide relevant, general information.
Control Programs
Model Plans and Programs for the OSHA Bloodborne Pathogens and Haza…. OSHA Publication 3186-06N, (2003). Also available as a 521 KB PDF, 29 pages. Includes a model exposure control plan that meets the requirements of the OSHA Bloodborne Pathogens Standard and can be tailored to meet the specific requirements for an establishment.
Preventing Exposures to Bloodborne Pathogens among Paramedics. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2010-113, (2010, April).
Information for Employers Complying with OSHA's Bloodborne Pathogen…. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2009-111, (2009, March).
Workbook for Designing, Implementing, and Evaluating a Sharps Injur… [2 MB PDF, 168 pages]. Centers for Disease Control and Prevention (CDC), (2008).
Preventing Occupational HIV Transmission to Healthcare Personnel. Centers for Disease Control and Prevention (CDC), (2002, February). Offers recommendations to prevent transmission of HIV to healthcare personnel in the workplace.
Checklist for Sharps Injury Prevention [21 KB PDF, 2 pages]. The University of Virginia, International Health Care Worker Safety Center. Provides a checklist intended to help facilities comply with the sharps safety requirements of OSHA's Bloodborne Pathogens Standard.
A Best Practices Approach for Reducing Bloodborne Pathogens Exposure [3 MB PDF, 100 pages]. Cal/OSHA Consultation Service, Department of Industrial Relations, (2001).
Safer Needle Devices
Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries t…. OSHA and the National Institute for Occupational Safety and Health (NIOSH) Publication No. 2008-101, (2007, October). Supersedes NIOSH Publication 2007–132.
Evaluation of Blunt Suture Needles in Preventing Percutaneous Injur…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 46(02);25-29, (1997, January 17). Identifies the effectiveness of blunt needles in reducing percutaneous injuries (PIs) and suggests that they should be considered for more widespread use in surgical procedures.
List of Safety-Engineered Sharp Devices — and other products desig…. The University of Virginia Health System, International Health Care Worker Safety Center, (2003). Provides a list of devices designed to prevent percutaneous injury and exposure to bloodborne pathogens in the health care setting.
Sharps Disposal Containers with Needle Removal Features. OSHA Hazard Information Bulletin (HIB), (1993, March 12). Alerts field personnel to the risk of possible safety and health hazards that may arise with the use of some sharps disposal containers that incorporate an "unwinder" mechanism to accomplish needle removal.
Safer Medical Device Implementation in Health Care Facilities – Sha…. National Institute for Occupational Safety and Health (NIOSH). NIOSH developed this forum to assist health care facilities that are working through the process of implementing safer needle devices in their workplaces.
Evaluation of Safety Devices for Preventing Percutaneous Injuries A…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 46(02);21-25, (1997, January 17). Indicates that the use of phlebotomy safety devices significantly reduces phlebotomy-related percutaneous injury (PI) rates.
Needlestick and Other Risks from Hypodermic Needles on Secondary I…. Food and Drug Administration (FDA) Safety Alert, (1992, April 16). Urges the use of needleless systems or recessed needle systems to reduce the risk of needlestick injuries.
Selected EPA-registered Disinfectants. Environmental Protection Agency (EPA), (2009, January 9). Includes lists of EPA registered anti-microbial products to assist in choosing the appropriate decontaminant.
Post-exposure Evaluation
According to the NIOSH Alert Preventing Needlestick Injuries in Health Care Settings, it is estimated that 600,000 to 800,000 needlestick injuries (NSIs) and other percutaneous injuries (PIs) occur annually among health care workers. PIs are caused by sharp objects such as hypodermic needles, scalpels, suture needles, wires, trochanters, surgical pins, and saws. Additional exposure incidents include splashes and other contact with mucous membranes or non-intact skin. Post-exposure management is an integral part of a complete program for preventing infection following exposure incidents.
The following references provide useful information about the management of occupational exposure incidents to blood or other potentially infectious materials.
Rapid HIV Testing. Centers for Disease Control and Prevention (CDC). These pages include descriptions of the rapid HIV tests approved by the FDA, how the tests can be implemented in different settings and research on the effectiveness and possible uses of the tests.
A Comprehensive Immunization Strategy to Eliminate Transmission of …. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 55(RR16);1-25, (2006, December 8).
Updated U.S. Public Health Service Guidelines for the Management of…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 54(RR09);1-17, (2005, September 30). Updates US Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain human immunodeficiency virus (HIV).
Updated U.S. Public Health Service Guidelines for the Management of…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 50(RR11);1-42, (2001, June 29). Updates and consolidates recommendations for the management of health-care personnel (HCP).
Immunization of Health-Care Workers: Recommendations of the Advisor…. Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 46(RR-18);1-42, (1997, December 26). Summarizes recommendations of the ACIP concerning the use of certain immunizing agents in health-care workers (HCWs), and assists workers and administrators, in optimizing infection prevention and control programs.
EPINet. The University of Virginia, International Health Care Worker Safety Center. The Exposure Prevention Information Network (EPINet) system provides standardized methods for recording and tracking percutaneous injuries and blood and body fluid contacts. EPINet consists of a Needlestick and Sharp Injury Report, a Blood and Body Fluid Exposure Report, and software for entering, accessing, and analyzing the data from the forms.
National HIV/AIDS Clinicians' Consultation Center. The University of California – San Francisco. Offers a post-exposure prophylaxis hotline called PEPline. PEPline offers health care providers around-the-clock advice about managing occupational exposures to HIV and Hepatitis B and C.
Additional Information
Related Safety and Health Topics Pages
Healthcare Facilities
Medical and First Aid
Nursing Homes and Personal Care Facilities
Training Resources. OSHA. Contains training and reference materials related to bloodborne pathogens.
OSHA's Revised Bloodborne Pathogens Standard. OSHA, (2001), 34 slides. Covers safe needle devices and provides new definitions from the revised standard.
Bloodborne Pathogens [1 MB ZIP*]. OSHA, (2001, December 17). Assists trainers conducting OSHA 10-hour general industry outreach training for workers. Since workers are the target audience, the material emphasizes hazard identification, avoidance, and control — not standards.
Public Health Training Network Catalog. Centers for Disease Control and Prevention (CDC), Public Health Training Network (PHTN). Browse for distance learning courses and resources.
OSHA Resources
Regional & Area Offices. Each Regional Office has a Bloodborne Pathogens Coordinator available to answer questions.
Small Business. OSHA.
On-site Consultation
Program Information and Benefits
Compliance Assistance Specialists (CASs). Provides general information about OSHA standards and compliance assistance resources.
Record Summary of the Request for Information on Occupational Expos…. (1999, May). Summarizes nearly 400 comments from health care facilities, workers and others who responded to OSHA's request for information on engineering and work practice controls used to eliminate or minimize the risk of occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.
Model Plans and Programs for the OSHA Bloodborne Pathogens and Haza…. Publication 3186-06N, (2003). Also available as a 521 KB PDF, 29 pages. Includes a model exposure control plan to meet the requirements of the OSHA bloodborne pathogens standard and a model hazard communication plan to meet the requirements of the hazard communication standard.
Access to Medical and Exposure Records. Publication 3110, (2001). Also available as a 1 MB PDF, 8 pages. Provides information for employees who have had possible exposure to or use toxic substances or harmful physical agents at their work site or employers who have employees who may be exposed.
Medical & Dental Offices: A Guide to Compliance with OSHA Stand…. Publication 3187-09R, (2003). Also available as a 787 KB PDF, 2 pages. Provides a glimpse of the most frequently found hazards in medical and dental offices.
OSHA Forms for Recording Work-Related Injuries and Illnesses. Forms 300, 300A, and 301.
Personal Protective Equipment. Publication 3151-12R, (2003). Also available as a 629 KB PDF, 46 pages. Helps both employers and employees understand the types of PPE, know the basics of conducting a "hazard assessment" of the workplace, select appropriate PPE for a variety of circumstances, and understand what kind of training is needed in the proper use and care of PPE.
RECORDKEEPING – It's new, it's improved, and it's easier… Publication 3169, (2001). Also available as a 2 MB PDF, 7 pages. Provides information on the new rule.
Publications, Posters, and Online Order Forms
OSHA Alliances
American Biological Safety Association (ABSA). Signed September 23, 2002; renewed October 13, 2004; renewed January 29, 2007; renewed March 3, 2009).
Association of periOperative Registered Nurses (AORN). Signed December 15, 2006; renewed April 1, 2009.
Association of Occupational Health Professionals in Healthcare (AOHP). Signed February 19, 2004; renewed August 27, 2006; renewed April 28, 2008.
The Joint Commission and Joint Commission Resources (JCR). Signed July 27, 2004; renewed November 8, 2006; renewed January 14, 2009.
Other Resources
Information for Employers Complying with OSHA's Bloodborne Pathogen…. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2009-111, (2009, March).
Worker Health Chartbook 2004. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2004-146, (2004, September).
Fatal and Nonfatal Injuries, and Selected Illnesses and Conditions
First Responders: Protect Your Employees with an Exposure Control Plan. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2008-115, (2008, July). First Responders face unique scenarios due to uncontrolled settings and the possible presence of large volumes of blood at the scene. A comprehensive bloodborne pathogens exposure prevention program will help protect your employees.
First Responders: Encourage Your Workers to Report Bloodborne Patho…. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2008-118, (2008, July). Encourage your employees to report all exposures. This way, you can carry out your responsibility to take appropriate post-exposure actions to protect your workers, their families, and the public against infection from bloodborne pathogens.
First Responders: Informational Poster on Bloodborne Pathogen Expos…. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2008-116, (2008, July).
Protect Your Employees with an Exposure Control Plan. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2007-158, (2007, September). NIOSH researches visited a number of prisons and jails to learn more about current practices and procedures being used to protect health care workers from bloodborne diseases. This brochure provides information to medical service administrators and supervisors about common problems with facility Exposure Control Plans.
2007 Guideline for Isolation Precautions: Preventing Transmission o…. Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP). Provides an outline of a single set of standard precautions to be used for the care of all patients in hospitals regardless of their presumed infection status.
The CDC Prevention Guidelines Database. Centers for Disease Control and Prevention (CDC). Provides a comprehensive compendium of all of the official guidelines and recommendations published by the Centers for Disease Control and Prevention (CDC) prior to October 1998 for the prevention of diseases, injuries, and disabilities.
Cardo, Denise M., et al. "." The New England Journal of Medicine (NEJM) 337(1997, November 20): 1485-1490. Abstract only.
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Safe Syringes For Injection Safety
There are four types of syringes currently used around the globe. The first two categories are cheaper but less safe. The two newer and safer devices are more expensive. Simpler disposable syringes cost on average 12 to 15 cents less than devices that prevent reuse and needle stick injuries. In industrialized countries, the injection systems are firmly established and well resourced, with the most advanced syringes broadly available. The vast majority of developing countries cannot afford the most recent technologies.
Group One: Reuse Prevention Feature
• Auto-disable (AD) syringes are designed to prevent reuse by patients and health care workers. After being utilized once, the syringes are put out of action due to an internal mechanism which blocks the plunger once it is fully pressed.
• Breaking Plunger syringes contain the same purpose and a similar functioning as the AD syringes. Once the plunger is fully pressed, an internal mechanism cracks it completely, impeding any possibility of reuse.
Group Two: Reuse and Needle Stick Prevention Features
• Needle Stick Prevention syringes, apart from having a mechanism to avoid reuse, also protect health care workers and patients from needle related injuries and infections. The syringes contain a shield, made either of paperboard or plastic, which covers the needle creating a protective cap.
• Retractable syringes, apart from preventing reuse and needle sticks, also avoid hazardous sharps waste. After being used, the needle is pulled back inside the syringe barrel upon retraction of the plunger.
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Injury and Hazards in Home Healthcare Nursing are a Growing Concern
"Although professionally and personally rewarding for many, home care nursing can be both physically and emotionally demanding. Our study findings suggest that home healthcare work may be dangerous for nurses who work in this setting. These types of injuries are serious as they can result in infection with bloodborne pathogens, such as hepatitis and HIV."
— Robyn Gershon, DrPH, professor of clinical Sociomedical Sciences
Injury and Hazards in Home Healthcare Nursing are a Growing Concern
October 1, 2009 — Patients continue to enter home healthcare ''sicker and quicker," often with complex health problems that may require extensive nursing care. This increases the risk of needlestick injuries in home healthcare nurses. While very few studies have focused on the risks of home healthcare, it is the fastest growing healthcare sector in the U.S. In a recent study, led by researchers at Columbia University Mailman School of Public Health, the rate of needlestick-type injuries was 7.6 per 100 nurses. At this rate, the scientists estimate that there are nearly 10,000 such injuries each year in home care nurses. The findings, reported in the paper, "The Prevalence and Risk Factors for Percutaneous Injuries in Registered Nurses in the Home Health Care Sector," were published in the September 2009 issue of American Journal of Infection Control.
According to lead author Robyn Gershon, DrPH, professor of clinical Sociomedical Sciences at the Mailman School of Public Health and principal investigator, "although professionally and personally rewarding for many, home care nursing can be both physically and emotionally demanding. Our study findings suggest that home healthcare work may be dangerous for nurses who work in this setting. These types of injuries are serious as they can result in infection with bloodborne pathogens, such as hepatitis and HIV."
A critical finding of this study was the statistical correlation between needlesticks and exposure to stressful conditions in the patients' household. Nurses reporting household stressors, such as cigarette smoke, unsanitary conditions, air pollution, and vermin, were nearly twice as likely to report needlestick injuries. Most significant was the fact that home healthcare nurses exposed to violence in their patients' households were nearly three and a half times more likely to also report needlestick injuries, according to the study.
The home healthcare sector is a very important part of the nation's healthcare infrastructure with over 1.3 million workers in the field, including roughly 125,000 RNs. Many procedures previously performed only in the hospital are now routinely performed in the home.
Over 700 home healthcare RNs from across New York State were recruited for this study, which was funded by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC).
The provision of a safe work environment in the home healthcare sector is complicated by the fact that worker safety in this setting is largely unregulated. Certain OSHA regulations do not apply to workers employed in individual households. However, home healthcare agencies accredited by the Joint Commission must be in compliance with certain infection control and other standards. Protecting workers from violence in the healthcare setting is an ongoing and well recognized challenge according to Dr. Gershon, "These results indicate that household hazards in general, and home care violence in particular, needs addressing."
"Many of the unsafe conditions identified in this study can also increase risk of harm to patients," said Dr. Gershon. She further noted that as healthcare increasingly moves out from the acute care setting and into the home setting, efforts to improve the health and safety of workers in this sector is critical, with benefits to home health care workers and patients alike.
"Dr. Gershon's research on home healthcare and how it affects elderly patients and caregivers alike is key to helping us evaluate the ways to ensure that both frail older adults and their home health providers remain as safe and healthy in the home setting as possible," says Linda Fried, MD, MPH, dean of the Mailman School of Public Health. "This research is especially important since we know that 20% of the U.S. population will be over 65 years old by the year 2030." Dr. Fried is an epidemiologist and geriatrician whose career has been dedicated to the science of healthy aging.
The study was supported by Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health (5 R01 OH008215-03).
About the Mailman School of Public Health
The only accredited school of public health in New York City and among the first in the nation, Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting millions of people locally and globally. The Mailman School is the recipient of some of the largest government and private grants in Columbia University's history. Its more than 1000 graduate students pursue master's and doctoral degrees, and the School's 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as infectious and chronic diseases, health promotion and disease prevention, environmental health, maternal and child health, health over the life course, health policy, and public health preparedness. http://www.mailman.columbia.edu Contact: Stephanie Berger, Mailman School of Public Health, 212-305-4372, email@example.com
Views: 3,332,476
We had a needle stick. What do we do now?
Coping with OSHA
We had a needle stick.
What do we do now?
HARRISBIOMEDICAL can help.
When your employee has an exposure incident, you must respond immediately. Exposure incidents include injuries from contaminated sharps or any blood, saliva or other potentially infectious material contact with eye, mucous membrane or non-intact skin.
For any exposure incident, you must:
* Provide immediate post-exposure medical evaluation to the employee. The treatment offered must include a medical evaluation for Post-Exposure Prophylaxis (PEP) for HIV. Document whether or not the employee chooses to pursue immediate medical evaluation.
* Request consent to test the source patient (if known). The consent must be in writing and must include consent to test for HBV, HCV and HIV and to disclose the test results to the exposed employee. Document whether or not the source patient gives consent to test and disclose.
* Investigate and document the exposure incident. You must document the circumstances that led to the exposure. You must also provide a copy of the documentation to the employee's treating health care professional if the employee seeks medical evaluation and/or treatment.
* Provide a copy of the Bloodborne Pathogens standard to the treating health care professional if the employee seeks medical treatment and/or evaluation.
Contact Harris Biomedical Here:
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Chapoutier Gigondas 2016
Gigondas is a great alternative to Chateau Neuf Du Pape. The wine is a ruby-red colour with a powerful and fine nose. The aromas of strawberry jam, red fruits and pepper are super enticing. Once tasted, the wine surprises with it`s floral and fruity notes, followed by firm ripe tannins and spice. Brilliant stuff.

subset: commoncrawl


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Birthday Giveaway Guess what party peeps? Today is my birthday. That's right. Another year older (32 big ones) and I think I've finally got a handle on the things that make me happy. This week...Learn More
Do you ever wish you could get out of your own head? You know the answers are there, but you just can't wrap your head around what to do or how to do it. Your mind buzzes and whirs and makes a lot of...Learn More
Today marks the final day of our 4 week challenge. How did you do? Was it harder than you thought it would be? Or easier? When you set your goal 4 weeks ago you had an idea in mind of what it would feel...Learn More
This is week 3 of the Put Your Health First challenge. How's it coming? Did you make a commitment to create one small change in your life? Habits are formed by doing the same thing repeatedly over...Learn More
How's the challenge coming? If you didn't commit on this post or this post, are you willing to commit this week? You don't have to agree to a grueling amount of different exercises you...Learn More
Is your health a priority? Most of us have health related goals. In fact, I don't think I've ever met someone who doesn't care about their health. But so many of us don't make...Learn More


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You are hereABC News: Study Shows Money Flooding into Campaigns for State Judgeships
ABC News: Study Shows Money Flooding into Campaigns for State Judgeships
Justices Ginsburg, O'Connor Say Fundraising Could Corrupt System, Reform is Needed
March 17, 2010- In rare public remarks last week, U.S. Supreme Court Justice Ruth Bader Ginsburg said the money involved in electing judges remains one of the most pressing concerns facing the American court system. And she joined her former colleague, Sandra Day O'Connor, in calling for reform.
"If there's a reform I would make, it would be that," Ginsburg said when asked about the issue at the National Association of Women Judges Thursday night.
Yet money has continued to pour into the campaign accounts of state judges around the country, and ABC News has obtained an advanced copy of a study showing the amounts involved are unprecedented.
In the past decade, candidates for state judgeships raised more than $206 million, more than double the $83 million judges raised in the 1990s, according to the soon-to-be released study by the Brennan Center for Justice at NYU School of Law and Justice at Stake, two non partisan groups that advocate for reforming the judicial selection process.
Three of the last five state Supreme Court election cycles topped $45 million. And judges shattered fundraising records in all but two of the 21 states with contested Supreme Court elections in the last ten years, the report found.
State judicial elections have been transformed," the report says, and the money involved has created "a grave and growing challenge to the impartiality of our nation's courts."


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This is an archived article and the information in the article may be outdated. Please look at the time stamp on the story to see when it was last updated.
HOUSTON, TX – The Texans have a new defensive coordinator and he's considered one of the best to ever do it.
Romeo Crennel is head coach Bill O'Brien's newest hire and he too was once a part of the New England Patriots success. He's the third former Patriot to sign onto the Houston Texans coaching staff. There's O'Brien, now Crennel and linebacker coach Mike Vrabel was also a Patriot and was even coached by Crennel for four years.
Crennel signed a three year deal and will make just under $2 million a season. After the worst season in franchise history, the Texans needed a revamp. So far so good!


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FABRIC – Front Body: 100% Quilted Nylon Ripstop Back/Sleeves: 95% Polyester, 5% Elastane Stretch Bonded Fleece Insulation: 100% Hi-loft Polyfil
FEATURES – Thumb loops to keep hands warm. Insulated quilting on chest front for lightweight warmth. Contrast front zipper and pockets. Stand up collar with integrated bonded fleece hood.
Modern Fit


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Selena Marie Gomez was born to Mandy Cornett and Ricardo Gomez on July 22, 1992. At a young age, she moved from New York to Grand Prairie, Texas. Giving birth to Selena at 16, her mom Mandy recalls living "paycheck-to-paycheck". Selena started out on "Barney & Friends" (1992) as "Gianna" in 2001 where she really discovered her talent. Unfortunately, they dropped her from the series after just two years. In 2003, she had a very small role in the movie Spy Kids 3-D: Game Over (2003) and a bit part in 2005 when she played "Julie" in Walker, Texas Ranger: Trial by Fire (2005) (TV) with Mitchel Musso and in 2006 as "Emily Grace Garcia" in Brain Zapped (2006) (TV) when she recorded a song for the movie.
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Michael Young of the Texas Rangers personally autographed this 8 x 10 unframed photo.
Michael Young is a former MLB infielder who played 14 seasons, primarily with the Texas Rangers. This versatile player was a 5 time All Star at shortstop, once at third base, and once as as a DH. Michael Young was the batting champ in 2005.
Celebrate your Rangers pride with this personally signed photo to add to your baseball memorabilia collection!
*All of our merchandise is obtained directly from the athletes through paid signing sessions. We work hand-in-hand with pro players and their agents to conduct signings all over the United States and a Gameday Connexion representative witnesses every item being signed.
Autograph placement may vary & does come with a Certificate of Authenticity.


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April 8, 2010 Guest Marci Javril CST, NCTMB
Topic: Want An Easy Detox? Try Self-Massage (re-air)
Marci Javril's diverse background in dance performance, bodywork and healing arts spans over 30 years. She maintains a private practice in Marina del Rey, CA working in association with other health professionals. Since 1986, Marci has offered her certification courses in lymphatic massage, internal organ cleansing, post-surgical therapy, and pregnancy & infant massage through professional massage schools in California, Hawaii and Australia. www.vitalenergycenter.com
Interview Description:
Marci Javril is strong advocate of self-care for digestive and respiratory health. She has developed effective self-massage programs that melt away toxic congestion, helping immune response, elimination and your well-being. Listen to today's show as she describes the easy-to-do process and how this can also help with additional body issues, such as post-surgical scar softening.
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To return to the main KPFK Radio episode index, please click here.


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Kickoff Date–Sunday, November 3, 2019
Drawing–Saturday, December 14, 2019
Shop in Altus, Oklahoma and collect Candy Cane Cash tickets beginning on the day of the Holiday Open House for your chance to win up to $12,500 in cash!!!
Vendors welcomed by reservation only.
Download the CCC Poster 2019
Download the CCC Table Tent 2019
2017 Winner's


text: Misery loves company so I was happy to learn I'm not only one hating on Extell's One57, aka the Sandy Crane Tower, aka the Towering Infernal. New York Magazine's architecture critic Justin Davidson brought the starchitect designed monstrosity down several notches this week in what I think is the first serious review of it (as well as 432 Park, a few blocks east). Each will briefly own the record for tallest residential tower in Manhattan, which leads Davidson to ask, "Shouldn't architects who reach for physical heights be extending themselves creatively, too?" Good question.


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Tag Archives: ROI
How to Calculate the ROI of Your Social Media Campaign
Posted on July 5, 2014 by MyDigiBrand™
0 Recently a friend of mine has launched his business and he was using social media as the marketing platform on my recommendation. Later he came back to me and told me that he heard from one of his friend … Continue reading →
Posted in Social Media | Tagged digital marketing, ROI, social media | Leave a comment
How to Measure a Twitter Campaign?
Posted on April 21, 2014 by MyDigiBrand™
Social Media is an indispensable asset to every company which can be used to broadcast and reach out to their audience. How do they generally plan to reach out and gain authority? The answer lies in conducting campaigns with social … Continue reading →
Posted in Marketing Campaign, ROI, Social Media | Tagged digital marketing, marketing campaign, ROI, social media, Twitter | Leave a comment
Social Success? How to Measure Social Media Marketing ROI
Posted on April 2, 2014 by MyDigiBrand™
What's the biggest challenge to Twitter marketing? Although making lasting connections and gaining followers are difficult goals to achieve, measuring return on investment (ROI) is the biggest obstacle for almost half of brands, new research reveals. Even though 64.9 percent … Continue reading →
Posted in Marketing, ROI, Social Media | Tagged marketing, online brand, Online Marketing, ROI, social media, success | 1 Comment
Small Businesses Find ROI in Social Media
Posted on June 17, 2013 by MyDigiBrand™
Small businesses can find a return on investment (ROI) in social media, but they have a hard time with Facebook. A new study from Manta provides insight from more than 1,200 small-business owners regarding their top concerns. Manta then created … Continue reading →
Posted in Social Media | Tagged Business, Facebook, Return on investment, ROI, Small business, social media, Twitter | Leave a comment


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Most business owners agree that electrical costs account for a large percentage of their unexpected expenses. Small business owners spend more than $60 billion in energy costs every year, in fact. If you want to cut costs and perhaps do good things for the environment, the tips below are made just for you.
Schedule an Energy Audit
An energy audit highlights exactly where you are spending money and looks for methods of reducing that amount of energy. Most energy companies offer free energy audits, but some may charge a nominal fee. The savings that come after an energy audit are worth any costs the audit may cost.
Energy-efficient Equipment
Look for the Energy Star label on any office equipment that you buy. Items labeled with the Energy Star label save as much as 40% on annual energy costs, which is a substantial amount of money for anyone to save, especially a small business.
Reduce Peak Demand
Peak demand is the hours of the day when most energy is used. Reduce the time energy is used during this time by staging work hours and better scheduling. It takes a bit of effort to reduce peak demand but is worth the effort when all is said and done.
Programmable Thermostats
Programmable thermostats are lifesavers for many busy business owners. If you're not using them already, it's time to make this upgrade. Not only will the office be more enjoyable and comfortable, you save a nice chunk of change on energy costs.
Last Word
Keep the above tips in mind to reduce energy consumption and costs at your small business. A few small changes within your business, great commercial electrical services houston, and know how are all that it takes to save money.


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Integrating Connectionist Learning and Dynamical Systems Processing: Case Studies in Speech and Lexical Development
Integrating Connectionist Learning and Dynamical Systems Processing: Case Studies in Speech and Lexical Development
This chapter examines the interplay of dynamical systems and connectionism at the level of both theory and computation. It begins with a discussion of developmental mechanism focusing on two particular processes—one typically associated with connectionist approaches and one typically associated with dynamical systems. It then illustrates potential hybrid approaches with case studies from the field of language acquisition. The first—a model of speech category learning—illustrates how a dynamical systems perspective may inform a classic connectionist mechanism (i.e., statistical learning). The second—a model of early word learning—combines connectionist and dynamical systems principles. Both suggest that we can no longer treat these two paradigms as independent.
Keywords: dynamic systems theory, connectionism, language acquisition, speech category learning, early word learning
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ABERCROMBIE — It was an interesting weekend in a number of ways for golfers in the Nova Scotia men's amateur championship at Abercrombie Country Club.
Calvin Ross from the Kingswood Golf Club in Fredericton, N.B. completed his wire-to-wire win with a final round 76 to finish the 54-hole competition with a three-day total of 213.
It marks Ross's second win on Nova Scotia soil. Ross won the 2017 Future Links Atlantic at Clare Golf Club. That win was just weeks before he won the 2017 Canadian Junior Championship.
The golfers were playing at Abercrombie this year, which marks the 100th anniversary of its founding in 1919.
It turned out to be a rewarding weekend for Abercrombie's Kevin Scott who is among seven Nova Scotians who have qualified for the 2019 Canadian Men's Amateur Championship at the Glen Arbour club in Hammonds Plains, outside Halifax.
Scott recorded his second straight round of 75 on Sunday after opening on Friday with an 80. He ended in a tie for 13th place with a 54-hole total of 230.
He played the front nine holes at even par by posting birdies on the third and fifth holes and bogeys on the second and fourth holes. His back nine was hurt by a double bogey five on the 10th hole and a triple bogey 7 on the 13th hole.
Clubmate Jeff Fraser was next after carding rounds of 79, 77 and 79 for a 235 total.
Gregg LeBlanc followed a reassuring 73 on Saturday with a 79 on Sunday to post 236 strokes over the three days. He shot an 84 on Friday.
"I didn't come into the tournament with high expectations," he said. "My game wasn't really that sharp. I had an 84 on Friday when I didn't get the breaks and I had a 73 on Saturday when I did get the breaks. My 79 was more like I play if I haven't played much."
Jamie Aitken followed with a 238 total, while John David Coffin ended at 240 and Brett McLanders recorded a total after an 85 on Sunday for a241 total.
"It was much better on Saturday," he said, referring to the 75 he posted. "I wasn't as good (on Sunday). The course was tough but it was fair. I think the green speed was fair."
Meanwhile, Julia Henderson of Abercrombie placed third on Sunday at the provincial women's amateur championship in Greenwood with a three-day total of 247.
Kevin Scott makes a putt during the Nova Scotia men's amateur golf championship at Abercrombie Country Club. (Goodwin photo)


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Browsing Titles index
Now showing items 533-541 of 541
Now showing items 533-541 of 541
|Titles index
|Wage Flexibility and Contract Structure in Germany [1]
|Wage policy of firms : an empirical investigation [1]
|The Wage Rate and the Profit Rate in the Price of Production Equation: a New Solution to an Old Problem [1]
|Wages and Mobility: the Impact of Employer-Provided Training [1]
|Welfare criteria from choice: the sequential solution [1]
|What Is a Commody? Two Axiomatic Anwers [1]
|What is ambiguity? [1]
|Why Have Aggregate Skilled Hours Become So Cyclical Since the Mid-1980's? [1]
|Yesterday's Games: Contingency Learning and the Growth of Public Spending, 1890-1938 [1]


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These four wind turbines stand offshore of Thornton Bank, Belgain, in the North Sea | Photo by Hans Hillewaert
If I told you the electricity running through the veins of our civilization was about to get a whole lot greener, would you believe me?
Renewable energy has, for as long as I can remember, been dismissed as an impractical alternative to fossil fuels. Our grids are not built to handle renewables, the necessary electrical storage doesn't exist and, above all else, renewable power is just too darned expensive. These are the excuses we have heard time and time again, dampening our hopes of a clean energy future for decades now, but in the last few years alone, each of these concerns have begun to evaporate.
This first post in A\J's new series Shades of Green will focus on the most imposing of obstacles mentioned above: cost. The Australian-based Climate Council, an independent public awareness organization dedicated to spreading the science of climate change, published a report tracking the progress of renewable energy globally between 2009 and 2015 — their findings were extraordinary.
Since 2009, a mere six years ago, the cost of solar power has plummeted a staggering 75 percent. It's now 154 times cheaper to derive electricity from the sun than it was in 1970, a mark of progress if ever there was one. As though that weren't enough, the cost is predicted to drop another 40 percent in the next three to four years. The costs of wind power have also enjoyed a drop of about 30 percent.
The market has responded in kind to these remarkable advances in technology. New investments in renewable energy have outpaced those made in fossil fuels every year since 2009, jumping approximately 50 percent. The majority of new power being pumped onto the grid globally is green. The countries and companies that made these investments have reaped the economic benefits, as the number of people employed in the renewable power industry has climbed from three million globally in 2009 to 7.7 million just last year — more than double.
All of these marvellous steps forward preceded the Paris Climate Conference (COP21) in December, a historic summit at which billions of dollars were dedicated to the advancement of renewable energy across the globe. The trends outlined above, on their own a reassuring sign for the future, will only be hastened by our recent international commitment to combat climate change. The tools to achieve a carbon neutral world will soon, finally, be at hand.
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posted Oct 2, 2019
American Trails Staff
This program will provide eligible groups the opportunity to apply for a grant to fund their next trail improvement related project, which could range from trail clean-up, trail restoration, trail expansion, to name a few.
posted Sep 6, 2019
Have questions about funding your trail? Check out these answers from presenters that have successfully courted private foundations to give you a holistic view of how projects can be pushed to the next level by engaging the private sector.
published Jun 1, 2020
An emerging grant program known as the "Trails Fund" serves the dual goals of bringing insurance expertise and continuity to the trails industry, while leveraging insurance commission and premium.
Page 1 of 1
Denver, Colorado
GOCO invests a portion of Colorado Lottery proceeds to help preserve and enhance the state's parks, trails, wildlife, rivers, and open spaces. Our independent board awards competitive grants to local governments and land...
1900 Grant Street, Suite 725, Denver, Colorado 80203(303) 226-4500 • [email protected]
Fredericksburg, Virginia
Founded in 1880, The American Canoe Association (ACA) is a national nonprofit organization serving the broader paddling public by providing education related to all aspects of paddling; stewardship support to help protec...
503 Sophia St. Suite 100, Fredericksburg, Virginia 22401(540) 907-4460


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Or not ... This week I went to Disneyland to check out their popular Easter Egg Hunt (officially called "Egg-stravaganza"). If you're not familiar with the Disneyland Easter Egg Hunt, it's a fun activity where you buy a map and go around the Parks looking for large egg … [Read more...] about If the Disneyland Easter Egg Hunt is Sold Out, Try This Alternative
Booze drinks
Boozy Unicorn Hot Chocolate
This post contains affiliate links. Technically it's not Valentine's Day any more, and I'm sad my day to celebrate pink and chocolate and love is over for another year. But this drink certainly keeps the celebration going! Unicorn Hot Chocolate is nothing new; I'm … [Read more...] about Boozy Unicorn Hot Chocolate
Easy Red Wine Hot Chocolate Recipe
This is a partnered post with CK Mondavi. All opinions are 100% mine. Search #CKMondaviHoliday on Instagram and Twitter for more recipes and entertaining tips! 2017 is already looking up! I'm happy to announce I have been chosen as a CK Mondavi Ambassador for the next … [Read more...] about Easy Red Wine Hot Chocolate Recipe
Cozy Monkey Hot Chocolate with Banana Rum
Hello! Please read me! This is a sponsored post. The company who sponsored it compensated me via a cash payment, gift, or something else of value to write this. I only recommend products or services I use personally and/or believe will be good fit for my readers. All opinions are … [Read more...] about Cozy Monkey Hot Chocolate with Banana Rum
Peach Blueberry Moscow Mule Recipe
Moscow Copper provided product for this post. All opinions are my own. Moscow Mules are one of my favorite summer drinks. Okay, if I'm being honest, they are one of my favorite winter drinks, too. I absolutely love the bite of ginger beer and I love experimenting with … [Read more...] about Peach Blueberry Moscow Mule Recipe


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Our Vintage Selfie Pod hire includes:
Still Photos
Animated GIFs
Instant upload via email or SMS (subject to wifi*)
Vintage wooden tripod
Beautify Filter!
Unlimited use
Optional Print station
Optional greenscreen background
Vintage Selfie Pod hire:
Our vintage selfie pod with beautify filter ensures your photos will look amazing! It really will be the talking point of your function. Allowing you to capture images and animated clips of your guests in a relaxed and fun way.
Our wooden vintage open air pod would look fantastic at your wedding or corporate event. Guests use the touch screen to choose between capturing a still photo or capture an animated GIF. Animated GIFs are the new craze for photo booths where guests perform for around 2 seconds and the booth captures this and turns it into an animated GIF! The still photos and GIFS can then be shared via social media, email and even SMS message (subject to internet connection at the venue)
Optionally at additional cost we can also add a print station producing photos that will last a lifetime.
Technical information:
- The vintage selfie pod requires a power point
- To make use of the upload feature the venue needs to provide free reliable wifi connection (or contact us for other options)
- It can be used inside or outside but not in the rain.
The price depends on a number of factors including length of hire and location. We believe our photobooth prices are very competitive, so please contact us today for a quote!
Unlimited Use
Box of Fun Props
Animated GIFS
Social Media Uploads
Member of staff to help
Have you also considered..
Alternative Photo Booths
Photobooth hire locations
We cover South East Queensland and Northern New South Wales including but not limited to:
Photobooth hire in the Sunshine Coast
Photobooth hire in the Gold Coast


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Review: PONSINC Wireless 10000mAh charger
The number one hassle with power banks on trips is that you also have to remember to take with you the right charging cable for each family device that you might need to rescue. For most of us, this means bringing along a Type C cable, a microUSB cable and Lightning too, for family members with iPhone or iPads. This PONSINC accessory is perhaps the ultimate swiss army knife in the power bank world, in that it can not only charge phones via Qi wireless, it has integral Type C, microUSB and Lightning cabling. So - quite literally - no extra wires are needed.
Buy Link | Download / Information Link
The PONSINC charger is something to behold in the hand - the glass top is clearly marked for Qi charging, while tough flex cables unfurl from either end, revealing extra input and output ports. The device is smaller than a typical smartphone in the hand, though understandably a little thicker. Weight is 221g, so comparable to some of the heavier smartphones, too.
The main body is textured plastic, for a good grip, and all corners are ergonomically rounded. Under the frosted glass front is a LCD display showing remaining capacity in percent, plus a number of other status icons which can't be seen clearly, since - unaccountably - the glass frosting obscures the finer detail! Still, the main charge indicator is clear enough, so we'll cut PONSINC some slack here.
At the top, the flex cable has an Apple Lightning connector with 1A output (I'll comment on charging output below, don't worry), and unfurling this reveals three input ports, for charging the power bank itself: microUSB and Type C (accepting 2A input) and Lightning (accepting 1.5A). I've said it before, but I do like having inputs separate from outputs, since it stops confusion where the 'other' device starts depleting itself to charge the powerbank - this is a real problem in the Type C world (the solution usually being to activate the power bank output before plugging in the other device!)
At the bottom, the flex cable ends in a microUSB connector with 1A output, but there's also a Type C adapter embedded in the power bank's body nearby. Simply insert the microUSB connector into the body and the Type C adapter comes with it and is then ready for use. It seems like a kludge but works pretty well in real life. I'm assuming there are tech reasons why the unit couldn't have a native Type C, with microUSB as the add-on adapter.
The bottom flex cable reveals a USB-A port with 2A output, so you'd use this when you do happen to have a charging cable in your pocket anyway, or when you want to plug in a generic USB accessory.
The Qi wireless charging is typical in terms of 'sweet spot' size to most other Qi pads, i.e. you've got a centimetre either way 'off centre' before charging is no longer possible. And, obviously, the better you line up the centre with your phone's charging coils the more efficient the charging. 1A is again the maximum here, though 1A is quite decent for wireless charging. Every device I tested this with charged successfully. And it's something of a novelty to see a phone wirelessly charging from something that's not wired into the mains!
In theory, this power bank can charge four things at the same time - via the two flex cables, via USB-A and via Qi wireless. And since the drain is quite modest overall, I think you'd get close to the stated currents for each. I did plenty of tests with three phones at once and couldn't detect a charging slowdown.
However, much as I love this gadget to bits (and note that I bought it, it wasn't a PR review freebie), I have to talk about the charging currents in the context of the tech world of 2020. Every company is trumpeting its own 'fast charging' capabilities - with talk of charging a smartphone in 30 minutes, and so on. I have to say that I'm a bit dismayed by the trend, since faster charging (whatever tech is used) will have some detrimental effect on battery chamistry and thus longevity. Then there's the extra heat generated, and we know that hotter batteries also see degradation. As a result, I deliberately avoid Quick Charge 3.0/SuperVOOC/Power Delivery/whatever-buzzword-is-trendy and charge my phones gently on a 1A Qi wireless pad (as here) or via 2A USB (as, coincidentally, on the bottom port here).
Now, I know that I'm possibly unusual in having the luxury of time to charge things up - some users may always be about to jet out the door and so time is more precious. But in view of my charging philosophy, I'm not downhearted at the current limits in this PONSINC power bank. It charges things and it doesn't need me to ever carry cables - and that's enough for me.
More current, delivered faster, as an option, would always be better in the grand scheme of things, of course, and so I've docked this otherwise almost perfect gadget a few points on the score. I'm just pointing out that high current or high voltage charging is not the be all and end all. In my opinion.
At £25 (on Amazon UK), I was impressed by the value for money too - I won't dignify any other brands with a link here, but the same exact power bank is sold under other accessory labels at up to £50, which is a little crazy - £25 sounds exactly right for what you get in terms of design and technology.
I've got power banks with more capacity, more ports, more current capacity, and with torches and other gadgets. But this PONSINC accessory just beats them all out in terms of a place in my jacket pocket because it's the one gadget that can keep me and my family going with zero preparation in terms of bringing along cables of every type.
Reviewed by Steve Litchfield at


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We've gone in the past by accident but this time we went on purpose.
The National Building Museum is a beautiful space inside but you can tell it's not a Smithsonian. We went for an exhibit on the cities built around the Manhattan Project which was interesting but that was about all.


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FATAL: Man dies in hospital following two-car crash
A MAN has died following a two-car crash north of Coffs Harbour.
Emergency services were called to Eggins Dr at Arrawarra on Monday at around 4pm following reports of a crash involving a 24-year-old female driver and her 80-year-old male passenger travelling in a Toyota, and a 26-year-old female driver in a Mazda.
It is understood the Toyota was travelling north while the Mazda was southbound at the time of the incident.
The elderly passenger was trapped in the vehicle and was freed by emergency services.
NSW Ambulance Media said the man was suffering shoulder and chest pain and was immediately transported to Coffs Harbour Hospital where he was placed into an induced coma.
The man, however, died this morning.
The two other occupants were uninjured.
The vehicles have since been seized by police as investigations continue.