CPH

performance assessment

"requires students to actively accomplish complex and significant tasks, while bringing to bear prior knowledge, recent learning and relevant skills to solve realistic or authentic problems".

rate

# of events in specified period/ average population during the period

uncertainty factor

One of several factors used in calculating the reference dose from experimental data. UFs are intended to account for (1) the variation in sensitivity among humans; (2) the uncertainty in extrapolating animal data to humans; (3) the uncertainty in extrapolating data obtained in a study that covers less than the full life of the exposed animal or human; and (4) the uncertainty in using LOAEL data rather than NOAEL data.

eutrophication

The slow aging process during which a lake, estuary, or bay evolves into a bog or marsh and eventually disappears. During the later stages the water body is choked by abundant plant life due to higher levels of nutritive compounds such as nitrogen and phosphorus. Human activities can accelerate the process.

standard error

The standard deviation of the sampling distribution of a statistic. For example, the __ of the sample mean of n observations is where s2 is the variance of the original observations.

receiver operating characteristic curve

a graphic means for assessing the ability of a screening test to discriminate between healthy and diseased persons.

bargaining unit

a group of employees with a clear and identifiable community of interests who are (under U.S. law) represented by a single labor union in collective bargaining and other dealings with management. Examples would be "non-management professors"; "law enforcement professionals"; "blue-collar workers"; "clerical and administrative employees".

biological exposure indices

a guidance value for assessing biological monitoring results

two sampled t test

a hypothesis test for answering questions about the mean where the data are collected from two random samples of independent observations, each from an underlying normal distribution

global rate

a risk-adjusted rate given by insurance providers based several factors such as age, sex, complications and comorbidities.

Emergency Planning and Community Right-to-Know Act (EPCRA)31:

establishes requirements for Federal, state and local governments, Indian Tribes, and industry regarding emergency planning and "Community Right-to-Know" reporting on hazardous and toxic chemicals. The Community Right-to-Know provisions help increase the public's knowledge and access to information on chemicals at individual facilities, their uses, and releases into the environment. States and communities, working with facilities, can use the information to improve chemical safety and protect public health and the environment. Was passed in response to concerns regarding the environmental and safety hazards posed by the storage and handling of toxic chemicals. These concerns were triggered by the disaster in Bhopal, India, in which more than 2,000 people suffered death or serious injury from the accidental release of methyl isocyanate. To reduce the likelihood of such a disaster in the United States, Congress imposed requirements on both states and regulated facilities.

expectancy theory

explains the processes that an individual undergoes to make choices. In organizational behavior study, expectancy theory is a motivation theory first proposed by Victor Vroom of the Yale School of Management. Predicts that employees in an organization will be motivated when they believe that: • putting in more effort will yield better job performance • better job performance will lead to organizational rewards, such as an increase in salary or benefits • these predicted organizational rewards are valued by the employee in question

indemnity insurance

fee-for-service insurance with a high degree of choice for the insured; can be obtained by the individual or through a group.

resource utilization group

measures of staffing intensity and are used to categorize residents for Medicare payment under the skilled nursing facility prospective payment system.

certification

refers to the confirmation of certain characteristics of an object, person, or organization. This confirmation is often, but not always, provided by some form of external review, education, or assessment. One of the most common types of certification in modern society is professional certification, where a person is certified as being able to competently complete a job or task, usually by the passing of an examination. There are two general types of professional certification: some are valid for lifetime, once the exam is passed. Others have to be recertified again after a certain period of time.

licensure

refers to the granting of a license in the US, usually to work in a particular profession or to obtain a privilege such as to practice medicine, nursing or allied health professions. Many privileges and professions require a license, generally the state government, in order to ensure that the public will not be harmed by the incompetence of the practitioners.

political action committee

refers to two distinct types of political committees registered with the FEC: separate segregated funds (SSFs) and nonconnected committees. Basically, SSFs are political committees established and administered by corporations, labor unions, membership organizations or trade associations. These committees can only solicit contributions from individuals associated with connected or sponsoring organization. By contrast, nonconnected committees--as their name suggests--are not sponsored by or connected to any of the aforementioned entities and are free to solicit contributions from the general public.

motivational interviewing

"A directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence ." 17 emphasizes drawing out an individual's internal motivations to change; allowing an individual to express and resolve her own ambivalence towards a behavior; and avoiding direct persuasion, confrontation and argumentation. The individual is viewed as the expert, while the primary role of the interviewer is to facilitate the individual's expression of goals and the discovery of an acceptable resolution to the ambivalence. In theory, an individual's ambivalence is the principle barrier to behavior change.

formative evaluation

"Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities or programs to discover, predict, control, ensure, or improve the quality of performance or delivery." This can include the combination of needs assessment, pilot testing, process evaluation, etc.

process evaluation

"Any combination of measurements obtained during the implementation of program activities to control, assure, or improve the quality of performance or delivery."

outcome evaluation

"Assessment of the effects of a program on the ultimate objectives, including changes in health and social benefits or quality of life."

impact evaluation

"The assessment of program effects on intermediate objectives including changes in predisposing, enabling, and reinforcing factors, behavioral and environmental changes, and possibly health and social outcomes."

summative evaluation

"The application of design, measurement and analysis methods to the assessment of outcomes of a program or specific interventions within a program." 7 Outcome and impact evaluation are collectively referred to as summative evaluation.

social capital

"Social capital represents the degree of social cohesion which exists in communities. It refers to the processes between people which establish networks , norms, and social trust, and facilitate co-ordination and co-operation for mutual benefit." 5 Social capital is "usually characterized by four interrelated constructs: trust, cooperation, civic engagement, and reciprocity."

processes of change

"The covert and overt activities that people use to progress through the stages" 1 of change in the transtheoretical model (TTM). There are ten processes of change that have been identified in conjunction with the development of the TTM: consciousness raising, dramatic relief, self-reevaluation, environmental reevaluation, self-liberation, helping relationships, counter-conditioning, contingency management, stimulus control, and social liberation. Different processes of change are used by individuals in different stages of change to progress towards action and maintenance. In the early stages, people tend to rely more on the cognitive, affective and evaluative processes (consciousness raising, dramatic relief, environmental reevaluation and self-reevaluation) while in the later stages the emphasized processes of change focus on making commitments, seeking support, contingency planning and other behavioral processes (counter-conditioning, helping relationship, stimulus control, reinforcement management).

reciprocal determinism

"The dynamic interaction of the person, behavior, and the environment in which the behavior is performed." In other words, the concept of reciprocal determinism emphasizes that health behaviors and individuals are not only influenced by the physical and social context in which they exist, but also that such individuals and their behavior influences the environment. Reciprocal determinism is a key construct of the Social Cognitive Theory and in ecological approaches to health promotion.

needs assessment

"The process of determining, analyzing and prioritizing needs, and in turn, identifying and implementing solution strategies to resolve high priority needs." 8 A needs assessment is meant to assist program planners in identifying a priority population, their specific needs, subgroups of the population with the greatest needs, the most significant problems facing the priority populations and subgroups, what is currently being done and/or what has been done in the past to effectively address their needs, etc. Needs assessment is generally viewed as the first step in health promotion program planning and depends on both secondary and primary data collection gathered through a variety of qualitative and quantitative methods.

national ambient air quality standards

Standards established by EPA that apply for outdoor air throughout the country

confounder

1. A situation in which the effects of two processes are not separated. The distortion of the apparent effect of an exposure on risk brought about by the association with other factors that can influence the outcome 2. A relationship between the effects of two or more causal factors as observed in a set of data such that it is not logically possible to separate the contribution that any single causal factor has made to an effect 3. A situation in which a measure of the effect of an exposure on risk is distorted because of the association of exposure with other factor(s) that influence the outcome under study

remediation

1. Cleanup or other methods used to remove or contain a toxic spill or hazardous materials from a Superfund site; 2. for the Asbestos Hazard Emergency Response program, abatement methods including evaluation, repair, enclosure, encapsulation, or removal of greater than 3 linear feet or square feet of asbestos-containing materials from a building.

bonds (payable)

a formal written promise to pay interest every six months and the principal amount at maturity.

non-ionizing electromagnetic radiation

1. Radiation that does not change the structure of atoms but does heat tissue and may cause harmful biological effects. 2. Microwaves, radio waves, and low-frequency electromagnetic fields from high-voltage transmission lines.

5 P's of strategy

1. plan 2. ploy 3. pattern 4. position 5. perspective

4 p's of marketing

1. product 2. price 3. place 4. promotion

additive effect

A biologic response to exposure to multiple substances that equals the sum of responses of all the individual substances added together [compare with antagonistic effect and synergistic effect ].

t-cell lymphocyte

>A type of immune cell that can attack foreign cells, cancer cells, and cells infected with a virus. Can also help control immune responses. A type of white blood cell.

b-cell lymphocyte

A type of immune cell that makes proteins called antibodies, which bind to microorganisms and other foreign substances, and help fight infections.

paired t-test

A Student's t-test for the equality of the means of two populations, when the observations arised as paired samples. The test is based on the differences between the observations of the matched pairs. The test statistic is given by t= d(bar)/(sd/sqrt(n)) where n is the sample size, d(bar) is the mean of the differences, and sd their standard deviation. If the null hypothesis of the equality of the population means is true then t has a Student's t-distribution with n - 1 degrees of freedom.

synergistic effect

A biologic response to multiple substances where one substance worsens the effect of another substance. The combined effect of the substances acting together is greater than the sum of the effects of the substances acting by themselves [see additive effect and antagonistic effect ].

PPO

A care plan that: (a) has a network of providers that have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan; (b) provides for reimbursement for all covered benefits regardless of whether the benefits are provided with the network of providers; and (c) is offered by an organization that is not licensed or organized under State law as an HMO. A PPO typically offers more choice at a greater cost

adverse health effect

A change in body function or cell structure that might lead to disease or health problems.

beta particle

A charged particle emitted from a nucleus during radioactive decay, with a mass equal to 1/1837 that of a proton. A negatively charged beta particle is identical to an electron. A positively charged beta particle is called a positron. Large amounts of beta radiation may cause skin burns, and beta emitters are harmful if they enter the body. May be stopped by thin sheets of metal or plastic.

cost benefit analyses

A classic management tool that involves calculating or estimating the monetary costs and potential benefits of a proposed course of action.

feedback system

A closed system influenced by its past behavior. Have feedback loop structure that consists of closed paths of cause and effect. They are self-regulating and can be either a positive feedback system or a negative feedback system.

Local Emergency Planning Committee

A committee appointed by the state emergency response commission, as required by SARA Title III, to formulate a comprehensive emergency plan for its jurisdiction.

SNP

A common type of change in DNA (molecules inside cells that carry genetic information) sequences between individuals. occur when a single nucleotide (building block of DNA) is replaced with another. These changes may cause disease, and may affect how a person reacts to bacteria, viruses, drugs, and other substances.

diffusion of innovations

A community-level theory that attempts to describe the rate and process of the adoption of new ideas and behaviors in a specific population or between populations. An innovation is defined as "an idea, practice or object that is perceived as new by an individual or other unit of adoption," while diffusion is defined as "the process by which an innovation is communicated through certain channels over time among the members of a social system." The process of diffusion occurs over the course of five stages: innovation development, dissemination, adoption, implementation, and maintenance. The adoption stage requires that an individual: 1) has knowledge of the innovation (has an awareness that the innovation exists, knowledge of how to use the innovation and how it works); 2) goes through a process of persuasion or attitude development, in which the individual discusses the innovation with others and forms a favorable or negative attitude toward it; 3) decides to adopt the innovation; 4) implements, or begins to use the innovation; and 5) goes through a process of confirmation, in which the individual integrates the innovation into his life and recommends it to others. In general, not everyone adopts an innovation at the same time. Diffusion of Innovations categorizes individuals into five groups, based on when they adopt an innovation: innovators are the first to adopt, followed by early adopters , then early majority adopters , followed by late majority adopters and finally laggards . The process of adoption in a population over time, as described by DOI, roughly follows a standard normal distribution: early majority adopters and late majority adopters are within one standard deviation of the mean; early adopters and laggards are within two standard deviations; and innovators are within three standard deviations of the mean. There are certain attributes of an innovation that determine the speed and extent of its diffusion. These attributes include: the relative advantage of the innovation over existing alternatives; its compatibility with the intended audience; its complexity , or ease of use; its trialability , or whether or not someone can try the innovation before deciding whether or not to adopt it; the observability or measurability of its results; its likely impact on social relations ; its reversibility ; its communicability , or how easily and clearly it can be understood; the time required to adopt the innovation; the level of risk or uncertainty associated with its adoption; the level of commitment required to use the innovation effectively; and the modifiability of the innovation over time.

asset mapping

A component of community capacity assessment and community development that involves conducting an inventory of individual, group and community resources, often physically designating them on a geographical map. A capacity assessment offers an alternative to a needs-based approach to community health and "is a measure of actual and potential individual, group and community resources that can be inherent and/or brought to bear for health maintenance and enhancement." 25 Once assets are "mapped," efforts are directed at mobilizing, strengthening and supplementing them while working to achieve a common vision.

balancing loop

A loop that seeks equilibrium — it tries to bring stocks to a desired state and keep them there. It limits and constrains, and is also called a negative loop . When it has a long delay, the response may overcorrect, often leading to instability, the opposite of what is intended.

cost-efficacy analyses

A criterion for comparing alternatives when benefits or outputs cannot be valued in dollars. This relates costs of programs to performance by measuring outcomes in nonmonetary form. It is useful in comparing methods of attaining an explicit objective on the basis of least cost or greatest effectiveness for a given level of cost. FOR EXAMPLE, a treatment program may be more cost-effective than an alternative program if it produces a lower rate of recidivism for the same or lower costs, or the same rate of recidivism for a lower cost.

certified output protection protocol

A device driver technology used to enable high-bandwidth Digital Content Protection ( HDCP ) during the transmission of digital video between applications and high-definition displays. COPP is a Microsoft security technology for video systems that require a logo certification. For security drivers are authenticated and protected from tampering to prevent unauthorized high-quality recording from the video outputs. COPP control signals are also encrypted .

prion

A disease-causing agent that is neither bacterial nor fungal nor viral and contains no genetic material. a protein that occurs normally in a harmless form. By folding into an aberrant shape, the normal __turns into a rogue agent. It then co-opts other normal __ to become rogue __.

effect modification

A factor that modifies the effect of a putative causal factor under study. Effect modification is detected by varying the selected effect measure for the factor under study across levels of another factor

mediating factors

A factor that partially or completely explains the relationship between a predictor and a behavior or outcome. A mediating factor is independently related to the outcome of interest and to the predictor of interest, thereby acting as a link between the two. For example, in the Theory of Reasoned Action, a person's behavioral intention acts as a mediating factor between his attitude and subjective norms and his behavior.

likelihood function

A function constructed from a statistical model and a set of observed data that gives the probability of the observed data for various values of the unknown model parameters. The parameter values that maximize the probability are the maximum likelihood estimates of the parameters.

information-motivation-behavior

A general model that holds that information, motivation, and behavioral skills are the primary determinants of health-related behaviors. Individuals who are well informed, highly motivated, and who have the necessary behavioral skills are more likely to engage in a specific health-related behavior. The specific types of information, motivational strategies and behavioral skills necessary to lead to behavior change are expected to vary between subpopulations and between behaviors. Behaviorally relevant information is considered "a necessary but not a sufficient condition" for risk reduction behavior. In general even a well-informed and behaviorally skilled individual must be highly motivated in order to engage in a specific health-promoting behavior and to maintain it over time.

locus of control

A generalized belief that circumstances and rewards are under one's own (internal locus of control) or others' control (external locus of control).

acculturation

A gradual process through which an individual adopts the behavioral norms, attitudes, and beliefs of a culture other than his own.

helminths

A group of parasites commonly referred to as worms. The group includes trematodes, cestodes, and nematodes. Schistosomes are trematodes; the species that most commonly infect humans are: Schistosoma haematobium , S. intercalatum , S. japonicum , S. mansoni , and S.mekongi . Cestodes include the beef and pork tapeworms, the largest of the helminths, and nematodes include the roundworm Ascaris lumbri-coides , the whipworm Trichuris trichiura , and the hookworms Necator americanus and Ancylostoma duodenale ; these nematodes are collectively referred to as .soil-transmitted helminths. (STH).

community assistance panel

A group of people from a community and from health and environmental agencies who work with ATSDR to resolve issues and problems related to hazardous substances in the community. CAP members work with ATSDR to gather and review community health concerns, provide information on how people might have been or might now be exposed to hazardous substances, and inform ATSDR on ways to involve the community in its activities.

social cognitive theory

A health behavior theory that describes the reciprocal influence and dynamic interaction between an individual's personal factors, the environment, and specific health behaviors. Major constructs of the SCT include environments , situations (an individual's cognitive perceptions of the environment that may affect his behavior), behavioral capability , outcome expectations , outcome expectancies (the value an individual places on an expected outcome), self-regulation (ability to engage in goal-directed behavior), observational learning, reinforcements, perceived self-efficacy , emotional coping responses, and reciprocal determinism . The SCT maintains that personal factors within individuals—their behavioral capability, self-efficacy, outcome expectations and expectancies, coping mechanisms, and self control—are key determinants of behavior and both influence and are influenced by the environment. The environment is important partially because it provides models for and opportunities for observational learning and reinforcement, increasing the likelihood that certain behaviors are performed. Based on the concept of reciprocal determinism any change in the person, environment or behavior results in a situational change, necessitating a reevaluation of the interaction between the three.

inversion

A layer of warm air that prevents the rise of cooling air and traps pollutants beneath it; can cause an air pollution episode.

logit model

A linear model for the logit (natural log of the odds) of disease as a function of a quantitative factor X: Logit (disease given X = x ) = α + β x This model is mathematically equivalent to the logistic model.

standard deviation

A measure of dispersion or variation. The most commonly used measure of the spread of a set of observations. Equal to the positive square root of the variance.

biochemical oxygen demand

A measure of the amount of oxygen consumed in the biological processes that break down organic matter in water. The greater the BOD, the greater the degree of pollution

kappa

A measure of the degree of nonrandom agreement between observers or measurements of the same categorical variable K=Po-Pe/1-Pe where Po is the proportion of times the measurements agree, and Pe is the proportion of times they can be expected to agree by chance alone. If the measurements agree more often than expected by chance, kappa is positive; if concordance is complete, kappa = 1; if there is no more nor less than chance concordance, kappa = 0; if the measurements disagree more than expected by chance, kappa is negative.

prevalence

A measure of the number of people in a population who have a particular disease at a given point in time. Can be measured in two ways, as point prevalence and period prevalence, these being defined as follows; point prevalence= # of cases at a particular moment/# in population at that moment period prevalence= # of cases during a specified time period/# in population at midpoint of period Essentially measure the existence of a disease.

incidence

A measure of the rate at which people without a disease develop the disease during a specific period of time. Calculated as it measures the appearance of disease. More generally, the number of new events, e.g. new cases of a disease in a specified population, within a specified period of time. The term is sometimes wrongly used to denote incidence rate.

capitation (rate)

A method of payment to a provider of medical services according to the number of members in a health benefit plan that the provider contracts to treat. The plan sponsor agrees to pay a uniform periodic fee for each member. (Capitation means cost per person.)

proportional hazards model

A method that allows the hazard function to be modeled on a set of explanatory variables without making restrictive assumptions about the dependence of the hazard function on time. The model involved is where x1, x2, ...,xq are the explanatory variables of interest, and h(t) the hazard function. The so-called baseline hazard function, a(t), is an arbitrary function of time. For any two individuals at any point in time the ratio of the hazard functions is a constant. Because the baseline hazard function, a(t), does not have to be specified explicitly, the procedure is essentially a distribution free method. Estimates of the parameters in the model, i.e. ß1, ß2,...,ßq are usually obtained by maximum likelihood estimation, and depend only on the order in which events occur, not on the exact times of their occurrence.

measurement error

A mismatch between an estimated value and its true value. Can be observed when using multiple measures of the same entity or concept.

transtheoretical model of change

A model of individual health behavior that integrates processes of change and theoretical principles from multiple leading theories across several disciplines. It is a stage-based model that takes into account an individual's readiness to change and views behavior change as a process that occurs over time and not as a finite event. Intervention messages and strategies are based on appropriate processes of change and are developed and matched to an individual's readiness to change. There are five main stages of change (see stages of change) and ten processes of change (see processes of change) that have been empirically linked in it. In addition to the concepts of stages and processes of change, also asserts that, in order for an individual to take action and maintain a behavior change, that person must perceive that the benefits, or pros, of change outweigh the cons ( decisional balance ). Situational self-efficacy —the confidence one feels in his or her ability to resist relapsing and engaging in an unhealthy or high-risk behavior in specific, tempting situations—is the final key construct.

kaplan-meier estimate

A nonparametric method of compiling life or survival tables. This combines calculated probabilities of survival and estimates to allow for censored observations, which are assumed to occur randomly. The intervals are defined as ending each time an event (death, withdrawal) occurs and are therefore unequal.

healthy worker effect

A phenomenon observed initially in studies of occupational diseases. Workers usually exhibit lower overall death rates than the general population, because the severely ill and chronically disabled are ordinarily excluded from employment. Death rates in the general population may be inappropriate for comparison if this effect is not taken into account

bonferroni correction

A procedure for guarding against an increase in the probability of a type I error when performing multiple significance tests. To maintain the probability of a type I error at some selected value (α), each of the m tests to be performed is judged against a significance level (α/m ). For a small number of simultaneous tests (up to five) this method provides a simple and acceptable answer to the problem of multiple testing. It is however highly conservative and not recommended if large numbers of tests are to be applied, when one of the many other multiple comparison procedures available is generally preferable.

alpha particle

A positively charged particle ejected spontaneously from the nuclei of some radioactive elements. It is identical to a helium nucleus that has a mass number of 4 and an electrostatic charge of +2. It has low penetrating power and a short range (a few centimeters in air). The most energetic particle will generally fail to penetrate the dead layers of cells covering the skin and can be easily stopped by a sheet of paper. Are hazardous when an alpha-emitting isotope is inside the body.

least squares

A principle of estimation, attributable to Gauss, in which the estimates of a set of parameters in a statistical model are those quantities that minimize the sum of squared differences between the observed values of the dependent variable and the values predicted by the model.

bayes theorem

A procedure for revising and updating the probability of some event in the light of new evidence. In its simplest form the theorem may be written in terms of conditional probabilities as, pr (Bj| A)= where Pr( A | Bj ) denotes the conditional probability of event A conditional on event Bj and B1 , B2 ,...,Bk are mutually exclusive and exhaustive events. The theorem gives the probabilities of the Bj when A is known to have occurred. The quantity Pr( Bj ) is termed the prior probability and Pr( Bj | A ) the posterior probability . Pr( A | Bj ) is equivalent to the (normalized) likelihood , so that the theorem may be restated as posterior (prior) x (likelihood

life table analysis

A procedure often applied in prospective studies to examine the distribution of mortality and/or morbidity in one or more diseases in a cohort study of patients over a fixed period of time. For each specific increment in the follow-up period, the number entering the period, the number leaving during the period, and the number either dying from the disease (mortality) or developing the disease (morbidity), are all calculated. It is assumed that an individual not completed the follow-up period is exposed for half this period, thus enabling the data for those 'leaving' and those 'staying' to be combined into an appropriate denominator for the estimation of the percentage dying from or developing the disease. The advantage of this approach is that all patients, not only those who have been involved for an extended period, can be included in the estimation process.

consciousness raising

A process of "learning new facts, ideas and tips that support the healthy behavior change." Efforts to increase awareness about the causes and consequences of a disease or unhealthy behavior during a media campaign would be considered ___. A process of change included in the Transtheoretical model that is most appropriate for individuals in the earliest stages of change (precontemplation and contemplation).

dimensional analysis

A process that checks for unit consistency in equations. The saying "one can't add apples and oranges" shows why dimensional analysis is necessary. Dimensional inconsistency is a sign of an incorrect equation.

intervention mapping

A program planning framework intended to facilitate the development of theory- and evidence-based health promotion programs. Following a thorough review of the literature and an appropriate needs assessment, the process of intervention mapping includes five steps: "1) creating matrices of proximal program objectives from performance objectives and determinants of behavior and environmental conditions; 2) selecting theory-based intervention methods and practical strategies; 3) designing and organizing programs; 4) specifying adoption and implementation plans; and 5) generating an evaluation plan." In step one, a list of performance objectives are generated that define the desired behavioral and environmental outcomes of the program; personal (internal) and external determinants of the behavioral and environmental outcomes are specified; if determinants vary by sub-population, the target population is differentiated; and, finally, performance objectives and determinants are linked in a matrix format, often by level (i.e. individual vs. organizational) and by sub-population, if applicable. Each cell in the resulting matrices will contain either a learning objective (linking a performance objective with a personal determinant) or a change objective (linking a performance objective with an external determinant) that defines what individuals need to learn or what changes need to take place in the environment as a result of the program. In step 2, a list of theoretical intervention methods (i.e. community planning) and a list of possible strategies for delivering those methods (i.e. community forums or meetings) are developed, based on the identified proximal objectives. In step 3, the selected strategies are operationalized into deliverable program components and delivery mechanisms (i.e. channel selection), and program materials are developed and pre-tested. During step 4, a "linkage system" between program users and developers is created so that the program can be modified to meet the needs of the users; adoption and implementation performance objectives are developed; determinants of adoption and implementation are specified; and an implementation plan is developed. Finally, step 5 involves developing an evaluation model, including a plan for process evaluation.

cryptosporidium

A protozoan microbe associated with the disease cryptosporidiosis in man. The disease can be transmitted through ingestion of drinking water, person-to-person contact, or other pathways, and can cause acute diarrhea, abdominal pain, vomiting, fever, and can be fatal as it was in the 1993 Milwaukee episode.

age-specific rate

A rate for a specified age group. The numerator and denominator refer to the same age group

adjusted rate (epi)

A rate in which the effects of differences in composition of the populations being compared have been minimized by statistical methods

total maximum daily load

A regulatory term in the U.S. Clean Water Act (CWA), describing a value of the maximum amount of a pollutant that a body of water can receive while still meeting water quality standards . [1] Alternatively, TMDL is an allocation of that pollutant deemed acceptable to the subject receiving waters . TMDLs have been used extensively by the United States Environmental Protection Agency (EPA) and state environmental agencies in implementing the CWA by establishing maximum pollution limits for industrial wastewater dischargers. EPA published regulations in 1992 establishing TMDL procedures. [2] Application of TMDL has broadened significantly in the last decade to include many watershed-scale efforts. This process incorporates both point source and nonpoint source pollutants within a watershed .

cluster investigation

A review of an unusual number, real or perceived, of health events (for example, reports of cancer) grouped together in time and location. Are designed to confirm case reports; determine whether they represent an unusual disease occurrence; and, if possible, explore possible causes and contributing environmental factors.

resource based relative value scale

A scale of national uniform relative values for all physicians' services. The relative value of each service must be the sum of relative value units representing physicians' work, practice expenses net of malpractice expenses, and the cost of professional liability insurance.

factor analysis

A set of statistical methods for analyzing the correlations among several variables in order to estimate the number of fundamental dimensions that underlie the observed data and to describe and measure those dimensions. Used frequently in the development of scoring systems for rating scales and questionnaires.

one-tailed test

A significance test for which the alternative hypothesis is directional; for example, that one population mean is greater than another. The choice between a one-sided and two-sided test must be made before any test statistic is calculated.

missense mutations

A single base pair substitution that results in the translation of a different amino acid at that position.

acute exposure

A single exposure to a toxic substance which may result in severe biological harm or death. Are usually characterized as lasting no longer than a day, as compared to longer, continuing exposure over a period of time.

cox regression model

A statistical model used in survival analysis developed asserting that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time.

log-linear model

A statistical model that uses an analysis of variance type of approach for the modeling of frequency counts in contingency tables.

antibody

A substance formed by the body to help defend it against infection.

analyte

A substance that is undergoing analysis or is being measured.

adjusted rate

A summarizing procedure for a statistical measure in which the effects of differences in composition of the populations being compared have been minimized by statistical methods. Examples are adjustment by regression analysis and by standardization. Adjustment is often performed on rates or relative risks, commonly because of differing age distributions in populations that are being compared. The mathematical procedure commonly used to adjust rates for age differences is direct or indirect standardization.

mantel-haenszel test

A summary chi-square test for stratified data and used when controlling for confounding.

amplification

A system response that is greater than is seemingly implied by input causes. occurs in information-feedback systems when policies adjust levels to values that change with varying flowrates. It is associated with delays , order/inventory processes, forecasting, etc.

length bias

A systematic error due to selection of disproportionate numbers of long-duration cases (cases who survive longest) in one group but not in another. This can occur when prevalent rather that incident cases are included in a case control study

homogeneity

A term that is used in statistics to indicate the equality of some quantity of interest (most often a variance), in a number of different groups, populations, etc.

converter

A term used in the STELLA software. Generally known as auxiliary variables. They are usually represented in diagrams by circles. Converters do not accumulate flows and do not have memory, but rather are recalculated from scratch each time calculations are performed. Three types of converters define constants, algebra, or graphs.

z test

A test for assessing hypotheses about population means when their variances are known. For example, for testing that the means of two populations are equal, i.e. H0 : μ1 = μ2, when the variance of each population is known to be σ2 the test statistic is where and are the means of samples of size n1 and n2 from the two populations. If H0 is true, z, has a standard normal distribution.

McNemar test

A test for comparing proportions in data involving paired samples. The test statistic is given by where b is the number of pairs for which the individual receiving treatment A has a positive response and the individual receiving treatment B does not, and c is the number of pairs for which the reverse is the case. If the probability of a positive response is the same in each group, then X2 has a chi-squared distribution with a single degree of freedom.

logrank test

A test for comparing two or more sets of survival times, to assess the null hypothesis that there is no difference in the survival experience of the individuals in the different groups. For the two-group situation the test statistic is where the weights, wj are all unity, d1j is the number of deaths in the first group at t(j) , the j th ordered death time, j = 1,2,..., r, and e1j is the corresponding expected number of deaths given by e1j =n1 jdj /n1j where dj is the total number of deaths at time t(j) , nj is the total number of individuals at risk at this time, and n1j the number of individuals at risk in the first group. The expected value of U is zero and its variance is given by where Consequently can be referred to a standard normal distribution to assess the hypothesis of interest. Other tests use the same test statistic with different values for the weights. The Tarone-Ware test, for example, uses and the Peto-Prentice test uses

F test

A test for the equality of the variances of two populations having normal distributions, based on the ratio of the variances of a sample of observations taken from each. Most often encountered in the analysis of variance , where testing whether particular variances are the same also test for the equality of a set of means.

hazard rate

A theoretical measure of the risk of an occurrence of an event, e.g. death or new disease, at a point in time, t , defined mathematically as the limit, as Δ t approaches zero, of the probability that an individual well at time t will experience the event by t + Δ t , divided by Δ t .

z transformation (fisher's)

A transformation of Pearson's product moment correlation coefficient, r, give by The statistic z has a normal distribution with mean where p is the population correlation value and variance 1/(n-3) where n is the sample size. The transformation may be used to test hypotheses and to construct confidence intervals for p.

fisher's z transformation

A transformation of Pearson's product moment correlation coefficient, r, given by The statistic z has a normal distribution with mean where ? is the population correlation value and variance 1/( n -3) where n is the sample size. The transformation may be used to test hypotheses and to contrast confidence intervals for ?.

leukocyte

A type of immune cell. Most leukocytes are made in the bone marrow and are found in the blood and lymph tissue. Leukocytes help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are leukocytes. Also called WBC and white blood cell.

b lymphocyte

A type of lymphocyte (white blood cells), produced in the bone marrow, which synthesizes and secretes antibodies in response to the presence of a foreign substance or one identified by it as being foreign.

ionizing radiation

A type of radiation made (or given off) by x-ray procedures, radioactive substances, rays that enter the Earth's atmosphere from outer space, and other sources. Ionizing radiation is so-called because it has enough energy to eject an electron from the nucleus (ionize), resulting in a positive and negative charge

conveyor

A type of stock that represents a space into which material flows and stays for a fixed amount of time, then exits. Its associated parameters determine transit time which represents how long material stays in it. Material that flows in at a given time is not mixed with material that had flowed in earlier — whatever entered first will also leave first.

alpha-radiation

A very damaging but low-penetrating form of ionizing radiation. It can be stopped by a sheet of paper and cannot penetrate human skin. However, if an alpha-emitting isotope is inhaled or ingested, it will cause highly concentrated local damage

evaluation report

A written document describing the overall approach or design that will be used to guide an evaluation. It includes what will be done, how it will be done, who will do it, when it will be done, and why the evaluation is being conducted.

academic medical center

Academic health centers (AHCs) - the preeminent institutions in the American health care system—are interrelated entities comprising a medical school, its affiliated hospitals and outpatient centers, and a faculty practice plan (FPP). Their unique missions are to provide undergraduate and graduate medical education and training, conduct basic science and clinical research on new medical practices and technologies, furnish state-of-the-art medical care for patients with complex illnesses, and care for the poor and medically indigent. Traditionally, AHCs have been leaders in their communities and the health care delivery system.

theory of reasoned action

According to this theory, the most important determinant of a behavior is an individual's behavioral intention , or "perceived likelihood of performing the behavior." An individual's behavioral intention is influenced directly by that person's attitude toward the behavior and subjective norms . Attitude toward a behavior is a function of a person's behavioral beliefs (beliefs about the likely outcomes and attributes of a particular behavior) and his evaluation of behavioral outcomes (the value that he places on the likely outcomes and attributes). Again, subjective norms are formed by a person's normative beliefs and motivations to comply .

ALARA

Acronym for "as low as (is) reasonably achievable." Means making every reasonable effort to maintain exposures to ionizing radiation as far below the dose limits as practical, consistent with the purpose for which the licensed activity is undertaken, taking into account the state of technology, the economics of improvements in relation to state of technology, the economics of improvements in relation to benefits to the public health and safety, and other societal and socioeconomic considerations, and in relation to utilization of nuclear energy and licensed materials in the public interest (see 10 CFR 20.1003 ).

advocacy

Active support of an idea or cause etc.; especially the act of pleading or arguing for something.

silicosis

Adisabling, nonreversible and sometimes fatal lung disease caused by overexposure to respirable crystalline silica. Silica is the second most common mineral in the earth's crust and is a major component of sand, rock, and mineral ores. Overexposure to dust that contains microscopic particles of crystalline silica can cause scar tissue to form in the lungs (fibrosis), which reduces the lungs' ability to extract oxygen from the air we breathe.

probability sample

All individuals have a known chance of selection. They may all have an equal chance of being selected, or, if a stratified sampling method is used, the rate at which individuals from several subsets are sampled can be varied so as to produce greater representation of some classes than of others

public health assessment

An ATSDR document that examines hazardous substances, health outcomes, and community concerns at a hazardous waste site to determine whether people could be harmed from coming into contact with those substances. The PHA also lists actions that need to be taken to protect public health [compare with health consultation].

halogenated hydrocarbon

An aliphatic or aromatic hydrocarbon in which one or more hydrogen atoms are substituted by a halogen, such as chlorine. Often these chemicals bioaccumulate.

fisher's exact test

An alternative procedure to use of the chi-squared statistic for assessing the independence of two variables forming a two-by-two contingency table particularly when the expected frequencies are small. The method consists of evaluating the sum of the probabilities associated with the observed table and all possible two-by-two tables that have the same row and column totals as the observed data but exhibit more extreme departure from independence. The probability of each table is calculated from the hypergeometric distribution.

auxiliary equation/variable

An equation that takes the present value of variables (levels, constants, or other auxiliary variables) to compute the present value of an auxiliary variable. Auxiliary variables are part of a rate equation connecting a level to a rate. Auxiliary equations embody unit consistency and are symbolized by a circle in a flow equation.

beneficence

An ethical principle discussed in the Belmont Report that entails an obligation to protect persons from harm. The principle of beneficence can be expressed in two general rules: (1) do not harm; and (2) protect from harm by maximizing possible benefits and minimizing possible risks of harm.

assessment endpoint

An explicit expression of the environmental value that is to be protected, operationally defined by an ecological entity and its attributes. For example, salmon are valued ecological entities; reproduction and age class structure are some of their important attributes. Together "salmon reproduction and age class structure" form an assessment endpoint.

theory of planned behavior

An extension of the Theory of Reasoned Action that takes into consideration an individual's perceived control over engaging in a particular behavior, in addition to his attitudes towards and subjective norms surrounding that behavior. Perceived behavioral control was added in efforts to account for factors beyond the individual's control that potentially influence his behavioral intentions and, ultimately, behavior. People may expend more energy and try harder to perform a behavior when they perceive that they have high behavioral control, or are capable and have sufficient resources to engage in that behavior and overcome any barriers. Perceived behavioral control is a function of control beliefs (beliefs about the presence or absence of resources and barriers to performing a behavior) and perceived power (beliefs about the influence of each perceived resource or barrier on the difficulty of engaging in the behavior).

correlation coefficient r

An index that quantifies the linear relationship between a pair of variables. In a bivariate normal distribution, for example, the parameter, p. An estimator of p obtained from n sample values of the two variables of interest, (x1, y1), (x2, y2),...,(xn,yn), is Pearson's product moment correlation coefficient, r, given by The coefficient takes values between -1 and 1, with the sign indicating the direction of the relationship and the numerical magnitude its strength. Values of -1 and 1 indicate that the sample values fall on a straight line. A value of zero indicates the lack of any linear relationship between the two variables.

behavioral capability

An individual's knowledge and skills related to a specific health behavior. In order for an individual to engage in a particular behavior, that individual must first know what the behavior is and how to successfully perform it. Behavioral capability is a key construct of the Social Cognitive Theory.

health belief model

An individual-level, value-expectancy health behavior theory developed in the 1950s by social psychologists in the U.S. Public Health Service in efforts to explain why people did not seek preventive health and screening services. The theory was first used in relation to a free Tuberculosis screening program, but has since been applied to numerous health behaviors. The HMB maintains that an individual will engage in behavior to prevent, screen for or control disease or negative health outcomes if they 1) perceive themselves to be at risk for that disease; 2) believe that the disease has potentially serious consequences; 3) believe that a recommended (and available) behavior is effective in reducing their risk for or the consequences of the disease; and 4) believe that the perceived barriers or costs of engaging in that behavior are fewer than the perceived benefits. Internal or external cues to action can motivate a person to take action. Self-efficacy was added as a construct to the HBM in the late 1980s.

community rating (health insurance)

An insurer using community rating to set insurance premiums ignores any differences in expected costs among insured groups or people. If an insurer uses community rating, but people know and use their expected costs to decide whether or not to buy insurance, then only the sickest people may wind up signing up for insurance.

hardiness

An intermediate approach to behavior change that emphasizes adopting a lower risk alternative to a high risk behavior when an individual is either unwilling or unable to stop the high risk behavior. Needle exchange programs that facilitate the use of sterile injection equipment in order to reduce the transmission of HIV among injection drug-users are an example of harm reduction.

aquifer

An underground geological formation, or group of formations, containing water. Are sources of groundwater for wells and springs.

post hoc comparisons

Analyses not explicitly planned at the start of a study but suggested by an examination of the data. Such comparisons are generally performed only after obtaining a significant overall F value.

air toxics

Any air pollutant for which a national ambient air quality standard (NAAQS) does not exist (i.e. excluding ozone, carbon monoxide, PM-10, sulfur dioxide, nitrogen oxide) that may reasonably be anticipated to cause cancer; respiratory, cardiovascular, or developmental effects; reproductive dysfunctions, neurological disorders, heritable gene mutations, or other serious or irreversible chronic or acute health effects in humans

zoonotic diseases

Any disease and/or infection which is naturally "transmissible from vertebrate animals to man" is classified as a zoonosis according to the PAHO publication "Zoonoses and communicable diseases common to man and animals". Over 200 zoonoses have been described and they are known since many centuries. They involve all types of agents: bacteria, parasites, viruses and unconventional agents.

potentially responsible party

Any individual or company--including owners, operators, transporters or generators--potentially responsible for, or contributing to a spill or other contamination at a Superfund site. Whenever possible, through administrative and legal actions, EPA requires PRPs to clean up hazardous sites they have contaminated.

cytokine

Any of a group of soluble proteins that are released by a cell causing a change in function or development of the same cell (autocrine), an adjacent cell (paracrine), or a distant cell (endocrine); are involved in reproduction, growth and development, normal homeostatic regulation, response to injury and repair, blood clotting, and host resistance (immunity and tolerance).

estrogen

Any of various natural steroids (as estradiol) that are formed from androgen precursors, that are secreted chiefly by the ovaries, placenta, adipose tissue, and testes, and that stimulate the development of female secondary sex characteristics and promote the growth and maintenance of the female reproductive system.

volatile organic compound

Any organic compound that participates in atmospheric photochemical reactions except those designated by EPA as having negligible photochemical reactivity.

antigen

Any substance that causes the body to produce natural antibodies.

chi-square distribution

Based on a normally distributed population with variance σ2, with randomly selected independent samples of size n and computed sample variance s2 for each sample. The sample statistic X2= ( n - 1) s2/σ2. The chi-square distribution is skewed, the values can be zero or positive but not negative, and it is different for each number of degrees of freedom. Generally, as the number of degrees of freedom increases, the chi-square distribution approaches a normal distribution.

goal seeking behavior

Behavior that results from a balancing loop which drives a system toward a specified goal. The farther the system from the goal, the quicker it changes towards that goal, the equilibrium homeostasis point, and as it approaches the goal, the growth/decay slows down. Associated with negative feedback.

perceived response efficacy

Belief whether the recommended action is effective in preventing or reducing risk for a health problem. It is important to note that ether low perceptions of self (self efficacy), or low perceptions of the recommended action (response efficacy) may lead to maladaptive behavior. For example, people may not feel confident that they can reduce their intake of fried foods (self efficacy) or they may not feel confident that reducing their intake of fried foods will lower their risk of heart attack (response efficacy). The implication for prevention is to ensure that health education supports both the belief in one's ability to change lifestyle behaviors as well as the belief that lifestyle changes are effective in reducing risks.

adherence

Closely following or sticking to a plan or protocol. In the context of health promotion, we use the term adherence to refer to individuals taking their medications as prescribed (i.e. adherence to antiretroviral therapy) or following program protocols (i.e. sticking to a diet and exercise plan). In the context of health promotion, adherence can also refer to following the implementation protocol when delivering a health promotion program, conducting interviews, etc.

health care amendments to the national labor relations act of 1974

Congress enacted in 1935 to protect the rights of employees and employers, to encourage collective bargaining, and to curtail certain private sector labor and management practices, which can harm the general welfare of workers, businesses and the U.S. economy. In 1974 the Act was amended to cover any hospital, convalescent hospital, health maintenance organization, health clinic, nursing home, extended care facility or other institution devoted to the care of sick or aged persons.

single nucleotide polymorphism

DNA sequence variations that occur when a single nucleotide (A, T, C, or G) in the genome sequence is altered. Each individual has many single nucleotide polymorphisms that together create a unique DNA pattern for that person. SNPs promise to significantly advance our ability to understand and treat human disease.

goodness of fit

Degree of agreement between an empirically observed distribution and a mathematical or theoretical distribution.

factorial designs

Designs which allow two or more questions to be addressed in an investigation. The simplest one is which each of two treatments or interventions are either present or absent, so that subjects are divided into four groups; those receiving neither treatment, those having only the first treatment, those having only the second treatment and those receiving both treatments. Such designs enable possible interactions between factors to be investigated. A very important special case is that where each of k factors of interest has only two levels; these are usually known as 2kfactorial designs. A single replicate of a 2kdesign is sometimes called an unreplicated factorial.

IRIS

EPA's Integrated Risk Information System, an electronic data base containing the Agency's latest descriptive and quantitative regulatory information on chemical constituents. The information is intended for those without extensive training in toxicology, but with some knowledge of health sciences.

efficiency (resource utilization)

Efficiency is defined as the production of a maximum amount of health services output with a given amount of resources or the production of a given amount of health services with a minimum amount of resources. Efficiency implies that there is no waste in the use of resources to produce and deliver health services. Efficiency does not indicate whether or to what extent outputs delivered are effective.

ecological approaches

Ecological approaches recognize the multiple levels of influence on and the varying nature of determinants of health. They view health behavior as both affected by and affecting the physical and social environment (reciprocal determinism). They move beyond a "victim blaming," individual-level approach to health promotion, emphasizing the use of multiple strategies to impact determinants of health, partnerships between multiple sectors to enhance health promotion efforts, and targeting change at multiple levels of intervention. The levels of an ecological approach in health promotion include intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy.

americans with disabilities act

Gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications. Purpose: (1) to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities; (2) to provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities;(3) to ensure that the Federal Government plays a central role in enforcing the standards established in this chapter on behalf of individuals with disabilities; and (4) to invoke the sweep of congressional authority, including the power to enforce the fourteenth amendment and to regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities.

asymptotic growth/decay

Goal-seeking behavior produced by negative feedback . The stock of the system moves towards the goal, slowing down as it approaches the goal.

beta-radiation

High-energy, electrons (beta particles) emitted from certain radioactive material classified as ionizing radiation. Can pass through 1 to 2 centimeters of water or human flesh and can be shielded by a thin sheet of aluminum. Beta particles are more deeply penetrating than alpha particles but cause less localized damage.

central limit theorem

If a random variable Y has population mean µ and population variance σ2, then the sample mean, , based on n observations, has an appropriate normal distribution with a mean µ and variance σ2/ n , for sufficiently large n. The theorem occupies an important place in statistical theory. In short, it states that if the sample size is large enough, the distribution of sample means can be approximated by a normal distribution, even if the original population is not normally distributed.

Emergency medical treatment and active labor act

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

contingency theory of leadership

In contingency theory of leadership, the success of the leader is a function of various contingencies in the form of subordinate, task, and/or group variables. The effectiveness of a given pattern of leader behavior is contingent upon the demands imposed by the situation. These theories stress using different styles of leadership appropriate to the needs created by different organizational situations.

horizontal integration

In microeconomics and strategic management, the term horizontal integration describes a type of ownership and control. It is a strategy used by a business or corporation that seeks to sell a type of product in numerous markets.

communication theories

In the context of public health, communication theories are meant to describe how communication processes impact health behavior change and how communication strategies can be used strategically to motivate behavior change. Although there are a number of communication theories and concepts, four that are particularly relevant to public health include the knowledge gap, agenda setting, cultivation studies, and risk communication . The knowledge gap refers to the fact that individuals with more formal education tend to be more knowledgeable about many issues when compared to those with less formal education; therefore, "an increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status than those of lower SES," thereby contributing to health disparities and other inequities. Knowledge gaps can be modified by content and channel factors, social conflict and mobilization, community structure, and individual motivational factors. Agenda-setting refers to the ability of the mass media to influence public opinion and priorities, particularly in relation to politics and policymaking. Cultivation studies investigate "the impact the mass media have on our perceptions of reality."

economic incentives

Incentives are a different approach. The idea of incentives is not to strictly forbid/allow, but rather to provide signals on public objectives while leaving some room for individual and collective decision-making to respond to them. Incentives play indirectly through the determinants of individual/collective choices, such as the profit motive or normative values. Market or social forces can be very efficient vectors to force the global outcome of individual actions towards collectively set objectives. Different kinds of incentives can be developed in isolation or in combination: • improving the institutional framework (definition of rights and participatory processes); • developing collective values (education, information, training); • creating nonmarket economic incentives (taxes and subsidies); and • establishing market incentives (tradable property/access rights; eco-labelling)

adverse selection

Insurance companies use this term to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $40.

feedback

Information provided to individuals based on their individual characteristics or based on comparisons with others. Major types of feedback, in the context of health communication and communication technology, include personal feedback, normative feedback, and ipsative (or iterative) feedback. Personal feedback "refers to the information that respondents obtain about the answers they have provided." Normative feedback "refers to the information respondents obtain when comparing their responses with the responses of another group." Ipsative feedback "refers to a comparison between a person's most recent status and that found at previous assessments."

learner-centered learning

Innovative learning style in which the teacher is no longer a dispenser of knowledge but rather a colleague. The teacher is a facilitating participant who sets directions and introduces opportunities. Students working in small groups acquire their own knowledge without having it spoon-fed to them. Such classrooms make acquisition of facts and information a consequence of needing inputs to reach an objective.

macrophage

Large (10-20 mm diameter) amoeboid and phagocytic cell found in many tissues, especially in areas of inflammation; are derived from blood monocytes and play an important role in host defense mechanisms.

doubling time

Length of time it takes an exponentially growing quantity to double in size. If a rate flowing into a level equals a multiplier times the level, then it equals approximately 0.7 divided by the multiplier. Associated with exponential growth.

lowest observed adverse effect leve

Lowest concentration or amount of a substance ( dose ), found by experiment or observation, which causes an adverse effect on morphology, functional capacity, growth, development, or life span of a target organism distinguishable from normal (control) organisms of the same species and strain under defined conditions of exposure .

td50

May be defined as follows: for a given target site(s), if there are no tumors in control animals, then TD50 is that chronic dose-rate in mg/kg body wt/day which would induce tumors in half the test animals at the end of a standard lifespan for the species. Since the tumor(s) of interest often does occur in control animals, TD50 is more precisely defined as: that dose-rate in mg/kg body wt/day which, if administered chronically for the standard lifespan of the species, will halve the probability of remaining tumorless throughout that period. A TD50 can be computed for any particular type of neoplasm, for any particular tissue, or for any combination of these. The range of statistically significant TD50 values for chemicals in the CPDB that are carcinogenic in rodents is more than 10 million-fold.

medicare and medicaid (act)

Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, extending health coverage to almost all Americans aged 65 or older (e.g., those receiving retirement benefits from Social Security or the Railroad Retirement Board), and providing health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities. Seniors were the population group most likely to be living in poverty; about half had insurance coverage.

heavy metals

Metallic elements with high atomic weights; (e.g. mercury, chromium, cadmium, arsenic, and lead); can damage living things at low concentrations and tend to accumulate in the food chain.

Ryan White CARE act

On August 18, 1990, Congress passed Public Law 101-381, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act by wide, bipartisan margins in both houses. Enactment followed reports of severe distress in major U.S. metropolitan areas that were becoming overburdened by the cost of care for a growing number of Americans living with AIDS who had little or no health insurance. The AIDS epidemic, which began in 1981, had created a need for primary medical care that was exceeding the capacity of local health departments, hospital emergency rooms, and other health care institutions. Individuals and families affected by HIV/AIDS were struggling to obtain desperately needed medical care. The Ryan White CARE Act supports the development of systems of care that are responsive to local needs and resources. It is founded on strong partnerships between the federal government, states, and local communities in need, and emphasizes less-costly outpatient, primary care to prevent costly emergency room visits and hospitalizations. The CARE Act is named in honor of Ryan White, an Indiana teenager whose struggle with AIDS and against AIDS-related discrimination who helped to educate our nation about the needs of people with AIDS. Mr. White died on April 8, 1990, at the age of 19, just a few months before Congress passed the Act that bears his name.

belmont report

On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law, there-by creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and to develop guidelines which should be followed to assure that such research is conducted in accordance with those principles. In carrying out the above, the Commission was directed to consider: (i) the boundaries between biomedical and behavioral research and the accepted and routine practice of medicine, (ii) the role of assessment of risk-benefit criteria in the determination of the appropriateness of research involving human subjects, (iii) appropriate guidelines for the selection of human subjects for participation in such research and (iv) the nature and definition of informed consent in various research settings. The Belmont Report attempts to summarize the basic ethical principles identified by the Commission in the course of its deliberations. It is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at the Smithsonian Institution's Belmont Conference Center supplemented by the monthly deliberations of the Commission that were held over a period of nearly four years. It is a statement of basic ethical principles and guidelines that should assist in resolving the ethical problems that surround the conduct of research with human subjects. By publishing the Report in the Federal Register, and providing reprints upon request, the Secretary intends that it may be made readily available to scientists, members of Institutional Review Boards, and Federal employees.

t lymphocyte

One type of white blood cell that attacks virus-infected cells, foreign cells, and cancer cells. T lymphocytes also produce a number of substances that regulate the immune response. Also called T cell.

endogenous variable

Opposite of exogenous, meaning internal. An endogenous view approaches a problem searching for its causes and cures within some boundary. Endogenous variables affect and are affected by the rest of the system.

lead time bias

Overestimation of survival time, due to the backward shift in the starting point for measuring survival that arises when diseases such as cancer are detected early, as by screening procedures

gamma-radiation

Penetrating electromagnetic waves or rays emitted from nuclei during radioactive decay, similar to x-rays. Dense materials such as concrete and lead are used to provide shielding against this type of ionizing radiation.

absporption

Penetration of a substance into an organism and its cells by various processes, some specialized, some involving expenditure of energy (active transport), some involving a carrier system, and others involving passive movement down an electrochemical gradient.

organophosphate

Pesticides that contain phosphorus, some of which are used in fertilizers and pesticides, are short-lived, but some can be toxic when first applied.

OSHA

Public Law 91-596, 84 STAT. 1590, 91st Congress, S.2193, December 29, 1970, as amended through January 1, 2004. An Act to assure safe and healthful working conditions for working men and women; by authorizing enforcement of the standards developed under the Act; by assisting and encouraging the States in their efforts to assure safe and healthful working conditions; by providing for research, information, education, and training in the field of occupational safety and health; and for other purposes.

medicare part d

Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Medicare Part D added Prescription drug coverage that is considered insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

risk assessment

Qualitative and quantitative evaluation of the risk posed to human health and/or the environment by the actual or potential presence and/or use of specific pollutants.

stages of change

Refers to the temporal progression towards behavior change that individuals go through over time. part of the Transtheoretical model, in which five stages of change are defined: precontemplation (no intention to take action in the next six months); contemplation (thinking about taking action in the next six months); preparation (intending to take action in the next month and has taken some behavioral steps toward change); action (has adopted behavior change for less than six months); and maintenance (has adopted behavior change for longer than six months). Although there is technically a sixth stage of change—termination (no longer tempted to engage in old behavior and has complete self-efficacy)—defined for use in the Transtheoretical model, very few people seem to reach this stage.

normative beliefs

Reflect individuals' beliefs about whether important referent individuals, or people whose opinion they value, approve or disapprove of a particular behavior. along with an individual's motivation to comply with the opinions and values of the referent individuals, form a person's subjective norms.

association

Statistical dependence between two or more events, characteristics, or other variables. An ___ is present if the probability of occurrence of an event of characteristic, or the quantity of a variable, depends upon the occurrence of one or more other events, the presence of one or more other characteristics, or the quantity of one or more other variables

nonparametric method

Statistical techniques of estimation and inference that are based on a function of the sample observations, the probability distribution of which does not depend on a complete specification of the probability distribution of the population from which the sample was drawn. Consequently the techniques are valid under relatively general assumptions about the underlying population. Often such methods involve only the ranks of the observations rather than the observations themselves. Examples are Wilcoxon's signed rank test and Friedman's two way analysis of variance. In many cases these tests are only marginally less powerful than their analogues which assume a particular population distribution (usually a normal distribution), even when that assumption is true.

bioaccumulants

Substances that increase in concentration in various tissues of living organisms as they take in contaminated air, water, or food because the substances are very slowly metabolized or excreted.

technical safety services

Technical Safety Services, Inc. has built its foundation by providing superior testing and certification services to the most demanding Fortune 100 biotechnology, pharmaceutical and medical device companies in the nation. Our ability to listen to clients' needs, in addition to our flexibility, innovation, and precision, are the qualities that distinguish TSS from all other service companies.

criteria pollutants

The 1970 amendments to the Clean Air Act required EPA to set National Ambient Air Quality Standards for certain pollutants known to be hazardous to human health. EPA has identified and set standards to protect human health and welfare for six pollutants: ozone, carbon monoxide, total suspended particulates, sulfur dioxide, lead, and nitrogen oxide. The term, "criteria pollutants" derives from the requirement that EPA must describe the characteristics and potential health and welfare effects of these pollutants. It is on the basis of these criteria that standards are set or revised.

hill-burton act

The Act authorizes assistance to public and other nonprofit medical facilities such as acute care general hospitals, special hospitals, nursing homes, public health centers, and rehabilitation facilities. The Community Service Assurance under Title VI of the Public Health Service Act requires recipients of Hill-Burton funds to make services provided by the facility available to persons residing in the facility's service area without discrimination on the basis of race, color, national origin, creed, or any other ground unrelated to the individual's need for the service or the availability of the needed service in the facility. These requirements also apply to persons employed in the service area of the facility if it was funded under Title XVI of the Public Health Service Act. Please note that the community service obligation is different from the uncompensated care provision. The community service obligation does not require the facility to make non-emergency services available to persons unable to pay for them. It does, however, require the facility to make emergency services available without regard to the person's ability to pay. There are several basic requirements that every Hill-Burton hospital or other facility must comply with to fulfill the community service obligation: • A person residing in the Hill-Burton facility's service area has the right to medical treatment at the facility without regard to race, color, national origin or creed. • Hill-Burton facilities must participate in the Medicare and Medicaid programs unless they are ineligible to participate. • Hill-Burton facilities must make arrangements for reimbursement for services with principal State and local third-party payors that provide reimbursement that is not less than the actual cost of the services. • A Hill-Burton facility must post notices informing the public of its community service obligations in English and Spanish. If 10 percent or more of the households in the service area usually speak a language other than English or Spanish, the facility must translate the notice into that language and post it as well. • A Hill-Burton facility may not deny emergency services to any person residing in the facility's service area on the grounds that the person is unable to pay for those services. • A Hill-Burton facility may not adopt patient admissions policies that have the effect of excluding persons on grounds of race, color, national origin, creed or any other ground unrelated to the patient's need for the service or the availability of the needed service. • The entire U. S. Department of Health and Human Services Hill-Burton regulation can be found at 42 CFR Part 124.

medicare advantage

The Balanced Budget Act of 1997 required that Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices changed for insurers that offer these plans, and "Medicare+Choice" plans became known as "Medicare Advantage" (MA) plans. Medicare Advantage plans may offer additional benefits to beneficiaries but they also charge additional premiums or may offer additional benefits with lower premiums or contribute to a reserve fund. The goals of Medicare Advantage are to maximize plan choices, especially in rural areas, offer better benefits for lower costs, and to introduce more competition into Medicare managed care plans.

CLAS standards

The Cultural and Linguistically Appropriate Services (CLAS) Standards are proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers. The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups; however, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans. The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The 14 standards are organized by themes: Culturally Competent Care (Standards 1:3), Language Access Services (Standards 4:7), and Organizational Supports for Cultural Competence (Standards 8:14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows: • CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7). • CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13). • CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations

safe harbor requirement

The European Commission's Directive on Data Protection went into effect in October, 1998, and would prohibit the transfer of personal data to non-European Union nations that do not meet the European "adequacy" standard for privacy protection. While the United States and the European Union share the goal of enhancing privacy protection for their citizens, the United States takes a different approach to privacy from that taken by the European Union. The United States uses a sectoral approach that relies on a mix of legislation, regulation, and self regulation. The European Union, however, relies on comprehensive legislation that, for example, requires creation of government data protection agencies, registration of data bases with those agencies, and in some instances prior approval before personal data processing may begin. As a result of these different privacy approaches, the Directive could have significantly hampered the ability of U.S. companies to engage in many trans-Atlantic transactions. In order to bridge these different privacy approaches and provide a streamlined means for U.S. organizations to comply with the Directive, the U.S. Department of Commerce in consultation with the European Commission developed a "safe harbor" framework. The safe harbor -- approved by the EU in 2000-- is an important way for U.S. companies to avoid experiencing interruptions in their business dealings with the EU or facing prosecution by European authorities under European privacy laws. Certifying to the safe harbor will assure that EU organizations know that your company provides "adequate" privacy protection, as defined by the Directive.

portability

The Health Insurance Portability and Accountability Act (HIPAA) offers protections for millions of American workers that improve ___ and continuity of health insurance coverage. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage.

baldridge national quality award

The Malcolm Baldrige National Quality Award was created by Public Law 100-107, signed into law on August 20, 1987. The Award Program, responsive to the purposes of Public Law 100-107, led to the creation of a new public-private partnership. Principal support for the program comes from the Foundation for the Malcolm Baldrige National Quality Award, established in 1988. The Award is named for Malcolm Baldrige, who served as Secretary of Commerce from 1981 until his tragic death in a rodeo accident in 1987. His managerial excellence contributed to long-term improvement in efficiency and effectiveness of government. The Findings and Purposes Section of Public Law 100-107 states that:" 1. The leadership of the United States in product and process quality has been challenged strongly (and sometimes successfully) by foreign competition, and our Nation's productivity growth has improved less than our competitors' over the last two decades. 2. American business and industry are beginning to understand that poor quality costs companies as much as 20 percent of sales revenues nationally and that improved quality of goods and services goes hand in hand with improved productivity, lower costs, and increased profitability. 3. strategic planning for quality and quality improvement programs, through a commitment to excellence in manufacturing and services, are becoming more and more essential to the well-being of our Nation's economy and our ability to compete effectively in the global marketplace. 4. improved management understanding of the factory floor, worker involvement in quality, and greater emphasis on statistical process control can lead to dramatic improvements in the cost and quality of manufactured products. 5. the concept of quality improvement is directly applicable to small companies as well as large, to service industries as well as manufacturing, and to the public sector as well as private enterprise. 6. in order to be successful, quality improvement programs must be management-led and customer-oriented, and this may require fundamental changes in the way companies and agencies do business. 7. several major industrial nations have successfully coupled rigorous private-sector quality audits with national awards giving special recognition to those enterprises the audits identify as the very best; and 8. a national quality award program of this kind in the United States would help improve quality and productivity by: a. helping to stimulate American companies to improve quality and productivity for the pride of recognition while obtaining a competitive edge through increased profits; b. recognizing the achievements of those companies that improve the quality of their goods and services and providing an example to others; c. establishing guidelines and criteria that can be used by business, industrial, governmental, and other organizations in evaluating their own quality improvement efforts; and d. providing specific guidance for other American organizations that wish to learn how to manage for high quality by making available detailed information on how winning organizations were able to change their cultures and achieve eminence."

path-goal theory of leadership (leadership)

The Path-Goal Theory of Leadership was developed to describe the way that leaders encourage and support their followers in achieving the goals they have been set by making the path that they should take clear and easy.

antitrust regulation

The Sherman Antitrust Act ( Sherman Act , July 2, 1890, ch. 647, 26 Stat. 209, 15 U.S.C. § 1-7), was the first United States government statute to limit cartels and monopolies. It is the first and oldest of all U.S. , federal, antitrust laws.

social security act

The Social Security Act (Act of August 14, 1935) [H. R. 7260] was signed into law by President Roosevelt on August 14, 1935. In addition to several provisions for general welfare, the new Act created a social insurance program designed to pay retired workers age 65 or older a continuing income after retirement. The Social Security Act did not quite achieve all the aspirations its supporters had hoped by way of providing a "comprehensive package of protection" against the "hazards and vicissitudes of life." Certain features of that package, notably disability coverage and medical benefits, would have to await future developments. But it did provide a wide range of programs to meet the nation's needs. In addition to the program we know think of as Social Security, it included unemployment insurance, old-age assistance, aid to dependent children and grants to the states to provide various forms of medical care. The two major provisions relating to the elderly were Title I- Grants to States for Old-Age Assistance, which supported state welfare programs for the aged, and Title II-Federal Old-Age Benefits. It was Title II that was the new social insurance program we now think of as Social Security. In the original Act benefits were to be paid only to the primary worker when he/she retired at age 65. Benefits were to be based on payroll tax contributions that the worker made during his/her working life. Taxes would first be collected in 1937 and monthly benefits would begin in 1942. (Under amendments passed in 1939, payments were advanced to 1940.)

BOD5

The amount of dissolved oxygen consumed in five days by biological processes breaking down organic matter.

biota

The animal and plant life of a given region.

ecological risk assessment

The application of a formal framework, analytical process, or model to estimate the effects of human actions(s) on a natural resource and to interpret the significance of those effects in light of the uncertainties identified in each component of the assessment process. Such analysis includes initial hazard identification, exposure and dose-response assessments, and risk characterization.

curie

The basic unit used to describe the intensity of radioactivity in a sample of material. Is equal to 37 billion (3.7 x 10 10 ) disintegrations per second, which is approximately the activity of 1 gram of radium. Is also a quantity of any radionuclide that decays at a rate of 37 billion disintegrations per second.

ecological fallacy

The bias that may occur because an association observed between variables on an aggregate level does not necessarily represent the association that exists at an individual level

intermediate public health hazard

The category used in ATSDR's public health assessment documents when a professional judgment about the level of health hazard cannot be made because information critical to such a decision is lacking.

health investigation

The collection and evaluation of information about the health of community residents. This information is used to describe or count the occurrence of a disease, symptom, or clinical measure and to evaluate the possible association between the occurrence and exposure to hazardous substances.

accumulation

The collection of some quantity over time. Examples include water in a bathtub, savings in a bank account, inventory . In the STELLA modeling software, the accumulator is also referred to as a Stock or Level.

attack rate

The cumulative incidence of infection in a group observed over a period during an epidemic

accuracy

The degree to which a measurement or an estimate based on measurements represents the true value of the attribute that is being measured

residual

The difference between the observed value of a response variable (yi) and the value predicted by some model of interest ( ). Examination, usually by informal graphical techniques, allows the assumptions made in the model fitting exercise, for example, normality, homogeneity of variance, etc., to be checked. Generally, discrepant observations have large residuals, but some form of standardization may be necessary in many situations to allow identification of patterns among the residuals that may be a cause for concern.

binary distribution

The distribution of the number of 'successes', X, in a series of n- independent Bernoulli trialswhere the probability of success at each trial is p and the probability of failure is q = 1- p . Specifically the distribution is given by , x = 0, 1, 2 ......, n The mean, variance, skewness and kurtosis of the distribution are as follows: mean = np variance = npq skewness = ( q - p )/( npq ) 1/2 kurtosis =

ed50

The dose of a drug that is pharmacologically effective for 50% of the population exposed to the drug or a 50% response in a biological system that is exposed to the drug.

LD 50

The dose of a toxicant or microbe that will kill 50 percent of the test organisms within a designated period. The lower the ___, the more toxic the compound.

hawthorne effect

The effect (usually positive or beneficial) of being under study upon the persons being studied; their knowledge of the study often influences their behavior

risk communication

The exchange of information to increase understanding of health risks.

risk reduction

The goal is to reduce the risk to life and property, which includes existing structures and future construction, in the pre and post-disaster environments. This is achieved through regulations, local ordinances, land use and building practices, and Mitigation projects that reduce or eliminate long-term risk from hazards and their effects.

population attributable risk

The incidence of a disease in a population that is associated with exposure to the risk factor. It is often expressed as a percentage

aggregation

The incorporation of numerous distinct system components into one variable . Aggregation is done for simplicity when combination generates the same behavior of interest as representing the components separately.

sievert

The international system (SI) unit for dose equivalent equal to 1 Joule/kilogram. 1 sievert = 100 rem.

gray (gy)

The international system (SI) unit of absorbed dose. is equal to an absorbed dose of 1 Joule/kilogram

aqueous solubility

The maximum concentration of a chemical that will dissolve in pure water at a reference temperature.

coefficient of variation

The measure of spread for a set of data defined as 100 x standard deviation / mean CV = s/x bar(100) = sample CV = σ/µ(100) = population Originally proposed as a way of comparing the variability in different distributions, but found to be sensitive to errors in the mean. Simpler definition: The ratio of the standard deviation to the mean. This is meaningful only if the variable is measured on a ratio scale

PRECEDE-PROCEED framework

The most well-known health program planning model. In PRECEDE-PROCEED a program planner begins by identifying the desired outcome of the program and working backwards to discover strategies for reaching that outcome. PRECEDE stands for p redisposing, r einforcing and e nabling c onstructs in e ducational/ecological d iagnosis and e valuation, and includes various stages of assessment and planning. PROCEED stands for p olicy, r egulatory, and o rganizational c onstructs in e ducational and e nvironmental d evelopment and deals mainly with program implementation and evaluation. PRECEDE-PROCEED has six main phases, followed by three phases of evaluation: Phase 1, social assessment and situational analysis, involves engaging the target population to identify general indicators of quality of life. Phase 2, epidemiological assessment, includes identifying specific health goals or problems that contribute to or interact with the social goals or problems identified in phase 1. Phase 3, behavioral and environmental assessment, involves identifying and prioritizing behavioral and environmental determinants of the specific health problems identified in phase 2. Phase 4, educational and ecological assessment, includes identifying and prioritizing predisposing, reinforcing and enabling factors that are related to the behavioral and environmental determinants. " Predisposing factors include a person's or population's knowledge, attitudes, beliefs, values and perceptions that facilitate or hinder motivation for change." Reinforcing factors are "the rewards received and the feedback the learner receives from others following adoption of a behavior." " Enabling factors are those skills, resources or barriers that can help or hinder the desired behavioral changes as well as environmental changes." Phase 5, intervention alignment and administrative and policy assessment, involves "intervention matching, mapping, and patching" to determine which program components and activities are needed to target the factors identified in the previous stages and determining whether or not the program has the policy, organizational and administrative capacity to do them. In phase 6, implementation occurs. Phase 7 includes process evaluation, phase 8 includes impact evaluation, and phase 9 includes outcome evaluation.

cumulative incidence

The number or proportion of a group of people who experience the onset of a health-related event during a specified time interval; this interval is generally the same for all members of the group, but, as in lifetime incidence, it may vary from person to person without reference to age

exogenous variable

The opposite of endogenous . An exogenous view considers systems under the influence of outside events that are not part of the internal dynamics of the system. An exogenous variable is an outside variable that affects but is not affected by the behavior of the system.

poisson distribution

The probability distribution of the number of occurrences, X, of some random event, in an interval of time or space. Given by Pr(X=x) = (e^-λ*λ^x)/x! , x = 0, 1, ... The mean and variances of the distribution are both λ. The skewness of the distribution is , and its kurtosis is 3+(1/λ). The distribution is positively skewed for all values of λ.

power

The probability of rejecting the null hypothesis when it is false. Gives a method of discriminating between competing test of the same hypothesis, the test with the higher power being preferred. It is also the basis of procedures for estimating the sample size needed to detect an effect of a particular magnitude. Mathematically, = 1-β (type II error).

conditional probability

The probability that an event occurs given the outcome of some other event. Usually written, Pr(A l B). For example, the probability of a person being colour blind given that the person is male is about 0.1, and the corresponding probability given that the person is female is approximately 0.0001. It is not, of course, necessary that Pr(A l B) = Pr(A l B); the probability of having spots given that a patient has measles, for example, is very high, the probability of measles given that a patient has spots is, however, much less. If Pr(A l B) = Pr(A l B) then the events Aand B are said to be independent.

risk management

The process of evaluating and selecting alternative regulatory and non-regulatory responses to risk. The selection process necessarily requires the consideration of legal, economic, and behavioral factors.

superfund

The program operated under the legislative authority of CERCLA and SARA that funds and carries out EPA solid waste emergency and long-term removal and remedial activities. These activities include establishing the National Priorities List, investigating sites for inclusion on the list, determining their priority, and conducting and/or supervising cleanup and other remedial actions.

etiologic fraction

The proportion of all cases that can be attributed to a particular exposure. It is the attributable difference divided by the incidence rate in the group. If the association is causal, this is also the proportion by which the incidence rate would be reduced if the exposure were eliminated. The attributable fraction may apply to exposed individuals or to the whole population

proportional mortality ratio

The proportion of observed deaths from a specified condition in a defined population, divided by the proportion of deaths expected from this condition in a standard population, expressed either on an age-specific basis or after age adjustment

attributable risk

The rate (proportion) of a disease or other outcome in exposed individuals that can be attributed to the exposure. This measure is derived by subtracting the rate of the outcome (usually incidence or mortality) among the unexposed from the rate among the exposed individuals; it is assumed that causes other than the one under investigation have had equal effects on the exposed and unexposed groups

incidence density

The rate at which new events occur in a population. The numerator is the number of new events that occur in a defined period; the denominator is the population at risk of experiencing the event during this period, sometimes expressed as person-time

likelihood ratio

The ratio of the likelihood of observing data under actual conditions, to observing these data under the other, e.g., "ideal" conditions; or comparison of various model conditions to assess which model provides the best fit. ___ are used to appraise screening and diagnostic tests in clinical epidemiology.

odds ratio

The ratio of two odds for a binary variable in two groups of subjects, for example, males and females. If the two possible states of the variable are labeled 'success' and 'failure' then the odds ratio is a measure of the odds of a success in one group relative to that in the other. When the odds of a success in each group are identical then the odds ratio is equal to one. Usually estimated as OR=AD/BC where a, b, c and d are the appropriate frequencies in the two-by-two contingency table formed from the data.

decisional balance

The relative weight an individual places on the perceived pros and cons of changing or engaging in a certain behavior. Typically, the pros of change need to outweigh the cons of change before an individual will be ready to take action and maintain a behavior change. Decisional balance is a key construct in the Transtheoretical model.

acceptable risk

The risk that has minimal detrimental effects or for which benefits outweigh the potential hazards. Note: Calculated risk of an increase of one case in a million people per year for cancer is usually considered to be negligible.

exposure pathway

The route a substance takes from its source (where it began) to its end point, and how people get exposed to it. Has five parts: a source of contamination (such as an abandoned business); an environmental media and transport mechanism (such as movement through groundwater); a point of exposure (such as a private well); a route of exposure (eating, drinking, breathing, or touching), and a receptor population (people potentially or actually exposed).

Hazardous Substance Release and Health Effects Database (HazDat)18:

The scientific and administrative database system developed by ATSDR to manage data collection, retrieval, and analysis of site-specific information on hazardous substances, community health concerns, and public health activities.

analysis of variance (ANOVA)

The separation of variance attributable to one cause from the variance attributable to others. By partitioning the total variance of a set of observations into parts due to particular factors, for example, sex, treatment group, etc, and comparing variances (mean squares) by way of F-tests, differences between means can be assessed. The simplest analysis of this type involves a one-way design, in which N subjects are allocated, usually at random, to the k different levels of a single factor. The total variation in the observations is then divided into a part due to differences between level means (the between groups sum of squares) and a part due to the differences between subjects in the same group (the within groups sum of squares, also known as the residual sum of squares). These terms are usually arranged as an analysis of variance table. If the means of the populations represented by the factor levels are the same, then within the limits of random variations, the between groups mean square and within groups mean square, should be the same. Whether this is so can, if certain assumptions are met, be assessed by a suitable F-test are that the response variable is normally distributed in each population and that the populations have the same variance. Essentially an example of a generalized linear model with an identity link function and normally distributed errors.

contingency table

The table arising when observations on a number of categorical variables are cross-classified. Entries in each cell are the number of individuals with the corresponding combination of variable values. Most common are two-dimensional tables involving two categorical variables, an example of which is shown below

protemoics

The term 'proteome' was first used in 1994 to refer to all the proteins in a cell, tissue, or organism. Proteomics refers to the study of the proteome. Because proteins are involved in almost all biological activities, including disease, the proteome is a critical target for understanding how disease arises and how to prevent it. Protein scientists pursue many avenues of inquiry about proteins, working to determine their function and amino acid sequence; their three-dimensional structure; how the addition of sugars, phosphates, or fats affects protein function; and how proteins interact with other molecules, including other proteins. Some researchers focus on the proteins present in particular parts of the cell such as the outer cell membrane, the nucleus, the cytoplasm (the region of the cell outside the nucleus), or the nuclear membrane; others analyze protein-protein interactions in a particular cell or organism; some study the differences between the proteins present in diseased vs. healthy cells.

Civilian Health and Medical Program for the Uniformed Services

This final rule establishes requirements and procedures for implementation of the TRICARE Program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Principal components of the final rule include: establishment of a comprehensive enrollment system; creation of a triple option benefit, including a Uniform HMO Benefit required by law; a series of initiatives to coordinate care between military and civilian delivery systems, including Resource Sharing Agreements, Health Care Finders, PRIMUS and NAVCARE Clinics, and new prescription pharmacy services; and a consolidated schedule of charges, incorporating steps to reduce differences in charges between military and civilian services. This final rule also includes provisions establishing a special civilian provider program authority for active duty family members overseas. The TRICARE Program is a major reform of the MHSS that will improve services to beneficiaries while helping to contain costs

organic vs. mechanistic models

Tom Burns and G.M. Stalker provided a continuum on which to understand organizations in " The Management of Innovation ". Mechanistic models are organizations that are described as extremely stable with a high degree of specialization and imposition of rules with a high level of authority. An organic model is an organization has a very low degree of job specialization with a broad knowledge of many different jobs with very little top-level authority and a high degree of self-control and coordination between peers.

agency principal theory

Treats the difficulties that arise under conditions of incomplete and asymmetric information when a principal hires an agent. Various mechanisms may be used to try to align the interests of the agent with those of the principal, such as piece rates/commissions, profit sharing, efficiency wages, the agent posting a bond, or fear of firing. The ____ is found in most employer/employee relationships, for example, when stockholders hire top executives of corporations. ____is directed at the ubiquitous agency relationship, in which one party (the principal) delegates work to another (the agent), who performs that work. _____ is concerned with resolving two problems that can occur in agency relationships. The first is the agency problem that arises when (a) the desires or goals of the principal and agent conflict and (b) it is difficult or expensive for the principle to verify what the agent is actually doing. The problem here is that the principal cannot verify that the agent has behaved appropriately. The second is the problem of risk sharing that arises when the principal and agent have different attitudes towards risk.

bioremediation

Use of living organisms to clean up oil spills or remove other pollutants from soil, water, or wastewater; use of organisms such as non-harmful insects to remove agricultural pests or counteract diseases of trees, plants, and garden soil.

slope factor

Value, in inverse concentration or dose units, derived from the slope of a dose-response curve; in practice, limited to carcinogenic effects with the curve assumed to be linear at low concentrations or doses. The product of the slope factor and the exposure is taken to reflect the probability of producing the related effect.

leachate

Water that collects contaminants as it trickles through wastes, pesticides or fertilizers. Leaching may occur in farming areas, feedlots, and landfills, and may result in hazardous substances entering surface water, ground water, or soil.

latency

time from the first exposure of a chemical until the appearance of a toxic effect

debenture

a certificate of acceptance of loans which is given under the company's stamp and carries an undertaking that the debenture holder will get a fixed return (fixed on the basis of interest rates) and the principal amount whenever the debenture matures.

survival analysis

a class of statistical procedures for estimating the survival function and for making inferences about the effects on it of treatments, prognostic factors, exposures, and other covariates.

sum of squares

a concept in inferential statistics and descriptive statistics. Mathematically, it is an unscaled, or unadjusted measure of variability. When scaled for the number of degrees of freedom, it estimates the variance, or spread of the observations about their mean value. The distance from any point in a collection of data, to the mean of the data, is the deviation. This can be written as Xi - Xbar, where Xiis the ith data point, and Xbar is the estimate of the mean

Health Registry

a federal public health agency of the U.S. Department of Health and Human Services . ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances.

agency for toxic substances and disease registry

a federal public health agency of the U.S. Department of Health and Human Services . Serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances.

cost benefit analysis

a formal discipline used to help appraise, or assess, the case for a project or proposal, which itself is a process known as project appraisal; and an informal approach to making decisions of any kind. Under both definitions the process involves, whether explicitly or implicitly, weighing the total expected costs against the total expected benefits of one or more actions in order to choose the best or most profitable option.

transformational leadership

a leadership when one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality. The term was used by James V. Downton in 1973 in Rebel Leadership: Commitment and Charisma in a Revolutionary Process.

arbitratio

a legal technique for the resolution of disputes outside the courts, wherein the parties to a dispute refer it to one or more persons by whose decision (the "award") they agree to be bound. ___ in the United States and in other countries often includes alternative dispute resolution (ADR), a category that more commonly refers to mediation (a form of settlement negotiation facilitated by a neutral third party). It is more helpful, however, simply to classify arbitration as a form of binding dispute resolution, equivalent to litigation in the courts, and entirely distinct from the various forms of non-binding dispute resolution, such as negotiation, mediation, or non-binding determinations by experts.

total quality management

a management strategy aimed at embedding awareness of quality in all organizational processes involving three domains: Total: Involving the entire organization, supply chain, and/or product life cycle; Quality: performance measures; and Management: The system of managing with steps like Plan, Organize, Control, Lead, Staff, and allocation. W. Edwards Deming, Joseph Juran, Philip B. Crosby, and Kaoru Ishikawa, known as the big four, contributed to the body of knowledge now known as Total Quality Management.

oligopolistic markets

a market form in which a market or industry is dominated by a small number of sellers (oligopolists).

PM-10/PM-2.5

a measure of particles in the atmosphere that are less than 10 micrometers in diameter that include both fine and coarse dust particles. These particles pose the greatest health concern because they can pass through the nose and throat and get into the lungs. a measure of smaller particles in the air. The particle mix in most U.S. cities is dominated by fine particles (less than 2.5 micrometers in diameter) generated by combustion sources, with smaller amounts of coarse dust (between 2.5 and 10 micrometers in diameter).has been the pollutant particulate level standard against which EPA has been measuring Clean Air Act compliance. On the basis of newer scientific findings, the Agency is considering regulations that will make PM-2.5 the new "standard".

six sigma

a measure of quality that strives for near perfection begun by the Motorola Corporation. Six Sigma is a disciplined, data-driven approach and methodology for eliminating defects (driving towards six standard deviations between the mean and the nearest specification limit) in any process -- from manufacturing to transactional and from product to service. The statistical representation of Six Sigma describes quantitatively how a process is performing. To achieve Six Sigma, a process must not produce more than 3.4 defects per million opportunities. A Six Sigma defect is defined as anything outside of customer specifications. A Six Sigma opportunity is then the total quantity of chances for a defect. Process sigma can easily be calculated using a Six Sigma calculator. The fundamental objective of the Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects.

relative risk

a measure of the association between exposure to a particular factor and risk of a certain outcome = incidence rate among exposed/incidence rate among non exposed

reference dose

a numerical estimate of a daily oral exposure to the human population, including sensitive subgroups such as children, that is not likely to cause harmful effects during a lifetime. Are generally used for health effects that are thought to have a threshold or low dose limit for producing effects.

point of service plan

a plan that allows beneficiaries to choose a provider that is or is not within a healthcare plan. The POS plan provides more choice but if providers chosen outside the network or plan are chosen it can result in higher out-of-pocket costs.

benchmarking

a process used in management and particularly strategic management, in which organizations evaluate various aspects of their processes in relation to best practice, usually within their own sector. This then allows organizations to develop plans on how to adopt such best practice, usually with the aim of increasing some aspect of performance. May be a one-off event, but is often treated as a continuous process in which organizations continually seek to challenge their practices. In simple terms, it is the process where organizations compare their process with that of a better process and try to improve the standard of the process the organization follows to improve quality of the system, product or services.

hazard analysis and critical control points

a production control system for the food industry. It is a process that identifies where potential contamination can occur (the critical control points or CCPs) and strictly manages and monitors these points as a way of ensuring the process is in control and that the safest product possible is being produced. Is designed to prevent rather than catch potential hazards.

persistent organic pollutants

a set of chemicals that are toxic, persist in the environment for long periods of time, and biomagnify as they move up through the food chain. Have been linked to adverse effects on human health and animals, such as cancer, damage to the nervous system, reproductive disorders, and disruption of the immune system. Because they circulate globally via the atmosphere, oceans, and other pathways, released in one part of the world can travel to regions far from their source of origin.

medical savings account

a special account owned by an individual used to pay for current and future medical expenses usually used in conjunction with a high deductible health plan. MSAs were created by the Medicare bill signed by President Bush on December 8, 2003 and are designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis.

average length of stay

a statistical calculation often used for health planning purposes. There is current belief that the type of reimbursement system or health insurance plan now plays a more significant role in the patient length of stay in hospitals. Therefore, with increased interest in the average length of a hospital stay, a review of this calculation in a "Tools of the Trade" article seems very appropriate. There are two methods of calculating average length of stay. The formula for each method follows: METHOD 1: (TOTAL DISCHARGE DAYS / TOTAL DISCHARGES) = AVERAGE LENGTH OF STAY (IN DAYS) METHOD 2: (TOTAL INPATIENT DAYS OF CARE / TOTAL ADMISSIONS) = AVERAGE LENGTH OF STAY (IN DAYS)

principal component analysis

a statistical method to simplify the description of a set of interrelated variables. Its general objectives are data reduction and interpretation; there is no separation into dependent and independent variables; the original set of correlated variables is transformed into a smaller set of uncorrelated variables called the principal components. Often used as the first step in a factor analysis.

two tailed test

a statistical significance test based on the assumption that the data are distributed in both directions from the central value(s).

strengths, weaknesses, opportunities, threats analysis

a strategic planning tool used to evaluate the S trengths, W eaknesses, O pportunities, and T hreats involved in a project or in a business venture. It involves specifying the objective of the business venture or project and identifying the internal and external factors that are favorable and unfavorable to achieving that objective. The technique is credited to Albert Humphrey, who led a research project at Stanford University in the 1960s and 1970s.

teratogen

a substance capable of causing birth defects

progressive discipline

a system of discipline where the penalties increase upon repeat occurrences. This term is often used in an employment or human resources context where rather than terminating employees for first or minor infractions, there is a system of escalating responses intended to correct the negative behaviour rather than to punish the employee.

diagnostic related group

a system to classify hospital cases into one of approximately 500 groups, expected to have similar hospital resource use, developed for Medicare as part of the prospective payment system. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, and the presence of complications or comorbidities. DRGs have been used since 1983 to determine how much Medicare pays the hospital, since patients within each category are similar clinically and are expected to use the same level of hospital resources.

Maslow's hierarchy of needs

a theory in psychology that Abraham Maslow proposed in his 1943 paper A Theory of Human Motivation . Maslow's hierarchy of needs is often depicted as a pyramid consisting of five levels: the four lower levels are grouped together as being associated with Physiological needs: survival needs, safety and security, love and belonging, and self-esteem, while the top level is termed growth needs associated with psychological needs such as self actualization.

repeated measures design

a type of analysis of variance that generalizes Student's t test for paired samples. It is used when two or more measurements of the same type are made on the same subject. Analysis of variance is characterized by the use of factors, which are composed of levels. involves two types of factors--between subjects factors and within subjects factors. The ___ make up the levels of the within subjects factor. For example, suppose each subject has his/her reaction time measured under three different conditions. The conditions make up the levels of the within subjects factor. Depending on the study, subjects may divided into groups according to levels of other factors called between subjects factors. Each subject is observed at only a single level of a between-subjects factor. For example, if subjects were randomized to aeorbic or stretching exercise, form of exercise would be a between-subjects factor. The levels of a within-subject factor change as we move within a subject, while levels of a between-subject factor change only as we move between subjects.

quality adjusted life year

a unit of health care outcomes that adjusts gains (or losses) in years of life subsequent to a health care intervention by the quality of life during those years. Can provide a common unit for comparing cost-utility across different interventions and health problems.

expectancy theory of leadership

a view that people will be motivated to behave in particular ways if they believe that doing so will bring them rewards they both seek and value. first applied in the context of the workplace by Victor Vroom in the 1960s. He defined the concepts of valence and expectancy to explain how people decide to act. Valence refers to somebody's perception of the value of the reward or outcome that might be obtained if he or she performs a task successfully.

sensitivity

a/(a+c) calculated as the percentage of individuals with a disease who are correctly classified as having the disease

360-degree performance appraisal

also known as 'multi-rater feedback', 'multisource feedback', or 'multisource assessment', is employee development feedback that comes from all around the employee. "360" refers to the 360 degrees in a circle. The feedback would come from subordinates, peers, and managers in the organizational hierarchy, as well as self-assessment, and in some cases external sources such as customers and suppliers or other interested stakeholders.

Hertzberg two-factor theory

also known as Herzberg's Motivation-Hygiene Theory , was developed by Frederick Herzberg, a psychologist who found that job satisfaction and job dissatisfaction acted independently of each other. Two Factor Theory states that there are certain factors in the workplace that cause job satisfaction, while a separate set of factors cause dissatisfaction. This theory suggests that to improve job attitudes and productivity, administrators must recognize and attend to both sets of characteristics and not assume that an increase in satisfaction leads to a commensurate decrease in dissatisfaction.

Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)18:

also known as Superfund, is the federal law that concerns the removal or cleanup of hazardous substances in the environment and at hazardous waste sites. ATSDR is responsible for assessing health issues and supporting public health activities related to hazardous waste sites or other environmental releases of hazardous substances. This law was later amended by the Superfund Amendments and Reauthorization Act (SARA) .

utilization review

also known as utilization management, UR is reviews of claims, services or procedures in a health care organization to ensure the service was necessary and appropriate. A UR can consist of a precertification review, admission review, continued stay review/concurrent review, discharge planning and case management. Throughout this continuum is the thread of quality management.

continuous quality improvement

an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems : it focuses on "process" rather than the individual; it recognizes both internal and external "customers"; it promotes the need for objective data to analyze and improve processes.

independent practice association

an association of independent physicians, or other organization that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.

medical monitoring

an automated medical device that senses a patient's vital signs and displays the results. In critical care units of hospitalsit allows continuous supervision of a patient without continuous attendance thus improving patient care.

co-optation

an election where members of a committee (or similar group) vote in order to fill a vacancy on that committee or group. Where a small committee is originally elected using a method of proportional representation a co-option may be thought unsuitable as the newly elected member will not necessarily represent the interests of the group represented by the vacating member.

hgprt

an enzyme in purine metabolism . The enzyme primarily functions to salvage purines from degraded DNA to renewed purine synthesis. In this role, it acts as a catalyst in the reaction between guanine and phosphoribosyl pyrophosphate (PRPP) to form GMP .

minimal risk level

an estimate of the daily human exposure to a hazardous substance that is likely to be without appreciable risk of adverse noncancer health effects over a specified duration of exposure. These substance specific estimates, which are intended to serve as screening levels, are used by ATSDR health assessors and other responders to identify contaminants and potential health effects that may be of concern at hazardous waste sites.

accreditation

an evaluative process in which a healthcare organization undergoes an examination of its policies, procedures and performance by an external organization to ensure that it is meeting predetermined criteria. It usually involves both on- and off- site surveys. The Joint Commission An independent, not-for-profit organization, CMS Manual System

existence, relatedness, and growth theory of motivation

an extension of Maslow's hierarchy of needs. Alderfer suggested that needs could be classified into three categories, rather than five. These three types of needs are existence, relatedness, and growth. Existence needs are similar to Maslow's physiological and safety need categories. Relatedness needs involve interpersonal relationships and are comparable to aspects of Maslow's belongingness and esteem needs. Growth needs are those related to the attainment of one's potential and are associated with Maslow's esteem and self-actualization needs.

linking pin theory of management

an idea developed by Rensis Likert in which an organization is represented as a number of overlapping work units in which members of one unit are leaders of another. In this scheme, the supervisor/manager has the dual task of maintaining unity and creating a sense of belonging within the group he or she supervises and of representing that group in meetings with superior and parallel management staff. These individuals are the linking pins within the organisation and so they become the focus of leadership development activities.

national toxicology program

an interagency program, within the Department of Health and Human Services, whose mission is to evaluate agents of public health concern by developing and applying tools of modern toxicology and molecular biology. The program maintains an objective, science-based approach in dealing with critical issues in toxicology and is committed to using the best science available to prioritize, design, conduct, and interpret its studies. To that end, the NTP is continually evolving to remain at the cutting edge of scientific research and to develop and apply new technologies.

strategic planning

an organization's process of defining its strategy, leadership and direction along with a framework for allocating its capital and human resources.

strategic business unit

an organizational unit within the overall organization's heirarchy which is distinguishable from other business because it serves an outside market where management can conduct strategic planning in relation to products and markets.

budget variance

analyzing the difference between the financial value of something (such as cost or revenue) as estimated in the budget, and the actual financial value.

time value of money

based on the premise that an investor prefers to receive a payment of a fixed amount of money today, rather than an equal amount in the future, all else being equal. All of the standard calculations are based on the most basic formula, the present value of a future sum, "discounted" to the present. For example, a sum of FV to be received in one year is discounted (at the appropriate rate of r ) to give a sum of PV at present. Some standard calculations based on the time value of money are: • Present Value (PV) of an amount that will be received in the future. • Present Value of an Annuity (PVA) is the present value of a stream of (equally-sized) future payments, such as a mortgage. • Present Value of a Perpetuity is the value of a regular stream of payments that lasts "forever", or at least indefinitely. • Future Value (FV) of an amount invested (such as in a deposit account) now at a given rate of interest. • Future Value of an Annuity (FVA) is the future value of a stream of payments (annuity), assuming the payments are invested at a given rate of interest.

Consumer Product Safety Commission (CPSC)25:

charged with protecting the public from unreasonable risks of serious injury or death from more than 15,000 types of consumer products. Deaths, injuries and property damage from consumer product incidents cost the nation more than $800 billion annually. Is committed to protecting consumers and families from products that pose a fire, electrical, chemical, or mechanical hazard or can injure children. Its work to ensure the safety of consumer products - such as toys, cribs, power tools, cigarette lighters, and household chemicals - contributed significantly to the 30 percent decline in the rate of deaths and injuries associated with consumer products over the past 30 years.

Health Plan Employer Data and Information Set (HEDIS):

consists of 71 measures across eight domains of care developed and maintained by the National Committee f or Quality Assurance (NCQA). Many health plans report this data to employers or use their results to make improvements in their quality of care and service. Employers, consultants, and consumers use this data, along with accreditation information, to help them select the best health plan for their needs. To ensure the validity of these results, all data are rigorously audited by certified auditors using a process designed by NCQA.

intermediate duration exposure

contact with a substance that occurs for more than 14 days and less than a year

health policy triangle

cost, quality, and accessibility of health care

specificity

d/(b+d) probability of a negative test result given that the disease is absent

sentinel event

defined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a person or persons, not related to the natural course of the patient's illness. Sentinel events specifically include loss of a limb or gross motor function, and any event for which a recurrence would carry a risk of a serious adverse outcome.

HIPAA

establishes, for the first time, a set of national standards for the protection of certain health information. The U.S. Department of Health and Human Services ("HHS") issued the Privacy Rule to implement the requirement of the Act The Privacy Rule standards address the use and disclosure of individuals' health information—called "protected health information" by organizations subject to the Privacy Rule — called "covered entities," as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights ("OCR") has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.

Consolidated Omnibus Budget Reconciliation Act (COBRA), 1986

gives workers who lose their health benefits the right to choose to continue group health benefits provided by the plan under certain circumstances. Generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage in certain instances where coverage under the plan would otherwise end.

medicare part b

helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most beneficiaries pay a monthly premium for Part B.

medicare part A

helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not pay a monthly premium for Part A.

multicollinearity

in multiple regression analysis, a situation in which at least some of the independent variables are highly correlated with each other. Such a situation can result in inaccurate estimates of the parameters in the regression model.

non operating revenue

include all types of income that an organization receives that are not part of its main line of business. In other words, revenues or gains resulting from something other than normal business operations such as Interest Income, Dividends, Commissions, Rental Income, Gain On Sale Of Assets or Other Gains.

root cause analysis

is a class of problem solving methods aimed at identifying the root causes of problems or events. The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimized. However, it is recognized that complete prevention of recurrence by a single intervention is not always possible. Thus, RCA is often considered to be an iterative process, and is frequently viewed as a tool of continuous improvement.

health maintenance organization act

is a law passed by the Congress of the United States that resulted from discussions Paul Ellwood had with what is today the Department of Health and Human Services. It provided grants and loans to provide, start, or expand a Health Maintenance Organization (HMO); removed certain state restrictions for federally qualified HMOs; and required employers with 25 or more employees to offer federally certified HMO options alongside traditional indemnity insurance upon request (the "dual choice provision"). HMOs were required to meet three basic requirements. These were to offer a specified list of benefits to all members, charge all members the same monthly premium, and be structured as a nonprofit organization. The Act solidified the term HMO and gave HMOs greater access to the employer-based market, providing for the rapid expansion of HMOs in later years. No longer needed now that HMOs are widespread, the dual choice provision expired in 1995.

price leadership

is an observation made of oligopic business behavior in which one company, usually the dominant competitor among several, leads the way in determining prices, the others soon following.

accounts receivable management

management of the money that is owed to a venture for goods and services that have been purchased from it or that have been committed as a grant or donation. Accounts receivable are included on the balance sheet under current assets.

prospective payment system

method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, DRGs for inpatient hospital services).

International Agency for Research on Cancer

mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships.

acid deposition

occurs after the release of nitrogen oxide and sulfur dioxide from point or nonpoint sources into the atmosphere. Chemical processes may transform these chemicals into sulfuric and nitirc acids. These are returned to the earth in snowfall, rain, fog, and dust and may deposit at distances far from the original sources.

cost containment

occurs when an insurance company attempts to reduce the benefit payment or costs associated with the health plan.

vertical integration

organizations that are united through a hierarchy and share a common owner. Usually each member of the hierarchy produces a different product or service, and the products combine to satisfy a common need.

predictive value

positive and negative): In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., does have the disease) is referred to as the "predictive value of a positive test." The predictive value of a negative test is the probability that a person with a negative test does not have the disease. The predictive value of a screening test is determined by the sensitivity and specificity of the test, and by the prevalence of the condition for which the test is used.

natural attenuation

processes (within the context of a carefully controlled and monitored site cleanup approach) to achieve site-specific remediation objectives within a time frame that is reasonable compared to that offered by other more active methods. The ___that are at work in such a remediation approach include a variety of physical, chemical, or biological processes that, under favorable conditions, act without human intervention to reduce the mass, toxicity, mobility, volume, or concentration of contaminants in soil or groundwater. These in-situ processes include biodegradation; dispersion; dilution; sorption; volatilization; radioactive decay; and chemical or biological stabilization, transformation, or destruction of contaminants."

civil rights act of 1964

prohibits discrimination in employment on the basis of race, sex, national origin and religion. It also is unlawful under the Act for an employer to take retaliatory action against any individual for opposing employment practices made unlawful by Title VII or for filing a discrimination charge or for testifying or assisting or participating in an investigation, proceeding, or hearing under Title VII.

mantel-haenzel estimate

provided an adjusted odds ratio as an estimate of relative risk that may be derived from grouped and matched sets of data. The statistic may be regarded as a type of weighted average of the individual odds ratios, derived from stratifying a sample into a series of strata that are internally homogeneous with respect to confounding factors. The summarization method can also be extended to the summarization of rate ratios and rate differences from follow-up studies. An estimator of the assumed common odds ratio in a series of two-by-two contingency tables arising from different populations, for example, occupation, country of origin, etc.

public health hazard categories

statements about whether people could be harmed by conditions present at the site in the past, present, or future. One or more hazard categories might be appropriate for each site. The five public health hazard categories are no public health hazard , no apparent public health hazard , indeterminate public health hazard , public health hazard , and urgent public health hazard .

path-goal theory of leadership

states that a leader's function is to clear the path toward the goal of the group, by meeting the needs of subordinates. The model was developed jointly by Martin Evans and Robert House.

biocide

substance intended to kill living organisms

command and control

tandards are usually tailor-made to regulate how a specific activity or class of activities need to be carried out. Compliance monitoring and eventual sanctioning of trespasses are usually indispensable features of effective C&C. The primary disadvantages of the C&C approach are that it is overly constraining, leaves little room for flexibility, is not adaptable on a case-by-case basis and tends to retard technological change. Moreover, regulations underlying the C&C approach offer no incentive for producers to attain standards higher than those imposed by the law. While C&C is often criticized for these reasons, it is widely used by government agencies and even sometimes requested by the industry. Producing regulations is done within the logic of public administration, often regardless of their enforceability. In terms of political relations, "something has been done", and since the same norm or standard applies to everybody, it provides a sense of fairness. The frequent weakness of results monitoring and accountability, in the political arena, however, often leaves implementation in the shadow.

access (to health care services)

the ability to obtain personal health services to achieve the best possible health outcomes when needed balanced by the health system's resource limitations. May be influenced by many factors, including travel, distance, waiting time, available resources, availability of a source of care and the health status of the population served.

equity

the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles.

case mix index

the average diagnosis-related group weight for all of a hospital's Medicare volume. It can be used to adjust the average cost per patient (or day) for a given hospital relative to the adjusted average cost for other hospitals by dividing the average cost per patient (or day) by the hospital's calculated CMI. The adjusted average cost per patient would reflect the charges reported for the types of cases treated in that year.

break even analysis

the break-even point (BEP) is the point at which cost or expenses and revenue are equal: there is no net loss or gain, and one has "broken even". A break even point is typically calculated in order for businesses to determine if it would be profitable to sell a proposed product, as opposed to attempting to modify an existing product instead so it can be made lucrative. Break-Even Analysis can also be used to analyse the potential profitability of an expenditure in a sales-based business.

homoscedastic

the constancy of the variance of a measure over the levels of the factors under study.

mean squared error

the expected value of the square of the difference between an estimator and the true value of a parameter. If the estimator is unbiased then ___ is simply the variance of the estimator. For a biased estimator is equal to the sum of the variance and the square of the bias.

kurtosis

the extent to which a unimodal distribution is peaked

bad debt expense

the portion of receivables that can no longer be collected, typically from accounts receivable or loans. Bad debt in accounting is considered an expense.There are two methods to account for bad debt: • Direct write off method (Non - GAAP) A receivable which is not considered collectible is charged directly to the income statement. • Allowance method (GAAP) An estimate is made at the end of each fiscal year of the amount of bad debt. This is then accumulated in a provision which is then used to reduce specific receivable accounts as and when necessary

risk

the probability that an event will occur

moral hazard

the prospect that a party insulated from risk may behave differently from the way it would behave if it were fully exposed to the risk. Arises because an individual or institution does not bear the full consequences of its actions, and therefore has a tendency to act less carefully than it otherwise would, leaving another party to bear some responsibility for the consequences of those actions.

measurement scale

the range of possible values for a measurement (e.g. the set of possible responses to a question, the physically possible range for a set of body weights). Can be classified according to the quantitative character of the scale: 1. dichotomous scale - one that arranges items into either of two mutually exclusive categories, e.g. yes/no, alive/dead. 2. nominal scale - classification into unordered qualitative categories, e.g. race, religion, country of birth. Measurements of individual attributes are purely nominal scales, as there is no inherent order to their categories. 3. ordinal scale - classification into ordered qualitative categories, e.g. grade, where the values have a distinct order but their categories are qualitative in that there is no natural (numerical) distance between their possible values. 4. interval scale -an equal interval involves assignment of values with a natural distance between them, so that a particular distance (interval) between two values in another region of the scale. Examples include Celsius and Fahrenheit temperature, date of birth. 5. ratio scale - a ratio is an interval scale with a true zero point, so that ratios between values are meaningfully defined. Examples are absolute temperature, weight, height, blood count, and income, as in each case it is meaningful to speak of one value as being so many times greater or less than another value.

basal metabolic rate

the rate at which heat is given off by an organism at complete rest

industrial hygiene

the science of anticipating, recognizing, evaluating, and controlling workplace conditions that may cause workers' injury or illness. Industrial hygienists use environmental monitoring and analytical methods to detect the extent of worker exposure and employ engineering, work practice controls, and other methods to control potential health hazards.

accountability

the set of processes, customs, policies, laws and institutions affecting the way a corporation is directed, administered or controlled. Corporate governance also includes the relationships among the many stakeholders involved and the goals for which the corporation is governed

t test

the t-distribution is the distribution of a quotient of independent random variables, the numerator of which is a standard normal variate and the denominator of which is the positive square root of the quotient of a chi-square distributed variate and its number of degrees of freedom. The t-test uses a statistic that, under the null hypothesis, has the t-distribution to test whether two means differ significantly, or to test linear regression or correlation coefficients.

gross national product

the total dollar value of all final goods and services produced for consumption in society during a particular time period, usually a calendar year. Its rise or fall measures economic activity based on the labor and production output within a country.

maximum likelihood estimate

the value for an unknown parameter that maximizes the probability of obtaining exactly the data that were observed. Used to solve logistic regression.

McGregor Theory X/Theory Y

theories of human motivation created and developed by Douglas McGregor at the MIT Sloan School of Management in the 1960s that have been used in human resource management, organizational behavior, and organizational development. Theory X implies management assumes employees are inherently lazy and will avoid work if they can. Because of this, workers need to be closely supervised and comprehensive systems of controls developed. A hierarchical structure is needed with narrow span of control at each level. Theory Y management assumes employees may be ambitious, self-motivated, anxious to accept greater responsibility, and exercise self-control, self-direction, autonomy and empowerment. It is believed that employees enjoy their mental and physical work duties. It is also believed that if given the chance employees have the desire to be creative and forward thinking in the workplace.

alpha

type I error (reject true null hypothesis)

beta

type II error (fail to reject a false null hypothesis)

gatekeeper

used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, organizations that use those techniques or provide them as services to other organizations, or systems of financing and delivering health care to enrollees organized around managed care techniques and concepts.

z score

variables values transformed to zero mean and unit variance

balanced budget act

was signed into law on August 5, 1997 by President Bill Clinton. It created the State Children's Health Insurance Program (SCHIP); enacted limits on Medicaid payments to disproportionate share hospitals were revised; enacted new Medicaid managed care options and requirements for states were established. Medicare changes include: • Establishing an array of new Medicare managed care and other private health plan choices for beneficiaries, offered through a coordinated open enrollment process; • Expanding education and information to help beneficiaries make informed choices about their health care; • Requiring CMS to develop and implement five new prospective payment systems for Medicare services (for inpatient rehabilitation hospital or unit services, skilled nursing facility services, home health services, hospital outpatient department services, and outpatient rehabilitation services); • Slowing the rate of growth in Medicare spending and extending the life of the trust fund for 10 years; • Providing a broad range of beneficiary protections; • Expanding preventive benefits; and • Testing other innovative approaches to payment and service delivery through research and demonstrations.

up-coding

when false diagnosis codes were assigned to patient records in order to increase reimbursement to the hospitals by Medicare, Medicaid, TRICARE and the Federal Employees' Health Benefits Program. In 2000, HCA-The Healthcare Company (formerly known as Columbia-HCA), the largest for-profit hospital chain in the United States , has agreed to plead guilty to criminal conduct and pay more than $840 million in criminal fines, civil penalties and damages for alleged unlawful billing practices.