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The main types of infiltration systems are infiltration basins medicine 512 order urimax d 0.4/0.5 mg overnight delivery, infiltration trenches/wells medicine 1975 lyrics purchase urimax d in united states online, and porous pavements treatment 5th toe fracture buy urimax d overnight. Infiltration Basins Infiltration basins are impoundments designed to capture medications bad for liver buy generic urimax d line, hold, and infiltrate the water into the ground. Moderate-to-high removal of suspended solids, nutrients, pathogens, and metals is achieved by a combination of filtration, adsorption, and biological conversion. Infiltration basins are less effective at removal of dissolved pollutants, some toxics, and chlorides. The efficiency of an infiltration basin can be improved by using vegetative systems, which help remove soluble nutrients, prevent migration of pollutants, and increase the permeability of the 6-16 soils. Pretreatment is required to prevent sediments from clogging the infiltration surface. Unless other vector mitigation measures are employed, the system should be designed to infiltrate all stored water within 72 hours, preventing mosquito breeding and other odor problems. Infiltration Trenches/Wells Infiltration trenches are shallow trenches filled with gravel where runoff is collected and then infiltrated into the ground. Moderate-to-high removal of suspended solids, nitrogen, pathogens, and metals and low-to-moderate removal of nitrogen is achieved through filtration, adsorption, and microbial decomposition. Infiltration trenches are less effective at removal of dissolved pollutants, such as nutrients. Pretreatment is typically required to prevent sediments from clogging the infiltration surface. Figure 6-11: Infiltration Trench United States Environmental Protection Agency, from Livingston and others(106,114 referenced in 106) Advantages 1. May contribute to groundwater recharge and may increase base flow in nearby streams. Infiltration trenches do not require large land areas as in the case of infiltration basins. Not suitable in cold climates, due to the possibility of freezing of the trench surface, thus preventing the runoff from reaching the trench. Periodic maintenance, such as sediment removal, is required to keep pretreatment facilities operating effectively. If clogging does occur, rehabilitation of the infiltration trench/well through replacement of topsoil and/or filters will be necessary. In combination with infiltration into the underlying soil, porous pavement can provide high removals of suspended solids, nitrogen, pathogens, and metals and moderate removal of nitrogen. Removal efficiencies depend on the surface area and the storage volume of the pavement and the soil infiltration rate. Groundwater levels should be at least 2 to 4 feet below the bottom of the installation. Filtration Practices Filtration systems use a filter media such as sand, gravel, peat, or compost to remove pollutants in stormwater. Water quantity control can also be accomplished by having vertical storage above the filter bed or by allowing water to pond in the stormwater collection system before discharging to the filter. Filters are typically suited for treating runoff from parking lots and small developments and in urbanized areas where availability of land is a factor. The main types of filtration practices for stormwater treatment are sand filters and bioretention systems. Sand Filters Sand filters consist of a filter bed with a gravel and perforated pipe under-drain system. Sand filters provide high removal of suspended solids, moderate-to-high removal of particulate metals,uu low-to-moderate removal of nitrogen, and low removal of phosphorus and pathogens. Figure 6-13: Austin Surface Sand Filter United States Environmental Protection Agency, from Bell(107,116 referenced in 107) uu Metals that have been oxidized and are in solid form. Can be placed under parking lots or building basements thus eliminating the need for large land areas.
Further dissemination of information should focus on key persons such as other school personnel treatment lice purchase genuine urimax d, parents and the school environment medicine zyprexa purchase urimax d 0.4mg/0.5mg line. In consultation with an asthma educator medications peripheral neuropathy buy cheap urimax d 0.4mg/0.5mg on-line, pediatrician medicine 9312 buy urimax d 0.4/0.5 mg amex, faculty advisor and faculty education expert, the education module focuses on an asthma overview aimed at the school nurse audience. The learning module consisted of a forty-minute voice-over PowerPoint presentation. Some of the key obstacles in the survey included (a) lack of education for parents, students and nurses, (b) unclear district policy, ( c) time constraints for asthma management, (d) asthma best practices unknown (Asthma Coalition of Erie County, 2015). It is expected that this education module will be available for the district school nurses at that time. The creation of an evaluation tool (Appendix A) was developed in consultation with an asthma educator and with a faculty education expert. The tool consists of a Likert scale of five questions with a range of scores from 1 (strongly disagree), 2 (disagree), 3 (neutral), 4 (agree), 5 (strongly agree), and a qualitative question asking about recommendations for improvements. Ten health care professionals completed the evaluation form including physicians (n=3), nurse practitioners (n=3) registered nurses (n=2), licensed practical nurse (n=l) and one asthma educator. Table 2 shows results of each individual question with corresponding mean score, categorized by profession. Application to practice responses included presenting a variation of the module to students and to parents. Another recommendation was to adapt the module for faculty and staff in the school. The evaluation of the learning module and recommendations proposed can be used to further enhance the presentation. Discussion the purpose of this review was to identify and map literature on evidenced-based guidelines in asthma management programs for school-aged children. One of the benefits of conducting a scoping review is to identify knowledge gaps that offer an opportunity for further research. The evidence suggests that school-aged asthma management programs that specifically involve the school community can contribute to positive asthma outcomes. However, the low number of studies on asthma management for school-aged children in the school setting was unexpected given the national attention at efforts to address asthma as a growing healthcare concern. Specific focus on the school community has the potential to establish a standard of care that can lead to coordinated efforts to alleviate the burden of asthma. There were a number of articles in this review that evaluated the needs of the school environment in relation to asthma management, but very few discussed how to streamline the existing programs, or provided guidance on implementation of such programs. The Asthma Coalition of Erie County reported the top three barriers for parents in asthma care for their children to be transportation, money and time (Asthma Coalition of Erie County, 2017). A strategic plan, which includes proper budgeting and staff resources, will allow for standardization of quality care across the district. However, in this scoping review, the most difficult articles to obtain were those published in nursing journals. For instance, the Journal of School Nursing offers an individual annual print only access for $208. There was no open access to articles specifically aimed at nurses that can offer insight and direction, in not only asthma care but also many areas of school nursing. In addition, the National Association of School Nurses has limited access on their website. Professional development for nurses varies from state to state with some states requiring on-going continuing education for maintenance of licensure while others defer to the individual to pursue continuing education on their own merits. Addressing this as a barrier to the sharing of information can foster discussions on how to maximize the scope of practice of the school nurse. Although the scores on the evaluation of the education module were favorable, there were areas noted in need of improvement. The recommended changes would be implemented prior to any discussions of a formal agreement with the district. Creation of a generalized presentation for students, parents, teachers and other school personnel can be modeled from the current education module. Professional marketing input or the addition of state of the art graphics, as well as appropriate videos to engage the learners would enhance the module.
Water Storage Hazards for Public Safety Water storage hazards associated with stormwater harvesting include injury or drowning in stormwater storage facilities medicine 911 quality urimax d 0.4/0.5 mg, and other public safety issues medicine gustav klimt 0.4mg/0.5mg urimax d overnight delivery, such as cross connections with the potable water supply and embankment failure/overtopping medicine holder effective urimax d 0.4mg/0.5mg. In addition symptoms for hiv discount urimax d 0.4/0.5 mg online, open storage facilities can become a vector habitat (including mosquitoes) if not properly controlled. Water storage hazards and mitigation should be evaluated during the design phase of a stormwater harvesting project. Where possible, consideration should be given to measures to minimize the uncontrolled access of the public to stormwater storage facilities. Risk Management Throughout the planning, design, and operation phases of a stormwater harvesting project, a systematic risk management approach, such as shown in Table 2-2, should be adopted to identify and manage risks to public health and to the environment. A defined risk evaluation process should create treatment, storage, and delivery goals that are incorporated into project design or operational procedures. A systematic approach to risk management will help to control hazards, improve reliability, incorporate redundancy, and enhance the overall performance of a stormwater harvesting system. The approach should include risk mitigation measures during the capture, treatment, storage, and delivery phases of the project. In addition to defining a systematic risk management approach, risk management for stormwater harvesting projects can be addressed through establishment of stormwater harvesting quality goals, screening investigations, and project design. Risk Management through Stormwater Harvesting Quality Goals the Texas Surface Water Quality Standards require that pollution in stormwater shall not impair existing or designated uses, including water supply. Risk Management through Screening Investigations Planners should conduct screening investigations to help identify potential risks. Various investigations and follow-up actions may be appropriate for watersheds with industrial land use or major roads, agricultural land use, on-site sewage management systems, and/or wastewater treatment plants (Table 2-3). In watersheds where the sewer overflow frequency is unknown or moderate to high (approximately 0. The screening process should assess whether the proposed types of water use are suitable for stormwater harvesting based on water quality goals established for the project. For example, stormwater quality should be screened for salinity concentrations that could adversely impact plant productivity and soil structure and for constituents that could adversely impact groundwater quality. Characteristics of proposed irrigated areas should be screened for the likelihood of excessive runoff or erosion, restricted plant growth, soil saturation, or other adverse impacts. The volume and frequency of stormwater diversions should be screened for potential impacts to environmental flows. The location and design of stormwater storage should consider the risks of animal inputs of fecal matter, mosquito breeding, public safety, algal blooms, turbidity, and mixing of dissimilar waters. This list of screening investigations is not comprehensive and is meant to serve as a starting point. Other site and watershed characteristics that should be screened during site selection are discussed in Section 2. The entry-level viability assessment includes evaluating whether there is: Sufficient demand for water, Adequate available stormwater A suitable aquifer for storage of the stormwater, and Sufficient space available for stormwater collection, storage, and treatment facilities. Regulatory authority requires appropriate design of on-site sewage management systems Regulatory authority audits on-site sewage management systems Wastewater treatment plant is appropriately designed, operated and maintained Treatment measures are managed by an organized commercial and/or government entity subject to regulation and audit Regulatory authority regulates and audits treatment plant water quality performance Treatment plant includes disinfection Agricultural land use Pathogens Nutrients On-site sewage management systems Wastewater treatment plants Pathogens Pathogens Pollutants National Resource Management Ministerial Council and others(13) the entry-level degree of difficulty assessment considers available information on stormwater quality, groundwater quality, proximity of other groundwater users, aquifer characteristics, and experience with similar projects. It serves as a preliminary indicator of human health and environmental risks and informs the extent of the investigations likely to be required in Stage 2. Stage 2 may involve site-specific investigations, estimation of maximal risk and uncertainty, and hazard identification and identification of preventive measures. Site-specific investigations may include source water and groundwater sampling and analysis, hydrogeological studies, watershed studies, groundwater modeling, and geochemical evaluation. Estimation of risks and uncertainties may include assessment of inactivation rates for pathogens in aquifers, assessment of environmental fate data for organic chemicals, and prediction of the fate of pathogens and 2-12 organic chemicals in groundwater and recovered water. The site-specific investigations and risk and uncertainty estimation will enable hazard and preventive measure identification. Stage 3 consists of validation of the preventive measures after design and construction and residual risk assessment. Finally, Stage 4 consists of an ongoing operation and maintenance plan that addresses residual risks. Water quality issues could occur at the interface between dissimilar waters that are mixed in an aquifer. In Texas, the Carrizo sandstone is reported to have elevated pyrite content near the East Texas salt domes. Risk Management through Project Design Potential risks identified through screening investigations can be managed through proactive design of stormwater treatment facilities and operational measures such as limiting hydraulic loading rates, limiting public access to project facilities, and monitoring of constituents of concern.
Each section first provides a brief overview of the relevant Guidelines recommendations and Medicaid requirements treatment group buy 0.4/0.5 mg urimax d with amex, and then describes relevant findings treatment for ringworm generic urimax d 0.4/0.5 mg with amex. First medicine abuse discount urimax d express, because the Lung Association believes that transparency of coverage information is critical to providers and patients symptoms type 2 diabetes cheapest urimax d, it only includes information contained in publicly available plan documents. There are some plans that may provide these services without mentioning them in their plan documents. Therefore, it is not possible to determine if the services are available for all enrollees, or only for those reached by a targeted program. Findings: Services, Providers & Settings this section describes the range of services, settings and providers of asthma self-management education in the ten states reviewed for this project. Each section describes the Guidelines; outlines relevant Medicaid requirements; and then presents findings on coverage policies and practices in the ten states. A multi-faceted approach to asthma management is recommended including asthma information and training in management skills, self-monitoring, and development of an asthma action plan. The Guidelines recommend a written asthma action plan and regular assessment by the same clinician. Providers are encouraged to develop an ongoing relationship with patients and their families and to consistently update the asthma action plan. The statute specifically requires that this benefit include "health education (including anticipatory guidance). For adults, preventive services are considered an "optional" Medicaid benefit, meaning that state Medicaid programs have discretion to determine whether and to what extent preventive services, such as asthma education, are offered to adults. Findings Of the Medicaid plans offered in the ten states, health plans appear to offer asthma education through a variety of programs ranging from broad chronic disease management programs to specific asthma education programs. However, few Medicaid plans specify the types or amount of asthma education services available to plan enrollees. The majority of plans mention in plan documents that they offer general chronic disease management programs for asthma and other chronic conditions with varying levels of self-management education. These programs are described using multiple terms including: "disease management," "care management," "population health program," "wellness program," and "health education program. In the ten states reviewed, plans describe services offered such as: clinic-based asthma self-management education; home-based asthma self-management education; home environmental assessments; telehealth services including education provided online and over the phone; asthma support groups; and educational information provided through postal mail. The Guidelines recommend that physicians provide asthma information and training in asthma management skills and self-monitoring, assistance developing a written asthma action plan and regular assessment. The Guidelines recommend that pharmacists provide asthma self-management education with a focus on medication adherence in a pharmacy setting. However, plans describe a wide range of providers used to deliver asthma education. In the community setting, evidence is cited for use of community peer educators,34 nurses,35 and child-life specialists36 with specialized asthma training. Findings In the ten states reviewed, asthma self-management education services are most commonly provided by nurses. However, plans describe a wide range of providers used to deliver asthma education including: respiratory therapists pharmacists community health workers asthma educators social workers care managers or coordinators health educators nutritionists chronic care assistants and health coaches ". Medicaid preventive services rule allows states the option to reimburse non-licensed providers for preventive services as long as they are recommended by a physician or other licensed practitioner. The following table provides examples of provider categories mentioned in some of the plans. Previously, Medicaid regulations limited the scope of allowable coverage of preventive services to those that were actually provided by a physician, nurse or other licensed practitioner, effectively preventing a broader range of qualified providers from seeking Medicaid reimbursement for asthma self-management education services delivered to Medicaid beneficiaries. As each setting may involve different providers or resources and may reach patients at a different point in their care, the Guidelines make recommendations on the general types of asthma self-management education that should happen in each care setting: Clinics. According to the Guidelines, practitioners in health clinic settings should provide education on self-management and medication adherence and work with patients to create a written asthma action plan. The Guidelines state that home-based asthma self-management education supplements and reinforces clinical disease education and treatment by reaching individuals where they live. Specifically, the Guidelines recommend that home-based asthma education be delivered to "In the ten states reviewed, asthma selfmanagement education services are most commonly offered in clinical settings.
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Note: For outpatient observation services related to maternity medications similar to vyvanse discount 0.4mg/0.5mg urimax d with mastercard, we waive your cost-share amount and pay for covered services in full when you use a Preferred facility symptoms kidney cancer discount urimax d. Preferred facilities: $350 copayment for the duration of services (no deductible) Member facilities: $450 copayment for the duration of services symptoms whooping cough order urimax d 0.4/0.5 mg otc, plus 35% of the Plan allowance (no deductible) Non-member facilities: $450 copayment for the duration of services medicine zetia purchase 0.4mg/0.5mg urimax d fast delivery, plus 35% of the Plan allowance (no deductible), and any remaining balance after our payment Preferred facilities: $175 per day copayment up to $875 Member/Non-member facilities: You pay all charges You Pay Standard Option See previous page Basic Option See previous page Outpatient Hospital or Ambulatory Surgical Center - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 82 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Outpatient Hospital or Ambulatory Surgical Center (cont. Outpatient Hospital or Ambulatory Surgical Center - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 83 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Outpatient Hospital or Ambulatory Surgical Center (cont. Preferred facilities: $30 copayment per day per facility Note: You may be responsible for paying a higher copayment per day per facility if other diagnostic and/or treatment services are billed in addition to the services listed here. Basic Option Preferred facilities: $30 copayment per day per facility Member/Non-member facilities: You pay all charges Note: You pay 30% of the Plan allowance for agents or drugs administered or obtained in connection with your care. You Pay Standard Option Preferred facilities: 15% of the Plan allowance (deductible applies) Member facilities: 35% of the Plan allowance (deductible applies) Non-member facilities: 35% of the Plan allowance (deductible applies). Note: See pages 45-46 for our payment levels for covered preventive care services for children billed for by facilities and performed on an outpatient basis. Outpatient drugs, medical devices, and durable medical equipment billed for by a facility, such as: · Prescribed drugs · Orthopedic and prosthetic devices · Durable medical equipment · Surgical implants Note: For outpatient facility care related to maternity, including outpatient care at birthing facilities, we waive your cost-share amount and pay for covered services in full when you use a Preferred facility. See page 42 for our payment levels for covered preventive care services for adults Preferred facilities: Nothing Member/Non-member facilities: Nothing for cancer screenings and ultrasound screening for abdominal aortic aneurysm Note: Benefits are not available for routine adult physical examinations, associated laboratory tests, colonoscopies, or routine immunizations performed at Member or Non-member facilities. Member/Non-member facilities: You pay all charges 2021 Blue Cross and Blue Shield Service Benefit Plan 85 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Blue Distinction Specialty Care We provide enhanced benefits for covered inpatient facility services related to the surgical procedures listed below, when the surgery is performed at a facility designated as a Blue Distinction Center for Knee and Hip Replacement, Blue Distinction Center for Spine Surgery, or Blue Distinction Center for Comprehensive Bariatric Surgery. Note: these benefit levels do not apply to inpatient facility care related to other services or procedures, or to outpatient facility care, even if the services are performed at a Blue Distinction Center. See pages 78-80 for regular inpatient hospital benefits and pages 81-85 for outpatient facility benefit levels. Outpatient facility services related to specific covered bariatric surgical procedures, when the surgery is performed at a designated Blue Distinction Center for Bariatric Surgery. Outpatient facility services related to specific covered hip and knee replacement or revision surgeries and certain spine surgery procedures, when performed at a designated Blue Distinction Center for hip/knee/spine surgery. Note: Members are responsible for regular cost-sharing amounts for the surgery and related professional services as described in Section 5(b). Note: these benefits do not apply to other types of outpatient surgical services, even when performed at a Blue Distinction Center. Basic Option Preferred facilities: $175 per day copayment up to $875 per admission for unlimited days Member/Non-member facilities: You pay all charges Residential Treatment Center - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 87 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Residential Treatment Center (cont. Note: No inpatient benefits (such as room and board) will be provided if precertification is not obtained prior to admission (see page 21). Standard Option Preferred facilities: $175 (no deductible) per admission Member facilities: $275 plus 35% of the Plan allowance (no deductible) per admission Non-member facilities: $275 plus 35% of the Plan allowance (no deductible), and any remaining balance after our payment, per admission Basic Option All charges Extended Care Benefits/Skilled Nursing Care Facility Benefits - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 88 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Extended Care Benefits/Skilled Nursing Care Facility Benefits (cont. Basic Option All charges Note: If Medicare Part A is your primary payor, we will only provide benefits if Medicare provided benefits for the admission. Standard Option See pages 90-92 Basic Option See pages 90-92 Hospice Care - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 89 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Hospice Care (cont. We provide benefits for preenrollment visits when provided by a physician who is employed by the home hospice agency and when billed by the agency employing the physician. However, our benefits will be limited to those services listed on this page and on pages 91-92. Members with a terminal medical condition (or those acting on behalf of the member) are encouraged to contact the Case Management Department at their Local Plan for information about hospice services and Preferred hospice providers. Covered services We provide benefits for the hospice services listed below when the services have been included in an approved hospice treatment plan and are provided by the home hospice program in which the member is enrolled: · Advanced care planning (see Section 10, page 152) · Dietary counseling · Durable medical equipment rental · Medical social services · Medical supplies · Nursing care See next page See next page You Pay Standard Option Nothing (no deductible) Basic Option Nothing Hospice Care - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 90 Standard and Basic Option Section 5(c) Standard and Basic Option Benefit Description Hospice Care (cont. The member must be enrolled in a home hospice program in order to receive benefits for subsequent continuous home hospice care, and the services must be provided by the home hospice program in which the member is enrolled. The member does not have to be enrolled in a home hospice care program to be eligible for the first inpatient stay. However, the member must be enrolled in a home hospice care program in order to receive benefits for subsequent inpatient stays. Professional ambulance transport services to or from the nearest hospital equipped to adequately treat your condition, when medically necessary, and when related to accidental injury Note: We also cover medically necessary emergency care provided at the scene when transport services are not required.