Federal Certification Research Articles

The End of the X-Waiver: Not a Moment Too Soon!

The X-waiver requires a physician to obtain specific training and federal certification to prescribe buprenorphine to treat opioid use disorder (OUD). Outgoing President Donald Trump issued an order that would have exempted many physicians from the X-waiver, but incoming President Biden stated they would repeal the Trump order despite campaign promises to better treat OUD. Opioid rehabilitation is a big business and a complex one, but there are not enough places in rehabilitation programs to meet demand, which is increasing year after year. In many cases, the X-waiver makes it more difficult and imposes more limitations on physicians to offer buprenorphine maintenance therapy than opioid prescribing. The Biden administration recently announced that it will not block the Trump orders, but rather will get rid of the X-waiver. The authors hope this is a permanent move away from the antiquated X-waiver. Further, this would provide greater access to accessible, affordable, and evidence-based OUD treatment to more patients, and may help break down some healthcare disparities in the treatment of drug disorders.

A comparison of halal inspection process between federal and state halal certification body in Malaysia

A comparison of halal inspection process between federal and state halal certification body in Malaysia

A comparison of halal inspection process between federal and state halal certification body in Malaysia

Halal certification is an important system for the award of halal status to product and services to ensure that anything to be certified halal are complying with the Shariah. Halal inspection is the key process that details out the Shariah and failure to do so is detrimental to its compliance. The rising demand of halal products shows a need to have an efficient system for the Muslim community. However, it poses a challenge as the different sects of Muslims may have different halal interpretations and limited resources to perform the inspection. Thus, it is crucial to identify issues among different Halal Certification Bodies. This study aims to investigate the differences in halal inspection practices in Malaysia through interviews with halal certification experts. The findings identify several problems that may influence the halal certification efficiency which will be helpful in the search for a better way to utilise information technology.

Naturalistic driving cycle synthesis by Markov chain of different orders

This paper evaluates the performance of using Markov chain of different orders to synthesise real-world representative drive cycles from numerous naturalistic drive cycles. The representative drive cycles can be a valuable input into the design of powertrains, especially for plug-in hybrid electric vehicle (PHEV) and electric vehicle (EV). Their onboard cost-sensitive electric components, such as battery, require an appropriate sizing by understanding how people drive in naturalistic settings. Applying representative drive cycles instead of federal certification drive cycles provides flexibility of drive cycle length and ensures realistic cycle aggressiveness. Even though Markov chain has been widely used to synthesise representative drive cycles, the effects of different orders have not been systematically compared. Based on a publicly accessible portion of GPS-enhanced regional household travel survey, after statistical hypothesis tests, the results show that higher degree of representativeness can be achieved with a 3-order Markov chain compared to a 2-order Markov chain. These findings help to improve the accuracy of cycle synthesis for PHEV and EV analysis.

Naturalistic driving cycle synthesis by Markov chain of different orders

This paper evaluates the performance of using Markov chain of different orders to synthesise real-world representative drive cycles from numerous naturalistic drive cycles. The representative drive cycles can be a valuable input into the design of powertrains, especially for plug-in hybrid electric vehicle (PHEV) and electric vehicle (EV). Their onboard cost-sensitive electric components, such as battery, require an appropriate sizing by understanding how people drive in naturalistic settings. Applying representative drive cycles instead of federal certification drive cycles provides flexibility of drive cycle length and ensures realistic cycle aggressiveness. Even though Markov chain has been widely used to synthesise representative drive cycles, the effects of different orders have not been systematically compared. Based on a publicly accessible portion of GPS-enhanced regional household travel survey, after statistical hypothesis tests, the results show that higher degree of representativeness can be achieved with a 3-order Markov chain compared to a 2-order Markov chain. These findings help to improve the accuracy of cycle synthesis for PHEV and EV analysis.

Naturalistic drive cycle synthesis for pickup trucks

Future pick-up trucks are meeting much stricter fuel economy and exhaust emission standards. Design tradeoffs will have to be carefully evaluated to satisfy consumer expectations within the regulatory and cost constraints. Boundary conditions will obviously be critical for decision making: thus, the understanding of how customers are driving in naturalistic settings is indispensable. Federal driving schedules, while critical for certification, do not capture the richness of naturalistic cycles, particularly the aggressive maneuvers that often shape consumer perception of performance. While there are databases with large number of drive cycles, applying all of them directly in the design process is impractical. Therefore, representative drive cycles that capture the essence of the naturalistic driving should be synthesized from naturalistic driving data. Naturalistic drive cycles are firstly categorized by investigating their micro-trip components, defined as driving activities between successive stops. Micro-trips are expected to characterize underlying local traffic conditions, and separate different driving patterns. Next, the transitions from one vehicle state to another vehicle state in each cycle category are captured with Transition Probability Matrix (TPM). Candidate drive cycles can subsequently be synthesized using Markov Chain based on TPMs for each category. Finally, representative synthetic drive cycles are selected through assessment of significant cycle metrics to identify the ones with smallest errors. This paper provides a framework for synthesis of representative drive cycles from naturalistic driving data, which can subsequently be used for efficient optimization of design or control of pick-up truck powertrains. Manufacturers will benefit from representative drive cycles in several aspects, including quick assessments of vehicle performance and energy consumption in simulations, component sizing and design, optimization of control strategies, and vehicle testing under real-world conditions. This is in contrast to using federal certification test cycles, which were never intended to capture pickup truck segment.

A House Divided: When State and Lower Federal Courts Disagree on Federal Constitutional Rights

Despite their many differences, Americans have long been bound by a shared sense of federal constitutional commonality. As this article demonstrates, however, federal constitutional rights do in fact often differ — even within individual states — as a result of state and lower federal court concurrent authority to interpret the Constitution and the lack of any requirement that they defer to one another’s positions. The article provides the first in-depth examination of intra-state, state-federal court conflicts on federal constitutional law and the problems that they create. Focusing on criminal procedure doctrine in particular, with its unique impact on individual liberty and privacy, the article highlights multiple instances in which state and lower federal courts disagree. As the article makes clear, creation of a “crazy quilt” of conflicting federal rights, which Justice Scalia has inveighed against more generally, generates an array of distinct and quite significant difficulties when localized. To date, however, the conflicts and their consequences have largely evaded the attention of commentators and, more importantly, often go unaddressed by the Supreme Court, which appears content to maintain its historically small plenary docket. In response, the article urges that Congress amend the federal certification provision, which since 1802 has allowed federal but not state courts to certify disputed questions to the Court for resolution. Allocating certification authority to state and federal courts alike will not only help ensure that the Court fulfills its role as arbiter of federal constitutional disputes. It will also help elevate state courts to their rightful place in the nation's constitutional order and allow for greater engagement with the nation’s “one supreme Court,” charged with overseeing the work of state and lower federal courts and ensuring federal constitutional consistency.

Facilities at Risk When CPR Isn't Implemented

Facilities at Risk When CPR Isn't Implemented

Choosing the right laboratory: a review of clinical and forensic toxicology services for urine drug testing in pain management.

Urine drug testing (UDT) services are provided by a variety of clinical, forensic, and reference/specialty laboratories. These UDT services differ based on the principal activity of the laboratory. Clinical laboratories provide testing primarily focused on medical care (eg, emergency care, inpatients, and outpatient clinics), whereas forensic laboratories perform toxicology tests related to postmortem and criminal investigations, and drug-free workplace programs. Some laboratories now provide UDT specifically designed for monitoring patients on chronic opioid therapy. Accreditation programs for clinical laboratories have existed for nearly half a century, and a federal certification program for drug-testing laboratories was established in the 1980s. Standards of practice for forensic toxicology services other than workplace drug testing have been established in recent years. However, no accreditation program currently exists for UDT in pain management, and this review considers several aspects of laboratory accreditation and certification relevant to toxicology services, with the intention to provide guidance to clinicians in their selection of the appropriate laboratory for UDT surveillance of their patients on opioid therapy.

High variability in Summative Usability Test methods & reporting among clinical informatics vendors complying with Federal certification requirements

The Office of the National Coordinator for Health Information Technology (ONC) has been tasked with managing the integration of usability best practices into electronic health record development but, has provided little guidance on how to conduct Summative Usability Testing (SUT). We reviewed three aspects of SUT in four publicly available SUT vendor reports. Significant deviations from human factors engineering (HFE) and user-centered design (UCD) best practices and clear methodological errors were found in all four reports. The main sources of variation involved non-representative participant selection, instructions that led participant performance, and varied interpretation of results reporting requirements. Although ONC has made significant gains in implementing best practice UCD approaches, more explicit guidance may be needed to enhance integrity and reduce variation.

A randomized study of the effect of anonymity, quasi-anonymity, and Certificates of Confidentiality on postpartum women's disclosure of sensitive information

BackgroundUnder-reporting of substance use and other sensitive information is a substantial threat to internal study validity, particularly during the perinatal period. Anonymous approaches are associated with greater disclosure but are incompatible with longitudinal follow-up. Alternative approaches include use of a U.S. Federal Certificate of Confidentiality (CoC) and quasi-anonymous methods, in which there is no link between name and data. However, the relative effect of these procedures on disclosure is unknown. This randomized study was designed to evaluate the effects of consent condition (anonymous, quasi-anonymous, CoC, and traditional confidentiality) on disclosure of sensitive information among postpartum women. MethodsParticipants were 200 postpartum, primarily African-American women who were randomly assigned to one of the four consent conditions and completed a brief computer-delivered assessment of alcohol and drug use, sexual risk, intimate partner violence, and emotional distress. ResultsParticipants in the anonymous and quasi-anonymous conditions disclosed significantly more sensitive information than those in the traditional consent condition. In contrast, no advantage in overall disclosure was observed for the CoC condition. This result was largely consistent across specific content areas with the exception of emotional distress, disclosure of which was unrelated to consent condition. ConclusionsAlthough use of a CoC has limited impact on disclosure, the quasi-anonymous method may increase disclosure to a similar extent as full anonymity. Quasi-anonymous approaches should be considered when under-reporting is likely, a context in which the disadvantages of this approach must be balanced against its advantages.

Adopting, Adapting, and Opting Out: State Response to Federal Voting System Guidelines

This article examines the state response to voluntary federal certification of electronic voluntary voting system guidelines (VVSGs) and current intergovernmental issues surrounding electronic voting systems across the country. Federal certification is not widespread, and most states have adapted modified methods of assuring system integrity or have opted out altogether. States that participate in VVSG have greater technological sophistication, higher levels of election administration professionalism, and are more likely to adopt touchscreen voting machines. Unlike other election administration reforms, VVSG does not appear to be linked to partisan political factors. Our findings have implications for understanding the limits of voluntary federal programs and the importance of technological capacity and professional human resources in American election administration.

The Integration of Counseling and Nursing Services into Schools

The purpose of this comparative review was to examine the legislative evolution of school guidance and school nursing over the past century, in hopes of identifying reasons why guidance counselors have been more successful in compliance to recommended ratios than school nurses. A literature review was conducted including CINAHL, MEDLINE, ERIC and other EBSCO databases. The results from this review indicate school guidance programs have been included in more federal legislation, mandating funding, education and certification requirements, which gives counselors a uniformly recognizable credential understood by educators. An extensive effort to develop a national model of school guidance has assisted counselors to uniformly show how they impact student academic success. School nurses can learn how to further integrate the school nursing role into education from the example of guidance counselors.

Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States

To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance. Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act. Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume. Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.

Job or further training?

PurposeThe two‐year basic training course leading to the Basic Federal Certificate was established in Switzerland by the new Vocational Training Act in 2002 with the intention of ensuring upper secondary education and training for disadvantaged young people. The purpose of this paper is to discuss the findings of a longitudinal study of youths who participated in a two‐year vocational education and training (VET) programme. The main objective is the evaluation of intentions regarding the two‐year training course.Design/methodology/approachA sample of 319 trainees on a two‐year training course in the retail sales and hotel sectors were questioned at the end of their training about their educational and family background, their occupational and personal situation as well as their prospects. Their integration into the labour market was recorded 14 months later. These results are compared with the results of a sample of 183 graduates of an Elementary traineeship in the same occupational fields.FindingsThe results of the study confirm some assumptions made about the effects of the training with Basic Federal VET Certificate. However, the findings also point to crucial aspects that require further investigation.Originality/valueThe findings of the investigation provide insight into initial experiences with the new standardised VET programme. In addition, the presented research is the first longitudinal study focusing on the occupational perspectives of underachieving youths in Switzerland.

Green Washing

In a United States where climate change legislation, concerns about foreign oil dependence, and mandatory curbside recycling are becoming the “new normal,” companies across a variety of sectors are seeing the benefit of promoting their “greenness” in advertisements. Many lay vague and dubious claims to environmental stewardship. Others are more specific but still raise questions about what their claims really mean. The term for ads and labels that promise more environmental benefit than they deliver is “greenwashing.” Today, some critics are asking whether the impact of greenwashing can go beyond a breach of marketing ethics—can greenwashing actually harm health?

Certification Standards in Works for Digital MH Records

Certification Standards in Works for Digital MH Records

'Huge Challenges' Could Hinder Electronic Record Adoption

Back to table of contents Previous article Next article Government NewsFull Access'Huge Challenges' Could Hinder Electronic Record AdoptionRich DalyRich DalySearch for more papers by this authorPublished Online:15 May 2009https://doi.org/10.1176/pn.44.10.0016The physician charged with implementing a $17 billion federal incentive program that will reimburse physicians for some of the costs of electronic health records recently highlighted problems that a national record system is likely to encounter.David Blumenthal, M.D., who was appointed as the national coordinator for health information technology (HIT) at the Department of Health and Human Services in March, will oversee the implementation of an unprecedented federal effort to spur nationwide HIT adoption—including use of electronic medical records (EMRs) and e-prescribing—by clinicians and hospitals. In a commentary published April 9 in the New England Journal of Medicine, Blumenthal highlighted some of the difficulties facing such a national system.The former Harvard Medical School professor wrote that “huge challenges” in efforts to establish a national EMR system could include low adoption rates for the technology, potential technical problems, high initial set-up costs, and data-privacy concerns by both clinicians and patients.The patient-privacy concerns were highlighted by a telephone survey of a nationally representative sample of 1,238 adults by the Kaiser Family Foundation in March; 76 percent of respondents said they believed it would be very or somewhat likely that an unauthorized person would be able to access their medical record.The privacy concerns and other challenges will need to be addressed by Blumenthal in his key role in implementing the federal program to reimburse physicians up to $44,000 over five years for their costs in installing digital record systems. That role was created by the American Recovery and Reinvestment Act of 2009 (ARRA, PL 111-5), which included $17 billion in grants to encourage the use of EMRs, HIT (which includes the software and hardware needed to operate EMRs), and e-prescribing (Psychiatric News, March 20). The law also includes penalties for physicians who have not installed EMR systems by 2015.Cost estimates for the adoption of HIT systems vary widely. The Agency for Healthcare Research and Quality concluded in 2005 that the average cost to place EMRs in practices overall was about $32,600 per clinician, while smaller practices were likely to incur a somewhat higher cost—about $37,200 per clinician. A March analysis by Avalere, a health care consulting company, concluded that a solo or small-group physician practice implementing an EMR system could spend an estimated $124,000 over five years, or $80,000 more than the maximum federal reimbursement.Eligibility for federal reimbursements will be limited to those who use“ certified” EMR systems, and that certification process and its criteria will be determined by Blumenthal's office. His role is expected to supersede the work of the Certification Commission for Healthcare Information Technology (CCHIT), which has been working with the health care industry—including physician groups—to develop HIT standards (Psychiatric News, January 5, 2007). The economic-stimulus law describes the CCHIT standards as a guide for future federal certification standards—due to be finalized by 2010—but those standards will not be constrained by CCHIT decisions.Blumenthal wrote that many EMRs certified through the CCHIT process are neither user friendly nor designed to meet the stimulus law's goal of improving quality and efficiency in the nation's health care system.“Tightening the certification process is a critical early challenge” for the national HIT coordinator, he said.The push toward a nationwide HIT system, which the stimulus law is designed to accelerate, has been driven by the belief that the technology can improve health care efficiency, reduce costs, and boost the quality of care. HIT advocates maintain that an interoperable system for exchanging patient data among physicians' offices, hospitals, and public agencies will reduce medical errors and provide alerts about dangerous medication interactions.However, some HIT experts have warned that poorly managed and badly designed systems could increase risks for patients through inadvertent loss of their medical data or poor system interoperability. Problems with EMRs also could arise from clinicians' trying to install the systems too quickly and without adequate technical support.Blumenthal's commentary, “Stimulating the Adoption of Health Information Technology,” is posted at<http://content.nejm.org/cgi/reprint/360/15/1477.pdf>. The Web site of the Office of the National Coordinator for Health Information Technology is<http://healthit.hhs.gov/portal/server.pt>.▪ ISSUES NewArchived

Replacing ineffective early alcohol/drug education in the United States with age‐appropriate adolescent programmes and assistance to problematic users

Despite more than a decade of federal sponsorship of 'evidence-based' alcohol/drug education, there has been no consistent downward trend in overall prevalence among youth over the past 15 years. Reasons underlying this situation are examined. Published technical critiques of initial research supporting widely used evidence-based programs are reviewed along with replication studies conducted later by independent researchers not associated with initial program development. Social and institutional barriers in the US against changes in AOD policy and practice for young people are also suggested. Emerging use of diverted pharmaceuticals (now second to cannabis in prevalence) may underlie moderate recent decline in use of alcohol. Early federal certification standards for 'evidence based' prevention education have been seriously compromised. Technical critiques of initial evaluations and negative replication studies of these programs are consistent with lack of impact. Finally, fidelity of implementation in regular school settings is commonly flawed. Failure of these mainly pre-secondary educational programs may underlie recent federal support for forced random AOD testing of secondary school students. A new approach to drug education for adolescent students seems warranted as a positive alternative to personally intrusive surveillance. An interactive approach at the secondary school level that incorporates an age-appropriate educational process is proposed. While advising abstinence, this approach also facilitates identifying and assisting problematic AOD users.

Prediction: In Seven Years Electronic Records the Norm

Prediction: In Seven Years Electronic Records the Norm