Enhancing Oil Recovery
Caleb Nelands
The site is secure.
The ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Importance: Survival from sepsis has improved in recent years, resulting in an increasing number of patients who have survived sepsis treatment. Current sepsis guidelines do not provide guidance on posthospital care or recovery.
Observations: Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 million survive to hospital discharge and their prognosis varies. Half of patients recover, one-third die during the following year, and one-sixth have severe persistent impairments. Impairments include development of an average of 1 to 2 new functional limitations (eg, inability to bathe or dress independently), a 3-fold increase in prevalence of moderate to severe cognitive impairment (from 6.1% before hospitalization to 16.7% after hospitalization), and a high prevalence of mental health problems, including anxiety (32% of patients who survive), depression (29%), or posttraumatic stress disorder (44%). About 40% of patients are rehospitalized within 90 days of discharge, often for conditions that are potentially treatable in the outpatient setting, such as infection (11.9%) and exacerbation of heart failure (5.5%). Compared with patients hospitalized for other diagnoses, those who survive sepsis (11.9%) are at increased risk of recurrent infection than matched patients (8.0%) matched patients (P < .001), acute renal failure (3.3% vs 1.2%, P < .001), and new cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons for deterioration of health after sepsis are multifactorial and include accelerated progression of preexisting chronic conditions, residual organ damage, and impaired immune function. Characteristics associated with complications after hospital discharge for sepsis treatment are not fully understood but include both poorer presepsis health status, characteristics of the acute septic episode (eg, severity of infection, host response to infection), and quality of hospital treatment (eg, timeliness of initial sepsis care, avoidance of treatment-related harms). Although there is a paucity of clinical trial evidence to support specific postdischarge rehabilitation treatment, experts recommend referral to physical therapy to improve exercise capacity, strength, and independent completion of activities of daily living. This recommendation is supported by an observational study involving 30 000 sepsis survivors that found that referral to rehabilitation within 90 days was associated with lower risk of 10-year mortality compared with propensity-matched controls (adjusted HR, 0.94; 95% CI, 0.92-0.97, P < .001).
Conclusions and relevance: In the months after hospital discharge for sepsis, management should focus on (1) identifying new physical, mental, and cognitive problems and referring for appropriate treatment, (2) reviewing and adjusting long-term medications, and (3) evaluating for treatable conditions that commonly result in hospitalization, such as infection, heart failure, renal failure, and aspiration. For patients with poor or declining health prior to sepsis who experience further deterioration after sepsis, it may be appropriate to focus on palliation of symptoms.
Enhancing Recovery: Preventing Underperformance in Athletes is the first book to address the multifaceted aspects and significance of recovery in maintaining high-level athletic performance. In this text, 21 contributors take an interdisciplinary approach to assist you in preventing overtraining and underperformance in athletes you work with. Enhancing Recovery focuses on recovery as a required component of training and the devastating effects of underrecovery, giving you new insights into treating and preventing overtraining and underperformance.
The editor, Michael Kellmann, PhD, combines a wealth of information from medicine, physiology, periodization training, and psychology as well as studies of people's motivation, health, and lifestyles to explore all aspects of underrecovery--not just in sports, but also in everyday life.
-full descriptions of how underrecovery affects athletic performance as well as everyday work and overall health.
Part I, "Conceptualizing the Problem," explains the concepts of underrecovery and overtraining by clarifying definitions and providing real-life examples that support the assertion that underrecovery is often the precursor to overtraining and underperformance in athletes.
Part II, "Determinants of Underrecovery," addresses the physiological factors that are indicators of overtraining in athletes and explains how athletes are constantly pushing the envelope of positive training adaptation to obtain small improvements in performance.
Part III, "Intervention of Underrecovery," focuses on the significance of correct competitive scheduling and training sequencing, which together underscore the processes leading to optimal performance. Emotional and mental factors in underrecovery and overtraining are also discussed.
Part IV, "Transfer to Related Areas," examines the relationship between recovery and both physical and psychological health. The importance of attitudes, beliefs, and perceptions are also addressed.
Addressing recovery as a key factor of performance, the text illustrates how a constant lack of recovery can result in overtraining in athletes you work with. Further, it shows how being even slightly underrecovered over an extended period results in underperformance in athletes and nonathletes alike. Enhancing Recovery: Preventing Underperformance in Athletes is a critical resource for anyone researching or practicing in the exercise science field.
The law authorizes several significant changes to the way FEMA may deliver federal disaster assistance to survivors. This page provides an overview of the provisions of the Sandy Recovery Improvement Act (SRIA) of 2013 as well as the status of FEMA's implementation.
STATUS: The pilot was first implemented following the Oklahoma tornadoes in May 2013. The nationwide pilot guidance for debris removal, issued on June 28, 2013. FEMA continued the pilot until June 2016 in order to gain additional data on whether the provisions of the pilot are meeting the goals outlined in law before deciding if the provisions should be made permanent.
STATUS: Regulation was issued August 16, 2013 which outlined the process for arbitration. As a requirmeent of SRIA and based on the consumer price index, on August 15, 2014 FEMA adjusted the legitimate amount in dispute to $1,015,000 and on August 17, 2015, FEMA adjusted the legitimate amount in dispute to $1,031,000 for disasters declared on or after October 30, 2012. By statute, the pilot program is authorized through December 2015. Following the conclusion of the pilot program, the Comptroller General of the United States will issue a report to congress analyzing the effectiveness of the program.
SRIA required the FEMA Administrator to complete an analysis to determine whether an increase in the Public Assistance grant program small project threshold is appropriate. This analysis had to consider the following factors: cost-effectiveness, speed of recovery, capacity of grantees, past performance, and accountability measures. FEMA submitted its findings in a report to the Committee on Transportation and Infrastructure of the House of Representatives and the Senate Committee on Homeland Security and Governmental Affairs in January 2014. SRIA also required the immediate establishment of a threshold for eligibility in an appropriate amount adjusted annually to reflect changes in the Consumer Price Index. Not later than 3 years after the date on which the Administrator establishes a threshold, and every 3 years thereafter, the FEMA Administrator, shall review the threshold for eligibility under this section.
STATUS: Following a through agency analysis, on January 29, 2014 FEMA submitted a Report to Congress. Based on the analysis within the report, FEMA published a final rule on February 26, 2014 amending the small project thresholds for disasters declared on or after February 26, 2014. On November 19, 2014 FEMA published a notice in the Federal Register seeking comments on the findings in the Report to Congress and to inform any future revisions of the thresholds.
Based on the consumer price index, FEMA amended the minimum and maximum small project thresholds for disasters declared on or after October 1, 2014 and the minimum and maximum small project thresholds for disasters declared on or after October 1, 2015.
SRIA authorizes rulemaking to address reimbursement of straight-time force account labor costs for state, tribal and local government employees performing emergency protective measures, if such work is not typically performed by those employees and is the type of work that may otherwise be carried out by contract or agreement with private entities or individuals.
When issuing a disaster declaration, the President may make Federal funding (Public Assistance) available through FEMA to state, tribal and eligible local governments and certain private nonprofit organizations. This is done on a cost-sharing basis for emergency work, debris removal and the repair or replacement of facilities damaged by the disaster event. The Disaster Relief Appropriations Act, 2013 requires FEMA to publish public assistance grants and mission assignments in excess of $1 million on the internet within 24 hours of award/issuance.
The Disaster Relief Appropriations Act, 2013 requires the grantee/sub-grantee expenditure of obligated grant funds within 24 months or funds be returned to the agency. Only the Office of Management and Budget (OMB) may waive this requirement and only for good cause with notice to Congress. On July 9, 2013, OMB announced provisions that allow FEMA to waive the 2 year expenditure requirement for $5 billion for the Public Assistance Grant Program and $1.5 billion for the Hazard Mitigation Grant Program.
c80f0f1006