Esas Reviewer For Ee Pdf Download
Giselda Sasao
This is the Engineering Sciences and Allied Subjects Pre-board Exams (ESAS) on March 21, 2017. Questions were from previous ESAS REE Board Exams Questions and cautiously selected questions from various topics in Engineering Sciences and Allied Subjects that could possibly be given on the future board exam. Choose, familiarize, and test yourself so that you will know the taste of the Board Exam Questions. Read each question and choice carefully! Choose the best answer.
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An essential step for a property transaction is identifying potential or existing environmental contamination concerns. At Hollaway, we conduct Phase I ESAs on various types of properties, including vacant land, agricultural, multi-family residential, commercial, and industrial uses.
Taffeta Burleson supports the Hollaway Environmental + Communications Services team as an Associate Environmental Scientist. She has gained experience in a wide range of environmental services during her time with HECS, including Phase I Environmental Site Assessments, wetland delineations, and threatened and endangered species assessments. She supports an array of projects including mitigation, transportation, and municipal infrastructure. She brings with her a strong skillset in field research, data analysis, and GIS mapping.
John Simmons has over four years of experience working in both the private and public sectors, serving as a scientist and natural resource specialist. Since joining the HECS team, he has gained experience in Phase I Environmental Site Assessments, wetland delineations, constraints analyses, and threatened and endangered species assessments. He has supported HECS in a variety of projects, including private development and public works. He brings with him a background in geology, environmental science, and remote sensing.
Kasey Clarke has a wide variety of experience in environmental services including wetland delineations, Clean Water Act permitting, threatened and endangered species habitat surveys, oyster surveys, freshwater mussel surveys, mitigation monitoring, and Phase I Environmental Site Assessments. She has managed an array of projects for federal and state agencies, municipalities, and private developers involving transportation improvements, stormwater facilities, utility lines, coastal dredging, and much more.
Molly Lenihan joined Hollaway in 2020 and is a Senior Environmental Scientist with extensive experience in wetland delineations, threatened and endangered species habitat assessments, Phase I Environmental Site Assessments, Clean Water Act permitting, National Environmental Policy Act documentation, and a variety of other environmental services. She has managed numerous projects, ranging from large-scale flood reduction projects to small, single family residential developments. She supports the Hollaway team as a project manager, field lead, technical writer, and reviewer.
Carmin Romero supports the Hollaway Environmental + Communications Services team as an Associate Environmental Scientist. Since joining the HECS team, she has gained experience in Phase I Environmental Site Assessments, wetland delineations, and threatened and endangered species assessments, and much more. She brings with her a background in environmental science, data analysis, and in air emission testing.
Staffed by highly qualified experts, our WBE/DBE/HUB/WOSB-certified firm brings a dynamic approach to large-scale project planning, environmental consulting, strategic communications, and community engagement. We bring the expertise of our entire firm to every project, leveraging the wide range of skills and experiences of our team to solve your unique challenges. Through our efficient processes and vast industry knowledge, we are able to respond quickly and complete projects faster than larger firms.
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I am supportive of the concept of an NCD for the use of Erythropoiesis Stimulating Agents (ESA) in cancer and related neoplastic conditions based on medical evidence and clinician experience. The proposed NCD should not be enacted because of the following reasons:
2. Inappropriate restrictions on ESA use that ignore a large body of scientific data and medical experience will have a severe negative impact on the treatment and quality of life (QOL) of cancer patients due to untreated anemia.
3. Blood transfusions are not an appropriate substitute for ESAs in the treatment of anemia in cancer patients. Additionally, the increased need for blood transfusions as a result of restrictions on ESAs would unnecessarily overwhelm the national blood supply, as well as put cancer patients at serious risk for medical complications avoidable with ESAs.
I call on CMS to carefully consider the serious ramifications of the proposed NCD. I urge CMS to substantially revise the proposed NCD so that it is based on sound scienfific data and analysis, and to make it reflective of the important on- label use of ESAs in enhancing the treatment and QOL of cancer patients. Thank you for the opportunity to comment. I am sure you will take steps to change the proposed decision memorandum.
During my over 30 year oncology practice,the most gratifying and exciting times were the arrival of Tamoxiphen in the early years and the ESAs in the recent times.The latter resulted in much happier patients with clearly better QOL.I am a proud member of ASCO and support Dr.J.Bailes' comments wholeheartedly.The proposed decision for ESAs usage is very cruel and unthinkable. I for one do not understand this.If I have to consciously provide a lower level of care to the Medicare beneficiaries,most of them my friends over the years,I may as well quit practicing before I reach Medicare and get a different line of work that does not involve any logic or coscience!
During my over 30 year oncology practice,the most gratifying and exciting times were the arrival of Tamoxiphen in the early years and the ESAs in the recent times.The latter resulted in much happier patients with clearly better QOL.I am a proud member of ASCO and support Dr.J.Bailes' comments wholeheartedly.The proposed decision for ESAs usage is very cruel and unthinkable. I for one do not understand this.If I have to consciously provide a lower level of care to the Medicare
ESA's are an effective treatment for myelodysplasia and should be allowed. ESA's should be started if Hgb drops lower than 11 I do not thhink we should wait till < 9 as patient will require blood transfusion before ESA will work.
I am very disturbed at the proposed policy from CMS. These agents are very effective in patients with anemia due to chronic kidney disease, chemotherapy-induced anemia and myelodysplasia. They have reduced transfusion need, kept patients out of the hospital, and improved their quality of life. Without adequate access to these drugs (by lowering Hgb requirements to < 9), transfusion needs will increase. The blood supply in this country cannot handle this increase. If you eliminate use in patients with diseases like MDS, it will require far more toxic therapies. How is that helping patients deal with their cancer?
In summary, access to ESA's with the proposed 9 gram Hgb level is too low to help this population of patients. Lack of access for MDS patients and lack of access to ESA's beyond 12 weeks per year (almost no chemotherapy program is finished in this short a time period) and capping dose levels below even current "label" doses makes the proposed changes impossible for good patient care.
I am very disturbed at the proposed policy from CMS. These agents are very effective in patients with anemia due to chronic kidney disease, chemotherapy-induced anemia and myelodysplasia. They have reduced transfusion need, kept patients out of the hospital, and improved their quality of life. Without adequate access to these drugs (by lowering Hgb requirements to < 9), transfusion needs will increase. The blood supply in this country cannot handle this increase. If you eliminate use in
The recent media coverage regarding Erythropoiesis Stimulating Agents (ESAs) such as Aranesp, Procrit or Neupogen are extremely concerning. While I worry about the negative health effects supposedly related to overuse of these drugs, I am even more concerned that hasty decisions based on media coverage or studies that might not be applicable to specific conditions might impact patient access to these lifesaving therapies. Further, most people do not realize that before the advent of this modern medicine, the only alternative was risky blood transfusions.We simply cannot rush to condemn these drugs, or the experienced doctors who prescribe them responsibly and effectively. I feel very strongly that without access to ESA treatment, many people would not have the energy to work and tend to family responsibilites in an efficient and positive manner. And they are not alone. There are many cancer survivors that benefit from this treatment that allows them to maintain a good quality of life and contributes to their state of health as they work toward healing and long term survivorship.
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