Threats and risks to Canadians and Canada are becoming increasingly complex due to the diversity of natural hazards affecting our country and the growth of transnational threats arising from the consequences of terrorism, globalized disease outbreaks, climate change, critical infrastructure interdependencies and cyber attacks. A key function of the Government of Canada is to protect the safety and security of Canadians. Effective EM results from a coordinated approach and a more uniform structure across federal government institutions. A SEMP establishes a federal government institution's objectives, approach and structure for protecting Canadians and Canada from threats and hazards in their areas of responsibility and sets out how the institution will assist the coordinated federal emergency response. The development and employment of a SEMP is an important complement to such existing plans, because it promotes an integrated and coordinated approach to emergency management planning within federal institutions and across the federal government. Federal government institutions in the early stages of developing a SEMP may find it useful to read the material in Sections One and Two, while other institutions with more established plans may wish to proceed directly to Section Three. Supporting templates and tools can contribute to effective emergency management planning and are provided with this Guide.
The Emergency Management Planning Guide uses a step-by-step approach and provides instructions that are supplemented by the Blueprint and the Strategic Emergency Management Plan (SEMP) template provided in Annexes A and B, respectively. The Emergency Management Planning Unit, Public Safety Canada, is responsible for producing, revising and updating this Guide. The purpose of this Guide is to assist federal officials, managers and coordinators responsible for emergency management (EM) planning. The EM plans of federal government institutions should address the risks to critical infrastructure within or related to the institution's areas of responsibility, as well as the measures for protecting this infrastructure. The SEMP is the overarching plan that provides a comprehensive and coordinated approach to EM activities. Given this variety of EM planning documents, the distinctions between them are summarized in the following table.
A SEMP establishes a federal government institution's objectives, approach and structure for protecting Canadians and Canada from threats and hazards in their areas of responsibility, and sets out how the institution will assist the coordinated federal emergency response. It outlines the processes and mechanisms to facilitate an integrated Government of Canada response to an emergency and to eliminate the need for departments to coordinate a wider Government of Canada response. It includes 13 emergency support functions that the federal government can implement in response to an emergency. Operational plans may be based on all four pillars of EM planning, or focus on the specific activities of a single pillar. The National Strategy and Action Plan for Critical Infrastructure establishes a public-private sector approach to managing risks, responding effectively to disruptions, and recovering swiftly when incidents occur. Implementation of the Strategy will feature targeted and accurate information products, such as security briefings for each critical infrastructure sector. Emergency management (EM) refers to the management of emergencies concerning all hazards, including all activities and risk management measures related to prevention and mitigation, preparedness, response and recovery. The Emergency Management Continuum is depicted in a wheel diagram where all four risk-based functions of emergency management are interconnected and interdependent in a system from prevention and mitigation to preparedness, response, and recovery. In the center of the wheel are the main elements that influence the development of a Strategic Emergency Management Plan (SEMP).
Figure 1 highlights the four interdependent risk-based functions of EM: prevention and mitigation of, preparedness for, response to, and recovery from emergencies. The SEMP should ideally be reviewed on a cyclical basis as part of a federal government institution's planning cycle, as presented in Figure 2 below.
This figure represents the optimal planning cycle federal institutions should consider for undertaking their emergency management planning activities.
May: Senior Institutional Management reviews year-end reports from the previous year's activities. September: Senior Institutional Management conducts mid-year check on progress of key performance objectives. February: Senior Institutional Management makes decision regarding the institution's strategic priorities for the upcoming fiscal year. This section of the Guide outlines a recommended approach for developing a tailored SEMP and is supported by a blueprint and a SEMP template provided in Annexes A and B, respectively. Please note that Step 5 is presented under Section Four: Implementing and Maintaining the SEMP. Each step identifies inputs or considerations at the outset and concludes with the associated outputs. This step involves starting the formal planning process in recognition of the responsibility to prepare a SEMP.
Consider having members of the EM planning team designated by your institution's senior management. One of the most crucial steps in the EM planning process is to identify appropriate members for the EM planning team. Consider including a member of your institution's corporate planning area on the EM planning team in order to help align the EM planning cycle with the institution's overall business planning cycle. Federal government institutions should consider identifying the range of experience and skill sets required in the EM planning team.
The team members should have the skills and training required to adequately carry out their assigned duties. The team members should have the skills and training required to adequately carry out their assigned duties. The composition of the EM planning team will vary depending on institutional requirements; however, it is important that clear terms of reference (TOR) for the team be established and that individual assignments be clearly defined.
After the EM planning team has clear authority and direction, the next step is to review any relevant existing legislation and policies. Consider giving a team member the responsibility of analyzing the legislative and policy obligations applicable to the development of the SEMP.
As noted in Section Two, the EM planning process should be carried out as part of an institution's overall strategic and business planning processes—this will support their alignment.
Developing the SEMP can be supported by a formal work or project plan to ensure that established timelines for plan development are met.
As a next step, federal government institutions should consider developing a comprehensive understanding of the planning context. Additional supporting planning tools and templates as well as an EM glossary are provided in Annexes C and D, respectively. An environmental scan involves being aware of the context in which an institution is operating so as to understand how it could be affected. As part of the environmental scan, the institution defines the internal and external parameters to be taken into account when managing the risk and setting the scope and risk criteria for the remaining risk assessment process. Additionally, federal government institutions are responsible for conducting mandate-specific risk assessments, including risks to critical infrastructure. The Planning Context is represented in a target diagram that consists of three circles representing the factors federal institutions should consider in order to understand the context in which it operates and how it could potentially be affected.
The outer and middle circles represent the external context in which the institution seeks to achieve its objectives. Understanding the internal context is essential to confirm that the risk assessment approach meets the needs of the institution and of its internal stakeholders.
Understanding the external context is important to ensure that external stakeholders, their objectives and concerns are considered. Consider reviewing your federal government institution's most current environmental scan, as well as the most current RCMP Environmental Scan (which can be found on the RCMP Web site), in order to develop a better understanding of pressures and issues facing your institution.
Once all documentation is identified, consider conducting a gap analysis to determine whether the institution is currently meeting its obligations as identified in Step 1. During this process, consider conducting a full review and analysis of stakeholder documentation and reports.
An inventory of critical assets and services will assist the planning team in identifying the associated threats, hazards, vulnerabilities and risks unique to their institution.
If a business impact analysis (BIA) has already been completed for your federal government institution's BCP, this analysis can greatly inform your criticality assessment. When conducting a criticality assessment, it is important to be objective when prioritizing the importance of institutional assets, as not all assets are critical to an institution's operations. Adopting the current Treasury Board Policy related to material and asset management and coding criteria will help structure an effective approach. A comprehensive but non-exhaustive list of hazards and threats relevant to the Canadian context can be found in Annex C, Appendix 3. Traditionally, a threat assessment is an analysis of intent and capabilities in the occurrence of a threat. A vulnerability assessment looks at an inadequacy or gap in the design, implementation or operation of an asset that could enable a threat or hazard to cause injury or disruption. In order to identify vulnerabilities, an institution should first identify and assess existing safeguards associated with critical assets and activities. Risk assessment is central to any risk management process as well as the EM planning cycle. The output of the risk assessment process is a clear understanding of risks, their likelihood and potential impact on achieving objectives. The all-hazards risk assessment (AHRA) process should be open and transparent while respecting the federal institution's context. In this section, risks translate into events or circumstances that, if they materialize, could negatively affect the achievement of government objectives. Once the institution's context is clearly understood (refer to the environmental scan in Step 2-1), the next step is to find and recognize hazards, threats and possibly trends and drivers, and to describe them in risk statements. Risks can be identified though several mechanisms: structured interviews, brainstorming, affinity grouping, risk source analysis, checklists and scenario analysis. A risk register or log is used to record information about identified risks and to facilitate the monitoring and management of risks. The objective of risk analysis is to understand the nature and level of each risk in terms of its impact and likelihood. Qualitative analysis is conducted where non-tangible aspects of risk are to be considered, or where there is a lack of adequate information and the numerical data or resources necessary for a statistically significant quantitative approach. Consider consulting your institution's subject matter experts when evaluating quantitative likelihood through historical data, simulation models and other methods.
Consequences can be expressed in terms of monetary, technical, operational, social or human impact criteria.
The purpose of risk evaluation is to help make decisions about which risks need treatment and the priority for treatment implementation. Risk criteria are based on internal and external contexts and reflect the institution's values, objectives, resources and risk appetite (over-arching expression of the amount and type of risk an institution is prepared to take).
Risks can be prioritized by comparing risks in terms of their individual likelihood and impact estimates. The risk-rating matrix allows for decisions to be made about which risks need treatment and the priority for treatment implementation. Risk treatment options can be prioritized by considering risk severity, effectiveness of risk controls, cost and benefits, the horizontal nature of the risk, and existing constraints. Consider gathering a list of institutional risks and cross-referencing the existing plans (as identified in Step 2-1c) that address each risk. This step will contribute to the concept that sound EM decision-making can be based on an understanding and evaluation of hazards, vulnerabilities and related risks. This step focuses on developing an informed EM approach for your institution based on the four pillars of EM. Each institution should establish an EM governance structure to oversee the management of emergencies. In identifying members of your institution's EM governance structure, keep in mind the relationship between your institution's mandate and the four pillars of EM.
It is important that the planning team confirm the strategic priorities of the institution and of senior management so that they can be reflected in the SEMP.
Consider developing an overview of these priorities and identifying potential areas for attention given risk probabilities and vulnerabilities. The planning team should aim to clearly identify the planning constraints and institutional limitations that will influence the SEMP building blocks and the subsequent development of the SEMP. The cross-reference table of existing plans by identified institutional risks provided in Annex C, Appendix 4, can assist in cross-referencing your most prevalent risks and the tools in place to address them (such as existing plans).
A SEMP should inform each federal government institution's overall priorities and tie into its business and strategic planning activities. The objective of planning activities associated with prevention and mitigation efforts is to reduce risk. The objective of planning activities associated with preparedness is to have an effective and coordinated approach to EM and operational readiness.
Federal government institutions should consider personnel surge capacity requirements in their plans to support sustained operations, as well as the ability to react to any additional hazard or event that may occur while the response and recovery operations are taking place. The objective of planning activities associated with institutional responses to changing threats, hazards or specific incidents is to have an effective and integrated response in accordance with established strategic priorities. Think about engaging your communications branch so that they are aware of internal and external communications requirements. The objective of planning activities associated with the recovery component of EM is to provide for the restoration and continuity of critical services and operations. Once the event is over and response operations are completed, federal institutions should participate in any whole-of-government reviews as appropriate. The SEMP establishes a federal government institution's objectives, approach and structure for protecting Canadians and Canada from threats and hazards in their areas of responsibility, and sets out how the institution will assist the coordinated federal emergency response.
Borzi has published numerous articles on ERISA, health care law and policy and retirement security issues and has been a frequent speaker to legal, professional, business, consumer and state and local governmental organizations.
Prior to joining EBSA, Mares was the Defined Contribution Committee Chair of the Committee on the Investment of Employee Benefit Assets (CIEBA), and a member of the Plan Sponsor Advisory Committee of the Defined Contribution Institutional Investment Association (DCIIA). The Office of Exemption Determinations is responsible for processing requests for individual and class exemptions from ERISA’s prohibited transaction provisions.
The Office of Exemption Determinations is comprised of two divisions, the Division of Individual Exemptions and the Division of Class Exemptions. The primary responsibilities of the Division of Class Exemptions include analyzing applications for class exemptions, and major individual exemptions related thereto, preparing Federal Register notices, reviewing petitions for good faith waivers of section 502(l) penalties, drafting advisory opinions and information letters regarding class exemptions, and handling special projects.
The Office of Policy and Research (OPR) carries out EBSA’s policy responsibilities and activities on behalf of the Assistant Secretary and Deputy Assistant Secretary for Policy. OPR also supports the Secretary and the Assistant Secretary in connection with the Secretary’s duties as Chairman of the Board of the Pension Benefit Guaranty Corporation and Trustee for the Social Security and Medicare Trust Funds, provides quantitative analytic support to EBSA’s enforcement and other programs, and serves as EBSA’s ears and voice in relevant international forums. In response to the significant health care responsibilities given to the Secretary of Labor under the Health Insurance Portability and Accountability Act of 1996, a Task Force was established to develop regulations and other guidance required to implement the new requirements imposed on employer sponsored health plans. The enactment of these health care laws marks a turning point in how group health plans are regulated at the federal level and significantly changed the nature and scope of the Employee Benefits Security Administration’s interpretive and administrative responsibilities.
The permanent Office of Health Plan Standards and Compliance Assistance was established in December of 1999.
The Office of Regulations and Interpretations is primarily responsible for carrying out the Agency’s regulatory agenda and interpretive activities. The Office is comprised of three divisions, the Division of Regulations, the Division of Fiduciary Interpretations and the Division of Coverage, Reporting and Disclosure. The Office of the Chief Accountant is concerned with annual reporting and audit requirements by employee benefit plans, and enforcement of those provisions through the imposition of civil penalties against a plan administrator whose annual report is rejected, as provided in Part 1, Sections 103 and 104, and Part 5, Section 502, of Title I of ERISA. The Division of Accounting Services actively performs numerous liaison and outreach activities with professional groups that service employee benefit plans and ensures that plan audits are done in accordance with industry standards.
The Division of Reporting and Compliance ensures that the ERISA data base contains timely, complete and accurate information about the regulated plan community. The Division of Federal Employees’ Retirement Income Security Act of 1986 (FERSA) Compliance conducts fiduciary compliance audits of the Thrift Savings Plan.
The Office of Technology and Information Services provides computer office automation, information processing, and local wide area, and Internet connectivity for EBSA staff nationwide. The Office of Outreach, Education, and Assistance (OEA) administers EBSA’s Participant and Compliance Outreach, Education and Assistance Program. EBSA's Benefits Advisors responded to over 201,000 telephone, written and electronic inquiries and complaints from plan participants, employers and plan sponsors in Fiscal Year 2015, assisting them in understanding their rights and obligations under the law and in obtaining benefits that may have been denied.
The mission of the Employee Benefits Security Administration is to assure the security of the retirement, health and other workplace related benefits of America's workers and their families.
Please take this 5 minute survey to evaluate the ways to sustain and support the UDL Center. In the context of technology, accessibility most commonly refers to providing access for all people to web environments, including people with disabilities. The National Center on Universal Design for Learning website was designed to be compatible with screen readers in order to increase its accessibility. Specialized formats of curricular content that can be used by and with learners who have print disablilities and include: braille, audio, large print, and electronic text. The student, who is visually impaired, relies on several different forms of accessible instructional materials in order to access her printed textbooks.
A change in instruction that does not result in a change in the standards or instructional goals for a student.
The idea or belief that schools and teachers must take responsibility for measurable student learning. As part of the state's accountability system, all students must take a state-wide English Language Arts and Mathematics assessment. The teacher was concerned because he noticed a change in the student's affect; usually she was energetic and lively, and today she appeared disinterested and preoccupied.
Networks in the brain that enable us to engage with learning; networks specialized to evaluate patterns and impact emotional significance to them. Image description: This medial view of the brain shows the limbic lobe, site of the affective networks.
Preferences for movies, motivation to get up early and go to the gym, and nervous feelings before a big presentation are all everyday examples of your affective network in action. Federal law that protects persons with disabilities from discrimination in the operations of public businesses and governments.
When teaching how to draw, the art teacher used an apprenticeship model, giving novice students hands-on experience and the opportunity to learn from more experienced peers.
Learners make progress when the task they put their minds to is neither overwhelmingly difficult nor boringly easy. The student found that Lois Lowry's The Giver was written at an appropriate level of challenge. Assessment is described as the process of gathering information about a learner’s performance using a variety of methods and materials in order to determine learners’ knowledge, skills, and motivation for the purpose of making informed educational decisions.
Assessments can provide teachers with data regarding students' progress and can also inform teachers regarding the effectiveness of their instructional techniques. Devices or services that are used to increase, maintain, or improve the functional capabilities of a student with a disability.
Text-to-speech (TtS) software is an assistive technology that reads any digital text aloud.
A general term that refers to any skilled and complex behavior that can be performed rather easily with little attention, effort, or conscious awareness; skills become automatic after extended periods of training with practice and good instruction. Image description: This avatar is a digital image of a young girl with ribbons in her hair. The students created avatars to look like themselves: they had choices in hair, skin, eye color, and even in the types of clothing.
The student is unable to decode the text of a short story he is assigned for his English class.
A nonprofit research and development organization that works to expand learning opportunities for all individuals, especially those with disabilities, through Universal Design for Learning. A procedure of breaking up learning materials into manageable sections (e,g., grouping of words in sentences into short meaningful phrases). Instead of asking the student to complete the entire chapter in one night, the teacher and the student worked together to chunk the assignment into more manageable pieces.
Live or animated support provided by an agent to help the performance of a task; aimed at improving the performance of the learner.
The teacher used several techniques to develop students' cognitive skills during the lesson. An umbrella term for the variety of approaches and models in education that involve the shared intellectual efforts by students working in small groups to accomplish a goal or complete a task.
As a final project for the unit on The Revolutionary War, the teacher wanted to focus on collaborative learning. A visual display that supports comprehension by depicting the relationships between concepts within a learning task. Changing the font size and increasing the sizing of images helped the student to see the math item more clearly; this change was construct irrelevant to the math skills being assessed by the item. The UDL framework can be applied to all aspects of the curriculum in order to decrease barriers and increase opportunities for learning.
Since the student was not able to decode the text, he was not able to access the meaning or to fully participate in the class discussion.
An approach to teaching that includes various approaches to content, process, and product in order to meet the needs of student differences in readiness, interests, and learning needs.
Differentiated Instruction and UDL share the same goal: to maximize learning opportunities for all students. A book, article, or other published material that can be retrieved by and read via an electronic device.
The principal federal law affecting public education from kindergarten through high school in the United States.
A method for measuring knowledge and ability where evaluations are part of the learning activity rather than happening after the fact. A term used to describe students who are in the process of acquiring English language skills and knowledge; some schools refer to these students using the term limited-English-proficient (LEP).
Associated with the prefrontal cortex in the brain, these capabilities allow humans to overcome impulsive, short-term reactions to their environment and to instead set long-term goals, plan effective strategies for reaching those goals, monitor their progress, and modify strategies as needed.
In order to support the student's executive functions in an assessment situation, the teacher provided him with a graphic organizer indicating all the items on his test.
The teacher provided the student with constructive feedback on ways to improve his project on the water cycle.
Curricula designed to be adjustable from the beginning, so it can adapt to the needs of diverse learners without significant add-ons. The teacher found that it was more efficient to create flexible curricula that accounted for all learners from the start rather than modifying preexisting curricula.
Special education and related services provided at public expense, under public supervision and direction, and without charge mandated by IDEA. Assessments given primarily to determine what students have learned in order to plan further instruction during the instructional episode; by contrast, an examination used primarily to document students' achievement at the end of a unit or course is considered a summative test. The teacher's use of formative assessment allowed her to adjust her daily lessons and instruction in order to maximize just in time learning.
In order to support his students' writing, the teacher provided graphic organizers to facilitate the organization of their ideas. The 2008 reauthorization established the first statutory definition for universal design for learning. A piece of text or a graphic within an electronic document that provides access to content within another document or website.
While searching the web, the student clicked on a hyperlinked word, and a new window with a definition of the word. A federal law ensuring services to children with disabilities throughout the nation, IDEA governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities. A student-centered and teacher-guided instructional approach that engages students in investigating real world questions that they choose within a broad thematic framework; students acquire and analyze information, develop and support propositions, provide solutions, and design technology and arts products that demonstrate their thinking and make their learning visible. As part of the inquiry-based instructional unit on green energy, students were responsible for collecting information about the school's energy efficiency, developing at least three recommendations, and presenting these recommendations to the school board. Materials that teachers use to teach and students use to learn (for example, printed text, digitized text, speech, images).
For the unit on the Civil Rights Movement, the social studies teacher included a range of instructional media: video clips, the era's most popular songs, primary source documents, and a slide show of photographs.
The 3rd grade team worked together to design an integrated unit on the ocean that incorporated content in marine biology, geography, ecology, history, mathematics, and literature. Subject matter benchmarks used to measure students' academic achievement; guidelines published by professional organizations or enacted by government specifying what is to be taught and learned.
Refers to the IDEA’s mandate that schools educate students with disabilities in integrated settings, alongside students with and without disabilities, to the maximum extent appropriate. An effective way to allow a reader to focus on the more relevant information of the text; done by covering up unnecessary text as well as hiding other distractions. The teacher encouraged some of her students to place a piece of paper under the line of text that they were reading. The teacher used mastery-oriented feedback to notify one student in her reading group how he was doing.
Materials are usually seen as the media used to present learning content and what the learner uses to demonstrate knowledge.
In order to develop students' ability to manage information, the English teacher created a checklist of the materials that they were responsible for bring to class each day: grammar textbook, ELA textbook, and their writing manuals. As an ongoing theme throughout the school year, the teacher worked to develop students' media literacy. Something inherent to the mode of presentation that is immaterial that obstructs or impedes access to and or use. The small font size of the student's copy of The Call of the Wild presented a media-specific barrier since the student could not clearly see the words on each page.
The school created a "Reading Buddies" program where sixth grade students act as mentors to first grade students during reading time.
At the end of the school year, the teacher asked students to reflect about their learning over the course of the year in their journals as a way to develop meta-awareness. The process of "thinking about thinking." For example, good readers use metacognition before reading when they clarify their purpose for reading and preview the text. Methods are generally defined as the instructional decisions, approaches, procedures, or routines that expert teachers use to accelerate or enhance learning. A category of function; for example, vision, hearing, and touch are different sensory modalities. In order to incorporate a range of modalities in the lesson on the life cycle of plants, the teachers encouraged students to touch, smell, and feel the different seeds that were on the table.
In order to demonstrate proper technique, the teacher modeled to students how to begin to dissect the frog. When a curriculum modification is made, either the specific subject matter is altered, or the performance level expected of the student is changed; a curriculum modification is made when a student is either taught something different from the rest of the class or taught the same information but at a different level of complexity. The student's IEP team decided to make a modification to the unit on Mark Twain's Adventures of Tom Sawyer.
Combining several media in one presentation; for example a multimedia Web page may combine text, graphics, audio clips, and video. The student's multimedia presentation on climate change impressed her audience; her peers and her teacher were highly engaged by her use of graphics, video, and audio clips. The teacher used multiple means of action and expression to assess what students had learned during the unit on the nervous system; students had the option of creating a diagram, an animation, a magazine article, or a poster. To ensure that the activity offered multiple means of engagement, student choice was built in as a way to provide students with a sense of autonomy.
A group of more than 40 national organizations that advocates for the incorporation of UDL in federal, state, and district education policy. The 2001 re-authorization of the Elementary and Secondary Education Act (ESEA)-- the principal federal law affecting public education from kindergarten through high school in the United States. A federal agency under the Office of Special Education and Rehabilitative Services (OSERS) dedicated to improving results for infants, toddlers, children and youth with disabilities ages birth through 21 by providing leadership and financial support to assist states and local districts. In order to assess the student's optimal knowledge, the student was provided with models and prompts during the activity. Providing choices and flexibility in the manner or in the way a task or item is approached.
Providing flexibility in the selection, method, or way a user may respond to a task or item. A method for measuring knowledge or ability based on a student's performance on a test or given task. The teacher used performance-based assessments to determine how students were arriving at their answers while performing a task, rather than just assessing after the activity was completed.
A systematic collection of a variety of teacher observations and student work, collected over time, that monitor growth of the student's knowledge, skills, and attitudes in a specific subject area; can be print based or digital.
During a parent-teacher conference, the teacher shared the student's portfolio with the parents in order to discuss the student's progress. Includes printed textbooks and related printed core materials that are written and published primarily for use in elementary school and secondary school instruction and are required by a SEA or LEA for use by students in a classroom.
Teaching approach that engages students in sustained, collaborative real-world investigations.
Many people are willing to make a donation to charitable organizations – you just need to connect with them.
Use the charity organization's official letterhead and make sure it includes the organization's logo, name, address, phone number and website. Make your argument using success stories and facts; these will help people feel the importance of your cause. Identify the specific action you wish the recipient to take to help achieve the organization's goal – whether it is donating money, items or time and how much.
You may wish to mention that their donations may be tax deductible if your organization qualifies under IRS guidelines. Be thankful – thank them for their time and their consideration or go ahead and thank them for their donation. Make sure the letters are signed by a real person and include their name and title below the signature. A post script (PS) is appropriate in this form of letter and can convey additional information such as deadlines, goals or a final reference to the story or facts used at the beginning of your message to tie it together.
In 2009 Number One Nonprofit helped over 350 underprivileged boys participated in Boy Scout activities in our community. Our goal for 2010 is to help 420 boys participate in scouting activities including a full week at summer camp. All donations to Number One Non-Profit go directly to the boys we have been helping since 1985.
The Super Duper Academy is a local school that seeks to help children with disabilities and learning challenges. We have a dream this year to add a music class in the hopes that each of our students who desires will have the opportunity to develop a talent in music. We are asking you to please look around your house and donate any instruments that you may no longer need, even if the instrument may need minor repairs. Instruments can be dropped off at our front desk or simply call (123)456-7890 and we will be happy to drop by and pick up the instrument.
It is through generous donations like yours that the Super Duper Academy has been able to provide life changing classes and experience to thousands of special needs students over the last five years. On June 16th, 2009 I will join thousands of others on a 20-mile walk as part of the MyCharity Walk-a-thon, an event that raises money for MyCharity and the fight against breast cancer. Please read the enclosed brochure that further describes MyCharity, its goals and details about our event on June 16th.
Thank you for taking the time to learn more about breast cancer and my efforts to end it, something I wish for so that others do not have to go through the experience of losing their loved one early.
Disclaimer: The content on this page is intended for educational use and not to be construed as legal or professional advice. Persons using assistive technology might not be able to fully access information in this file.
The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director.
This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC.
CDC recommends routine vaccination to prevent 17 vaccine-preventable diseases that occur in infants, children, adolescents, or adults. The guidance in this report will help vaccination providers to assess vaccine benefits and risks, use recommended administration and storage practices, understand the most effective strategies for ensuring that vaccination coverage in the population remains high, and communicate the importance of vaccination to reduce the effects of vaccine-preventable disease. The Advisory Committee on Immunization Practices (ACIP) General Recommendations Work Group (GRWG) revises the General Recommendations on Immunization every 3 to 5 years.
The recommendations in this report are based not only on available scientific evidence but also on expertise that comes directly from a diverse group of health-care providers and public health officials. Optimal response to a vaccine depends on multiple factors, including the type of vaccine, age of the recipient, and immune status of the recipient.
Certain products, including inactivated vaccines, toxoids, recombinant subunit vaccines, polysaccharide conjugate vaccines, and live vaccines, require ?2 doses to elicit an adequate antibody response. The Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and the Recommended Adult Immunization Schedule are revised annually. Vaccination providers should adhere as closely as possible to recommended vaccination schedules (Table 1).
Administration of doses of a multidose vaccine using intervals that are shorter than recommended might be necessary in certain circumstances, such as impending international travel or when a person is behind schedule on vaccinations but needs rapid protection. Before administering a vaccine dose, providers might need to verify that all previous doses were administered after the minimum age and in accordance with minimum intervals (Table 1). If the first dose in a series is given ?5 days before the recommended minimum age, the dose should be repeated on or after the date when the child reaches at least the minimum age. Simultaneous administration of vaccines is defined as administering more than one vaccine on the same clinic day, at different anatomic sites, and not combined in the same syringe. With some exceptions, simultaneously administering the most widely used live and inactivated vaccines has produced seroconversion rates and rates for adverse reactions similar to those observed when the vaccines are administered separately (10--13). Combination vaccines merge equivalent component vaccines into single products to prevent more than one disease or to protect against multiple strains of infectious agents causing the same disease. In this report, a combination vaccine is defined as a product containing components that can be divided equally into independently available routine vaccines. Situations might arise in which one component of a combination vaccine is specifically preferred to another component in that same vaccine.
FDA generally licenses a combination vaccine based on studies demonstrating that the product's immunogenicity (or efficacy) and safety are comparable or equivalent to monovalent or combination products licensed previously (46).


Licensure of a vaccine by FDA does not necessarily indicate that the vaccine is interchangeable with products from other manufacturers.
Although vaccination providers should stock sufficient quantities of combination and monovalent vaccines needed to vaccinate children, adolescents, and adults against all diseases for which vaccines are recommended (20,28), all available types or brand-name products need not be stocked.
Administering extra antigens contained in a combination vaccine should be avoided in most situations. A vaccination provider might not have vaccines available that contain only the antigens needed as indicated by a child's vaccination history.
There is no evidence that inactivated vaccines interfere with the immune response to other inactivated vaccines or to live vaccines.
Limited data are available regarding interference between live vaccines used in the United States.
To minimize the potential risk for interference, injectable or nasally administered live vaccines not administered on the same day should be administered ?4 weeks apart (Table 3). Ty21a typhoid, yellow fever, LAIV, zoster, and rotavirus vaccines may be administered at any time before, concurrent with, or after administration of any immune globulin, hyperimmune globulin, or intravenous immune globulin (IGIV) (55).
Interference might occur if administration of an antibody-containing product becomes necessary after administration of MMR or varicella vaccines.
A humanized mouse monoclonal antibody product (palivizumab) is available as prophylaxis for serious lower respiratory tract disease from respiratory syncytial virus among infants and young children.
Antibody-containing products interact less with inactivated vaccines, toxoids, recombinant subunit, and polysaccharide vaccines than with live vaccines (61). Certain vaccines that provide protection from the same diseases are available from different manufacturers, and these vaccines usually are not identical in antigen content or in amount or method of formulation.
Available data indicate that infants who receive sequential doses of different Hib conjugate, hepatitis B, and hepatitis A vaccines produce a satisfactory antibody response after a complete primary series (62--65). Vaccination providers should administer vaccines as close to the recommended intervals as possible. Vaccination providers frequently encounter persons who do not have adequate documentation of vaccinations.
Contraindications and precautions to vaccination are conditions under which vaccines should not or likely should not be administered.
National standards for pediatric vaccination practices have been established and include descriptions of valid contraindications and precautions to vaccination. The presence of a moderate or severe acute illness with or without a fever is a precaution to administration of all vaccines (Table 6). Clinicians or other health-care providers might misperceive certain conditions or circumstances as valid contraindications or precautions to vaccination when they actually do not preclude vaccination (Table 7).
The decision to administer or delay vaccination because of a current or recent acute illness depends on the severity of symptoms and etiology of the condition. Parents, guardians, legal representatives, and adolescent and adult patients should be informed about the benefits of and risks from vaccines in language that is culturally sensitive and at an appropriate educational level. Certain parents or patients question the need for or safety of vaccinations and want to discuss the risks from and benefits of certain vaccines.
Each person understands and reacts to vaccine information on the basis of different factors, including previous experience, education, personal values, method of data presentation, perceptions of the risk for disease and perceived ability to control these risks, and risk preference. When a parent or patient initiates a discussion about a perceived vaccine adverse reaction, the health-care provider should discuss the specific concerns and provide factual information, using appropriate language.
The American Academy of Pediatrics (AAP) does not recommend that providers exclude from their practice patients whose parents or guardians question or refuse vaccination.
Syncope (vasovagal or vasodepressor reaction) can occur after vaccination and is most common among adolescents and young adults.
Although anaphylactic reactions are rare after vaccination, their immediate onset and life-threatening nature require that all personnel and facilities providing vaccinations have procedures in place for anaphylaxis management. Modern vaccines are safe and effective; however, adverse events have been reported after administration of all vaccines (84). Many adverse events require more detailed epidemiologic studies to compare the incidence of the event among vaccinees to the incidence among unvaccinated persons.
The National Childhood Vaccine Injury Act requires health-care providers and vaccine manufacturers to report to VAERS specific adverse events that occur after vaccination. In addition to the mandated reporting of events listed on the reportable events table, health-care providers should report to VAERS all events listed in product inserts as contraindications, as well as all clinically significant adverse events, even if they are uncertain that the adverse event is related causally to vaccination. The National Vaccine Injury Compensation Program, established by the National Childhood Vaccine Injury Act of 1986, is a no-fault system in which persons thought to have experienced an injury or to have died as a result of administration of a covered vaccine can seek compensation.
The program relies on the Vaccine Injury Table, which lists the vaccines covered by the program and the injuries (including death), disabilities, illnesses, and conditions for which compensation might be awarded.
Persons administering vaccinations should follow appropriate precautions to minimize risk for spread of disease. Safety-engineered needles and syringes or needle-free injection devices are preferred and should be encouraged to reduce risk for injury. Needle-shielding or needle-free devices that might satisfy the occupational safety regulations for administering injectable vaccines are available in the United States (87--89).
Rotavirus and oral typhoid vaccines are the only vaccines administered orally in the United States. LAIV is licensed for healthy nonpregnant persons aged 2--49 years and is the only vaccine administered by the intranasal route. With the exception of bacille Calmette-Guerin (BCG) vaccine and smallpox vaccine, injectable vaccines are administered by the intramuscular or subcutaneous route. Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. For all intramuscular injections, the needle should be long enough to reach the muscle mass and prevent vaccine from seeping into subcutaneous tissue, but not so long as to involve underlying nerves, blood vessels, or bone (91,95--97).
A decision on needle size and site of injection must be made for each person on the basis of the size of the muscle, the thickness of adipose tissue at the injection site, the volume of the material to be administered, injection technique, and the depth below the muscle surface into which the material is to be injected (Figure 1). For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides a large muscle mass (Figure 2). For toddlers, the anterolateral thigh muscle is preferred, and if used, the needle should be at least 1 inch long. Subcutaneous injections are administered at a 45-degree angle, usually into the thigh for infants aged <12 months and in the upper-outer triceps area of persons aged ?12 months. If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site. Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues (101,102).
Recommendations for route, site, and dosage of immunobiologics are derived from data from clinical trials, practical experience, normal periodicity of health-care visits, and theoretical considerations. Failure to adhere to recommended specifications for storage and handling of immunobiologics can reduce or destroy their potency, resulting in inadequate or no immune response in the recipient.
Refrigerators and freezers used for vaccine storage must maintain the required temperature range year-round, be large enough to hold the year's largest inventory, and be dedicated to storage of vaccines. Agencies should conduct a systematic assessment of their websites and website infrastructure and of their staff’s skills and knowledge in readiness to apply WCAG 2.0.
Emergencies can quickly escalate in scope and severity, cross jurisdictional lines, take on international dimensions and result in significant human and economic losses.
Federal government institutions are increasing their focus on emergency management (EM) activities, given the evolving risk environment in their areas of responsibility. This is why Public Safety Canada has developed this Emergency Management Planning Guide, which is intended to assist all federal government institutions in developing their all-hazards Strategic Emergency Management Plans (SEMPs). Many federal government institutions already have specific planning documents or processes to deal with aspects of emergency management that relate to their particular mandates; many also have a long track record of preparing and refining BCPs.
An All-Hazards Risk Assessment Framework and associated tools are also under development and will be included in a subsequent version of the Guide. As a matter of process, the Emergency Management Planning Guide will be reviewed annually or as the situation dictates, and amendments will be made at that time. The Guide includes a Blueprint (see Annex A), a Strategic Emergency Management Plan (SEMP) template (see Annex B), and supporting step-by-step instructions, tools and tips to develop and maintain a comprehensive SEMP—an overarching plan that establishes a federal government institution's objectives, approach and structure, which generally sets out how the institution will assist with coordinated federal emergency management, including response.
As such, federal institutions are to base EM plans on mandate-specific all-hazards risk assessments, as well as put in place institutional structures to provide governance for EM activities and align them with government-wide EM governance structures. It reflects leading practices (such as those provided by the International Organization for Standardization (ISO) and Canadian Standards Association) and procedures within the Government of Canada, and should be read in conjunction with the Federal Emergency Response Plan, the Emergency Management Framework for Canada and the Federal Policy for Emergency Management.
It should integrate and coordinate elements identified in operational plans and business continuity plans (BCPs). Each of these functions addresses a need that may arise before or during an emergency.
It is intended that governments and industry partners will work together to assess risks to the sector, develop plans to address these risks, and conduct exercises to validate the plans. This work at the sector level will inform, and will be informed by, work at the organizational level such as EM plans and their component parts. Those elements are as follows: Environmental Scan, Leadership Engagement, All-Hazards Risk Assessment, Training, Exercise, Capability Improvement Process, and Performance Assessment. These functions can be undertaken sequentially or concurrently, and they are not independent of each other. In order to effectively depict the cycle, the four seasons are placed in a wheel diagram showing how spring, summer, fall, and winter are interconnected and continuously flow into one circle.
The upcoming year's critical objectives are indentified with input from the various Working Groups and the appropriate Business Lines.
Emergency Management resource requirements should be identified as early as possible to integrate into plans.
Inputs should ideally be assembled, reviewed and well understood prior to engaging in each distinct planning activity as they form an important foundation for the work to be completed. The SEMP should be central to the federal government institution's EM activities and provide clear linkages for integrating and coordinating all other intra-departmental and inter-departmental emergency management plans. The size and composition of the team may vary between federal government institutions; however, the planning team should ideally have the skill and experience necessary to develop the SEMP. This team should be established under the authority of the institution's governance framework and have clear directions, including objectives. Training is available to address EM requirements at the Canadian Emergency Management College (CEMC) and the Canada School of Public Service. Training is available to address EM requirements at the Canadian Emergency Management College (CEMC) and the Canada School of Public Service. These TOR can identify the responsibilities assigned to each team member and the requirements to allow that member to carry out the assigned function.
This is also an ideal time to involve institutional legal advisors to determine whether legislative requirements are being met. Update the analysis regularly, as legislation and policies can change and have an influence on the scope of your SEMP. After completing the above steps, the planning team should consider developing a detailed work plan that includes a schedule with realistic timelines, milestones that reflect the institutional planning cycle, and a responsibility assignment matrix with assigned tasks and deadlines.
It entails a process of gathering and analyzing information and typically considers both internal and external factors (see Figure 3: The Planning Context for additional information on the factors to consider). It sets the time, scope and scale and contributes to adopting an approach that is appropriate to the situation of the institution and to the risks affecting the achievement of its objectives. The key to any emergency planning is awareness of the potential situations that could impose risks on the organization and on Canadians and to assess those risks in terms of their impact and potential mitigation measures.
It is the environment in which the institution operates to achieve its objectives and which can be influenced by the institution to manage risk. If gaps are identified, these should ideally be gathered and presented as part of Step 3 when developing the EM Planning Framework and confirming the institution's strategic EM priorities.
Assets can be both tangible and intangible and can be assessed in terms of importance, value and sensitivity. All available threat assessments should ideally be reviewed by analyzing the assessment's evaluation of hostile capability, intentions and activity, the environment influencing hostile and potentially hostile groups, and environmental considerations, including natural, health and safety hazards.
For further information, you may wish to consult the Canadian Disaster Database, which contains detailed disaster information on over 900 natural, technological and conflict events (excluding war) that have directly affected Canadians over the past century. A threat awareness collection process should ideally link to the federal institution's information requirements and available resources. As appropriate, more specific terrorist threat and hazard information can be obtained from ITAC.
With respect to known threats and hazards, a vulnerability exists when there is a situation or circumstance that, if left unchanged, may result in loss of life or may affect the confidentiality, integrity or availability of other mission-critical assets.
It is a formal, systematic process for estimating the level of risk in terms of likelihood and consequences for the purpose of informing decision-making.
It provides improved insight into the effectiveness of risk controls already in place and enables the analysis of additional risk mitigation measures. A risk assessment should generate a clear understanding of the risks, including their uncertainties, their likelihood and their potential impact on objectives.
It should be tailored to the institution's needs and should identify any limitations such as insufficient information or resource constraints. Risks should be described in a way that conveys their context, point of origin and potential impact. Characterization of risks should use an appropriate breadth and scope; it can be difficult to establish a course of action to treat risks if the scope is too broad, while a scope that is too narrow will create too much information, thereby making it difficult to establish priorities. A risk register will typically describe each risk, assess the likelihood that it will occur, list possible consequences if it does occur, provide a grading or prioritization for each risk, and identify proposed mitigation strategies. Probabilistic methods provide more information on the range of risks and can effectively capture uncertainty, but require more data and resources.
It is usually used for analyzing threats with less tangible intent (judgements on terrorism, sabotage, etc.). Subject matter experts can also assist in evaluating likelihood from a qualitative perspective, for instance by using a Delphi technique (a group communication process for systematic forecasting). Additional information on analyzing likelihood and impact is provided in the Treasury Board Integrated Risk Management Framework Guidelines. Prioritization can be shown graphically in a logarithmic risk diagram, risk-rating matrix or other forms of visual representations.
In order to prioritize risks, comparison is made based on their likelihood and impact estimates.
Treatments that deal with negative consequences are also referred to as risk mitigation, risk elimination, risk prevention, risk reduction, risk repression and risk correction. These treatment options, forming recommendations, would be used to develop the risk treatment step in the risk management or emergency management cycle.
A sample cross-reference table of existing plans by identified institutional risks is provided in Annex C, Appendix 4.
The resulting SEMP building blocks will reflect strategic priorities—the desired balance between developing measures that respond to emergencies versus mitigating the risk. The EM planning governance structure may include representatives of an institution's senior management team, from all functional areas (such as programs) and all corporate areas (including communications, legal services and security).
It is also crucial that roles and responsibilities, lines of accountability and decision-making processes be aligned and well understood by all concerned. For example, an institution can be constrained by the availability of training for EM planning team members and by the number of EM positions they have staffed. A further cross-referencing can then be undertaken with the four pillars of EM to help target specific activities in one or more of the following areas. The ICS helps to promote clear lines of authority, is scalable to large or small events, and is widely used by first responders such as police or fire departments in various jurisdictions.
The cross-reference table provided in Annex C, Appendix 5, as stated above, can serve as a tool to complete this task.
It should be strategic and be designed to have safeguards and processes to trigger appropriate actions in response to changing threats and hazards, as well as in response to specific incidents and events. Borzi was confirmed on July 10, 2009 as Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA). Borzi was a research professor in the Department of Health Policy at George Washington University Medical Center’s School of Public Health and Health Services. House of Representatives, Subcommittee on Labor-Management Relations of the Committee on Education and Labor. An active member of the American Bar Association, Borzi is the former chair of the ABA’s Joint Committee on Employee Benefits. Hauser is the Deputy Assistant Secretary for Program Operations of the Employee Benefits Security Administration and as such is the chief operating officer of the Agency.
Hauser joined the Department of Labor in 1991 as a trial attorney for the Plan Benefits Security Division (PBSD), where he represented the Department in federal district court and appellate litigation.
The Division of Individual Exemptions is staffed by a division chief and three teams of analysts each of which is headed by a supervisor or team leader.
OPR’s products include policy analysis, economic research, and tracking of all benefits policy related developments and activities. These have come to include Part 7 of the Employee Retirement Income Security Act amended by the Health Insurance Portability and Accountability Act of 1996, the Mental Health Parity Act of 1996, and the Newborns’ and Mothers’ Health Protection Act of 1996.
These health care provisions, as well as the provisions of the Women’s Health and Cancer Rights Act of 1998, create shared jurisdiction and shared regulatory responsibility for the Departments of Labor, the Treasury, and Health and Human Services. The Office is the primary source of regulations and interpretive guidance related to health plans and provides education, technical assistance and other support to health plans, other government agencies with related responsibilities, policy makers and Employee Benefits Security Administration program offices on health care matters. The Office also plays a major role in the development, analysis and implementation of pension and health care policy issues by providing technical assistance and support to the Assistant Secretary, external groups and other offices within EBSA. The Division of Regulations is responsible for managing and implementing the Agency’s regulatory priorities under Title I of ERISA and coordinating regulatory activities with other Federal agencies. This division is also responsible for the administration of the Delinquent Filer Voluntary Compliance Program.
The Office provides leadership and direction in the use of information technology to support EBSA’s management and operations, including the enforcement and public disclosure requirements of the Employee Retirement Income Security Act of 1974 (ERISA). This program provides participant and compliance assistance directly to the public through a staff of Benefits Advisors, located in EBSA’s field offices, who answer inquiries and complaints received by phone, mail, electronically or in person. The Benefits Advisors obtained over $402 million on behalf of participants and beneficiaries through informal dispute resolution. The limbic lobe includes primitve cortical tissue (stippled area), the fontal lobes, and underlying cortical structures (hippocampus and dentate gyrus, not shown). She was able to comprehend the dialog and storyline, and she was challenged by a few vocabulary terms that she needed to look up in the dictionary. Even though he understands the language and story structure, he is unable to read for understanding since decoding is a barrier to his learning. However, in the image on the right, the items are chunked, and the student is responsible for completing only the first 3 items at one time.
She asked students to make predictions, ask clarifying questions, and summarize information. The class was responsible for writing and producing a fifteen minute play that would capture a critical event that took place during the War.
However, he realized that identifying the symbols for a math calculation problem is a construct relevant change to the assessment item.
The distinction between the two frameworks lies within the goal; DI focuses on differentiating with a focus at the student level, whereas UDL focuses on designing flexible curricula with the needs of the broadest range of students in mind from the start. From 2001-2009, the law was known as the No Child Left Behind Act but is again referred to as ESEA in current policy discussions. She stated that she was impressed by the visual that he created to depict water's journey, and she suggested that he may also want to include labels for each step.
Concept maps, story maps, advance organizers, story webs, semantic maps, and cognitive organizers are all commonly used graphic organizers. This definition incorporates the three principles of UDL--representation, expression, and engagement--and emphasizes reducing barriers with appropriate supports and challenges built into instruction.
When individual forms of instructional media (text, video, audio) are combined to represent information in multiple ways they are called multimedia.
This strategy allowed the students to focus on one line of text at a time and masked the other text on the page. Rather than telling him he was "very smart," she commented on how he was working hard at answering in complete sentences. She used an array of formats to present content, and she varied the media with which students could use to express their learning.
Expert teachers apply evidence-based methods and differentiate those methods according to the goal of instruction.
To "practice what you preach." In regular practice and behavior, the teacher is a model of thoroughness, or self-evaluation, or courtesy, or whatever else is expected of students. Instead of reading the original work, the student would read an abridged version written at his individual reading level. Students are different in the ways that they express their knowledge; therefore, it is crucial to allow them to express verbally, physically, with written text, etc. Students are different in the ways that they will become interested or motivated to learn; therefore, it is crucial to provide multiple ways to engage learners.
Students are different in the ways that they perceive and understand information; therefore, it is crucial to provide different ways of presenting content. Department of Education, OSERS supports programs that help educate children and youth with disabilities, provides for the rehabilitation of youth and adults with disabilities, and supports research to improve the lives of individuals with disabilities. Projects are organized around a driving question, and students participate in a variety of tasks that seek to meaningfully address this question. Writing a Request for Donation Letter is a great way to aid in fundraising, especially when properly written.
The information in [brackets] should be replaced with your specific information or details.
The organization may have many purposes and projects, but make sure your letter is focused on a particular need. They had a chance to learn to swim, learn basic survival and first-aid skills and learn how to work with other boys.
If you would still like to give, but do not have an instrument, consider giving a cash donation that can be used for other music supplies or check your local pawn shop for a suitable instrument. The goal of this event is to increase awareness of breast cancer, to highlight stories of survivors and to raise money to help fund research into curing this deadly disease.
General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive details. This report provides information for clinicians and other health-care providers about concerns that commonly arise when vaccinating persons of various ages. These recommendations are intended for use in the United States; vaccine availability, use, and epidemiologic circumstances might differ in other countries and might warrant different recommendations. Relevant topics are those identified by ACIP as topics that relate to all vaccines, including timing and spacing of doses, vaccine administration, and vaccine storage and handling.
In February 2009, revisions were made to Storage and Handling of Immunobiologics, and ACIP approved the section.
Recommendations for the age at which vaccines are administered are influenced by age-specific risks for disease, age-specific risks for complications, age-specific responses to vaccination, and potential interference with the immune response by passively transferred maternal antibodies.
Tetanus and diphtheria toxoids require booster doses to maintain protective antibody concentrations.
Administration at recommended ages and in accordance with recommended intervals between doses of multidose antigens provide optimal protection.
In these situations, an accelerated schedule can be implemented using intervals between doses that are shorter than intervals recommended for routine vaccination.
In clinical practice, vaccine doses occasionally are administered at intervals less than the minimum interval or at ages younger than the minimum age.
If the vaccine is a live vaccine, ensuring that a minimum interval of 28 days has elapsed from the invalid dose is recommended. Careful record keeping, maintenance of patient histories, use of immunization information systems (IISs), and adherence to recommended schedules can decrease the incidence of such reactions without adversely affecting immunity. Experimental evidence and extensive clinical experience provide the scientific basis for administering vaccines simultaneously. Routine administration of all age-appropriate doses of vaccines simultaneously is recommended for children for whom no specific contraindications exist at the time of the visit. Although there is no exact limit on the number of injections, with a little flexibility, a provider can ensure that the primary series doses are given without administering too many injections at each visit. Licensed combination vaccines can be used whenever any components of the combination are indicated and its other components are not contraindicated and if licensed by the Food and Drug Administration (FDA) for that dose in the series. The economic impact of the use of combination vaccines is unclear because combination products have the potential for either increased or decreased costs compared with single-antigen component vaccines. A dash ( - ) between vaccine products indicates that products are supplied in their final form by the manufacturer and do not require mixing or reconstitution by the user.
Future research considerations for newly licensed combination vaccines should focus on safety of doses that are not needed because a patient is already vaccinated against the agents, whether the combination vaccine will improve the timeliness of vaccination, and potential reduced costs from disease prevention resulting from timely vaccination. Vaccination providers should not combine separate vaccines into the same syringe to administer together unless mixing is indicated for the patient's age and is explicitly specified on the FDA-approved product label inserts. FDA licensure also generally indicates that a combination vaccine may be used interchangeably with monovalent formulations and other combination products with similar component antigens produced by the same manufacturer to continue the vaccination series.
Potential advantages of stocking a limited number of vaccines include 1) reducing confusion and potential errors when staff members must handle redundant products and formulations, 2) minimizing waste when less commonly used products expire, 3) decreasing cold storage capacity requirements, and 4) minimizing administrative costs related to accounting, purchasing, and handling. Using combination vaccines containing certain antigens not indicated at the time of administration to a patient might be justified when 1) the extra antigen is not contraindicated, 2) products that contain only the needed antigens are not readily available, and 3) potential benefits to the patient outweigh the potential risk for adverse events associated with the extra antigens. Alternatively, although the indicated vaccines might be available, the provider might prefer to use a combination vaccine to reduce the required number of injections.
Because clinical experience suggests low reactogenicity, an extra dose of Hib or hepatitis B vaccine may be administered as part of a combination vaccine to complete a vaccination series for another component of the combination. Protein conjugates used in Hib conjugate vaccines produced in the United States include an outer membrane protein complex from Neisseria meningitidis (in PRP-OMP), and tetanus toxoid (in PRP-T).
Any inactivated vaccine can be administered either simultaneously or at any time before or after a different inactivated vaccine or live vaccine (Table 3).
If injectable or nasally administered live vaccines are separated by <4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated.
Because of the importance of rubella and varicella immunity among women of child-bearing age (4,60), the postpartum vaccination of women without evidence of immunity to rubella or varicella with MMR, varicella, or MMRV vaccines should not be delayed because of receipt of anti-Rho(D) globulin or any other blood product during the last trimester of pregnancy or at delivery.
Usually, vaccine virus replication and stimulation of immunity occurs 1--2 weeks after vaccination. This product contains only antibody to respiratory syncytial virus and does not interfere with the immune response to licensed live or inactivated vaccines. Therefore, administering inactivated vaccines and toxoids either simultaneously with or at any interval before or after receipt of an antibody-containing product should not substantially impair development of a protective antibody response (Table 4). Manufacturers use different production processes, and their products might contain different concentrations of antigen per dose or a different stabilizer or preservative.
All brands of Hib conjugate, hepatitis B,¶ hepatitis A, rotavirus,** and quadrivalent meningococcal conjugate vaccines are interchangeable within their respective series. However, intervals between doses that are longer than recommended typically do not reduce final antibody concentrations, although protection might not be attained until the recommended number of doses has been administered. With the exception of influenza vaccine and PPSV, providers should only accept written, dated records as evidence of vaccination; self-reported doses of influenza vaccine and PPSV are acceptable (49,68).
Because the majority of contraindications and precautions are temporary, vaccinations often can be administered later if one or more exist.
Persons who administer vaccines should screen patients for contraindications and precautions to the vaccine before each dose of vaccine is administered (Table 6).
In addition, severely immunocompromised persons generally should not receive live vaccines.
A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. These misperceptions result in missed opportunities to administer recommended vaccines (69). The safety and efficacy of vaccinating persons who have mild illnesses have been documented (70--73). These materials, known as vaccine information statements (VISs), must be provided by all public and private vaccination providers each time a vaccine is administered.
Increasingly, decisions about vaccination are based on inaccurate information about risk provided by the media and certain websites.
Effective, empathetic vaccine risk communication is essential in responding to misinformation and concerns, with health-care providers recognizing that risk assessment and decision-making can be difficult and confusing.
A limited number of providers might exclude patients on this basis; however, an effective public health strategy is to identify common ground and discuss measures that need to be followed if the decision is to defer vaccination. In 2005, the Vaccine Adverse Event Reporting System (VAERS) began detecting a trend of increasing syncope reports that coincided with the licensure of three vaccines for adolescents: human papillomavirus (HPV), MCV4, and Tdap (77). All vaccination providers should be familiar with the office emergency plan and be currently certified in cardiopulmonary resuscitation. Rapid recognition and initiation of treatment are required to prevent possible progression to cardiovascular collapse.
Reporting adverse events, including serious events, to VAERS is a key mechanism for identifying potential vaccine safety concerns. The program became operational on October 1, 1988, and is intended as an alternative to civil litigation under the traditional tort system in that negligence need not be proven. The table defines the time during which the first symptom or substantial aggravation of an injury must appear after vaccination to be eligible. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing the vaccine and between each patient contact (85). ACIP discourages the routine practice of prefilling syringes because of the potential for administration errors and vaccine wastage. The Needlestick Safety and Prevention Act was enacted in 2000 to reduce the incidence of needle-stick injury and the consequent risk for bloodborne diseases acquired from patients.
To prevent inadvertent needle-stick injury or reuse, safety mechanisms should be deployed after use and needles and syringes should be discarded immediately in labeled, puncture-proof containers located in the same room where the vaccine is administered. The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. The method of administration of injectable vaccines is determined, in part, by the presence of adjuvants in some vaccines. Use of longer needles has been associated with less redness or swelling than occurs with shorter needles because of injection into deeper muscle mass (92). Vaccinators should be familiar with the anatomy of the area into which they are injecting vaccine. Knowledge of body mass can be useful for estimating the appropriate needle length (99); however, neither a physical examination nor measurement of body mass is necessary to administer vaccines. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. Jet injectors prevent needle-stick injuries to health-care providers (86) and can overcome improper, unsterile reuse and other drawbacks of needles and syringes in developing countries (87,103--104).
Pretreatment (30--60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia (111,112). ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. In adults (but not in infants) (117), the immunogenicity of hepatitis B is substantially lower when the gluteal rather than the deltoid site is used for administration (90). PPSV and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Using reduced doses administered at multiple vaccination visits that equal a full dose or using smaller divided doses is not recommended. Recommendations in the product package inserts, including methods for reconstitution of the vaccine, should be followed carefully. Liquid vaccines containing an aluminum adjuvant permanently lose potency when exposed to freezing temperatures. Vaccine storage units must be carefully selected, used properly, and consistently monitored to ensure that recommended temperatures are maintained. EM can save lives, preserve the environment and protect property by raising the understanding of risks and by contributing to a safer, more prosperous and resilient Canada. It does not lay out the requirements for preparing related EM protocols, processes, and standard operating procedures (SOP) internal to the institution; however, these should be developed in support of the SEMP and related plans. As outlined in the Preface, many federal government institutions already have specific plans or processes to deal with aspects of emergency management; many also have a long track record of preparing and refining BCPs, which endeavour to ensure the continued availability of critical services. Each season has its own wheel quadrant describing the activities usually undertaken in each month of the year.
Planning can be triggered by the EM planning cycle or it can be initiated in preparation for, or in response to, an event that is induced either by nature or by human actions. Consideration should be given to having representation from several program and corporate areas, including (if applicable) regional representation. Those federal government institutions that have mandated emergency support functions (ESFs) under the FERP should have these clearly identified.
Notwithstanding the blueprint provided, this step is not proposed as a linear process, but rather as a set of related components and activities that can be undertaken in the sequence that best suits the institution. Scanning can be done on a regularly scheduled basis, such as annually, or on a continuous basis for environmental factors that are dynamic or that are of greatest interest to the institution.
The following diagram illustrates the external and internal environmental factors to consider. This process will add the extra assurance that your institution is linked in with partner agencies and others to assist in developing the broader environmental picture and in identifying EM-related interdependencies. Each institution has its own strategic and operational objectives, with each being exposed to its own unique risks, and each having its own information and resource limitations. An all-hazards approach to risk management does not necessarily mean that all hazards will be assessed, evaluated and treated, but rather that all hazards will be considered.
The aim is to generate a comprehensive list of risks based on those events that might prevent, degrade or delay the achievement of objectives. Risks should be realistic, based on drivers that exist in the institution's operating environment. It can be a useful tool for managing and addressing risks, as well as facilitating risk communication to stakeholders. Descriptive scales can be formed or adjusted to suit the circumstances, and different descriptions can be used for different risks.
Risk evaluation is the process of comparing the results of the risk analysis against risk criteria to determine whether the level of risk is acceptable or intolerable.


The one most commonly used is the risk matrix (Figure 4), which normally plots the likelihood and impact on the x- and y-axes (the measured components of risks).
Similarly, certain assumptions will be made that influence the development of the SEMP building blocks. Although planning considerations will vary from institution to institution, the following identifies the most common planning considerations associated with the four pillars of EM planning.
EBSA oversees approximately 681,000 private-sector retirement plans, approximately 2.3 million health plans, and a similar number of other welfare benefit plans that provide benefits to approximately 143 million Americans. In that position, she was involved in research and policy analysis involving employee benefit plans, the uninsured, managed care, and legal barriers to the development of health information technology. In 1993, she served on working groups dealing with insurance reform, workers’ compensation and employer coverage in connection with the Clinton Task Force on Health Care Reform. District Court for the Northern District of Ohio and served as a public member of the Administrative Committee for the Goodyear retiree health trust. The primary responsibilities of the Division of Individual Exemptions include analyzing individual exemption applications which involve a wide array of financial transactions, preparing interpretive letters and Federal Register notices, and reviewing petitions for good faith waivers of section 502(l) penalties. OPR is headed by EBSA’s Director of Policy and Research, who also serves as EBSA’s Chief Economist. The Division of Research and Economic Analysis conducts and disseminates economic research calibrated to advance EBSA’s mission and expand economic knowledge related to employee benefits.
In addition, the Office coordinates regulatory and interpretive activities with other Federal agencies such as the Department of Treasury, the Internal Revenue Service and the Pension Benefit Guaranty Corporation.
The general interpretive responsibilities of the Office are allocated on a subject matter basis between the Division of Fiduciary Interpretations and the Division of Coverage, Reporting and Disclosure. OEA coordinates the development of the Agency’s Strategic Plan for Outreach, Education and Assistance, establishes policies and operating procedures for the program, provides oversight and support to the Regional Offices in carrying out these activities, and oversees quality reviews and customer satisfaction surveys related to the program. The Office leads the development and publication of a variety of educational materials for consumers and plan officials and is responsible for policy and content development for the Agency’s Website. They will determine which option in the mode for presenting information will work best for her in this assignment. Whether you're writing a donation request letter for a charity, a church, or other sponsorship, our sample donation letter template can help you get started. We can't guarantee the results you will get for sending fundraising letters like this, but this template and the sample donation letters below should at least provide some ideas. More importantly, they were given the chance to develop confidence, to feel wanted and to develop dreams for their future, dreams that have included becoming engineers, accountants, doctors and politicians.
Providers and patients encounter numerous issues, such as the timing of each dose, screening for contraindications and precautions, the number of vaccines to be administered, the educational needs of patients and parents, and interpreting and responding to adverse events. New topics often are added when ACIP decides that previous ACIP statements on general issues such as combination vaccines, adolescent vaccination, or adult vaccination should be revised and combined with the General Recommendations on Immunization. GRWG, which met monthly beginning June 2007, formed subgroups on the basis of interest in topics such timing and spacing, vaccine administration, and storage and handling.
In June 2009, ACIP voted to incorporate the contents of a 1999 ACIP statement on combination vaccines. Vaccines are recommended for members of the youngest age group at risk for experiencing the disease for which efficacy and safety have been demonstrated. Unconjugated polysaccharide vaccines do not induce T-cell memory, and additional doses (although they elicit the same or a lower antibody concentration) might increase the level of protection.
Doses administered too close together or at too young an age can lead to a suboptimal immune response.
For example, if the first dose of varicella vaccine were inadvertently administered at age 10 months, the repeat dose would be administered no earlier than the child's first birthday (the minimum age for the first dose).
Simultaneously administering all vaccines for which a person is eligible at the time of a visit increases the probability that a child, adolescent, or adult will be vaccinated fully by the appropriate age (8).
To reduce the number of injections at the 12- through 15-month visit, the hepatitis B series and 3 doses of IPV (20) can be administered before the child's first birthday. The third (PRP-OMP) or fourth (PRP-T) dose of the Hib series and the fourth doses of DTaP and PCV are critical in boosting antibody titer and ensuring continued protection (22--25). Use of combination vaccines can reduce the number of injections patients receive and alleviate concern associated with the number of injections (20,27,28). The price of a combination vaccine might exceed the total price of separate vaccines containing the same antigens. For diseases without such surrogate laboratory markers, prelicensure field vaccine efficacy (phase III) trials or postlicensure surveillance generally are required to determine protection (47).
An extra dose of many live-virus vaccines and Hib or hepatitis B vaccine has not been found to be harmful (48).
In such cases, the benefits and risks of administering the combination vaccine with an unneeded antigen should be carefully considered and discussed with the patient or parent.
Administration of extra doses of tetanus toxoid vaccines earlier than the recommended intervals can increase the risk for hypersensitivity reactions (16,24,50).
Simultaneous administration of quadrivalent meningococcal conjugate vaccine (MCV4), PCV, and Tdap, all of which contain diphtheria toxoid, is not associated with reduced immunogenicity or an increase in local adverse events (24,51). The effect of blood and immune globulin preparations on the response to mumps and varicella vaccines is unknown; however, commercial immune globulin preparations contain antibodies to these viruses. These women should be vaccinated immediately after giving birth and, if possible, tested ?3 months later to ensure immunity to rubella and, if appropriate, to measles (2). If the interval between administration of any of these vaccines and subsequent administration of an antibody-containing product is <14 days, vaccination should be repeated after the recommended interval (Tables 4 and 5) unless serologic testing indicates a protective antibody response. The vaccine or toxoid and antibody preparation should be administered at different sites using the standard recommended dose. However, in the absence of a clear serologic correlate of protection for pertussis, the relevance of these immunogenicity data for protection against pertussis is unknown. With exception of oral typhoid vaccine, an interruption in the vaccination schedule does not require restarting the entire series of a vaccine or toxoid or addition of extra doses. Although vaccinations should not be postponed if records cannot be found, an attempt to locate missing records should be made by contacting previous health-care providers, reviewing state or local IISs, and searching for a personally held record.
A contraindication is a condition in a recipient that increases the risk for a serious adverse reaction. Children who experienced encephalopathy within 7 days after administration of a previous dose of diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTP), DTaP, or Tdap not attributable to another identifiable cause should not receive additional doses of a vaccine that contains pertussis. A recent study found an increased risk for febrile seizures in children who receive MMRV compared with MMR and varicella vaccine (35). Among the most common conditions mistakenly considered to be contraindications are diarrhea, minor upper respiratory tract illnesses (including otitis media) with or without fever, mild to moderate local reactions to a previous dose of vaccine, current antimicrobial therapy, and being in the convalescent phase of an acute illness. Vaccination should not be delayed because of the presence of mild respiratory tract illness or other acute illness with or without fever. Discussion of the benefits of and risks from vaccination is sound medical practice and is required by law. Having a basic understanding of how patients and parents of patients view vaccine risk and developing effective approaches to address vaccine safety concerns are imperative for vaccination providers.
Health-care providers should reinforce key points about each vaccine, including safety, and emphasize risks for disease among unvaccinated children. Of particular concern among adolescents has been the risk for serious secondary injuries, including skull fracture and cerebral hemorrhage. If flushing, facial edema, urticaria, itching, swelling of the mouth or throat, wheezing, dyspnea, or other signs or symptoms of anaphylaxis occur, the patient should be placed in a recumbent position with the legs elevated if possible (81,82). An adverse event is an untoward event that occurs after a vaccination that might be caused by the vaccine product or vaccination process. Potential causal associations between reported adverse events after vaccination can be assessed through epidemiologic or clinical studies. Claims arising from covered vaccines must first be adjudicated through the program before civil litigation can be pursued.
Successful claimants receive a legal presumption of causation if a condition listed in the table is proven, thus avoiding the need to prove actual causation in an individual case. Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands.
Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated.
Because the majority of vaccines have a similar appearance after being drawn into a syringe, prefilling might result in administration errors.
An adjuvant is a vaccine component distinct from the antigen that enhances the immune response to the antigen. Intramuscular injections are administered at a 90-degree angle to the skin, preferably into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the age of the patient (Table 10). A ?-inch needle is adequate only for the deltoid muscle and only if the skin is stretched flat between thumb and forefinger and the needle is inserted at a 90-degree angle to the skin. Most children in this age range require a ?- or 1-inch needle (or intermediate size, if available). A ?-inch, 23- to 25-gauge needle should be inserted into the subcutaneous tissue (Figures 4 and 5). For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. Immune responses generated by jet injectors against both attenuated and inactivated viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection. Evidence indicates that this cream does not interfere with the immune response to MMR (113). Hepatitis B administered intradermally might result in a lower seroconversion rate and final titer of hepatitis B surface antibody than when administered by the deltoid intramuscular route (118,119). Response to vaccines recommended by the subcutaneous route are unlikely to be affected if the vaccines are administered by the intramuscular rather than subcutaneous route. Any vaccination using less than the standard dose should not be counted, and the person should be revaccinated according to age unless serologic testing indicates that an adequate response has developed. Maintenance of vaccine quality is the shared responsibility of all handlers of vaccines from the time a vaccine is manufactured until administration.
Live, attenuated virus vaccines that should be frozen lose potency when exposed to higher temperatures because the viruses degrade more quickly at storage temperatures that are warmer than recommended (Table 11). Refrigerators without freezers and stand-alone freezers (either manual defrost or automatic defrost) are usually the most effective at maintaining the precise temperatures required for vaccine storage.
EM planning, in particular, aims to strengthen resiliency by promoting an integrated and comprehensive approach that includes the four pillars of EM: prevention and mitigation, preparedness, response and recovery. In addition, there are other existing EM planning documents and initiatives that apply to a range of federal government institutions, such as the Federal Emergency Response Plan (FERP) and deliverables under the National Strategy for Critical Infrastructure. This is also an ideal time to develop an initial budget for such items as training, exercises, research, workshops and other expenses that may be necessary during the development and implementation of the SEMP. Stakeholders may include First Nations, emergency first responders, the private sector (both business and industry), and volunteer and non-government organizations.
This part of the process consists of three main activities: risk identification, risk analysis and risk evaluation. It involves the identification of risk sources, areas of impact, events and their causes, as well as potential consequences. A risk portfolio or profile can be created from the register, helping to compile common risks in order to assess interdependencies and to prioritize groups of risks. Existing controls, the cost of further risk treatment and any policy requirement implications are considered when deciding on additional mitigation measures. Based on a risk diagram or rating matrix, a clustering of risks can be shown, leading to decisions on priorities. The aim is to develop a SEMP that integrates and coordinates elements identified in hazard-specific plans and BCPs. For example, an assumption might be made that the resources required to develop the SEMP will be paid out of the current fiscal year's budget.
As agency head, she oversees the administration, regulation and enforcement of Title I of the Employee Retirement Income Security Act of 1974 (ERISA).
Its staff consists mainly of professional economists and attorneys, and includes EBSA’s Chief Actuary. The Division of Fiduciary Interpretations is responsible for interpretive matters including the fiduciary responsibility, prohibited transaction, qualified domestic relations order and qualified medical child support order provisions of Parts 2, 4, and 6 of Title I of ERISA, as well as related provisions of the Internal Revenue Code and FERSA. The Office is also responsible for the operation of the nationwide toll free hotline for technical assistance and free publications.
The paradoxes of high stakes testing: How they affect students, their parents, teachers, principals, schools and society. 89-329), legislation signed into United States law on November 8, 1965 as part of President Lyndon Johnson's Great Society domestic agenda.
Accessing the general curriculum: Including students with disabilities in standards-based reform.
Be sure to continue reading after the download box to find sample donation request letters, additional tips to improve your own donation letter and links to additional resources. Vaccination providers help patients understand the substantial, occasionally conflicting, information about vaccination. These subgroups also met monthly, conducted literature reviews, and contributed expert opinion on the need for revisions to specific language. Conjugation with a protein carrier improves the effectiveness of polysaccharide vaccines by inducing T-lymphocyte--dependent immunologic function. However, administering a dose a few days earlier the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. If the first dose of varicella vaccine were administered at age 11 months and 2 weeks, the repeat dose should be administered no earlier than 4 weeks thereafter, which would occur after the first birthday.
A study conducted during a measles outbreak demonstrated that approximately one third of measles cases among unvaccinated but vaccine-eligible preschool children might have been prevented if MMR had been administered at the same visit when another vaccine was administered (9). Live, attenuated influenza vaccine (LAIV) does not interfere with the immune response to MMR or varicella vaccines administered at the same visit.
The fourth dose of DTaP is recommended at age 15--18 months but may be administered as early as age 12 months if 6 months have elapsed since the third dose and if there is concern that the child might not return by age 18 months (23). Studies have demonstrated that parents and providers might be uncomfortable with multiple injections during single visits (29--31). However, combination vaccines might represent a better overall economic value if the direct and indirect costs of extra injections, delayed or missed vaccinations, and additional handling and storage are taken into consideration (38). Seven combination vaccines for which separate antigens or antigen combinations exist have been licensed by FDA since 1996 in the United States (Table 2) (39--45). ACIP prefers that doses of vaccine in a series come from the same manufacturer; however, if this is not possible or if the manufacturer of doses given previously is unknown, providers should administer the vaccine that they have available. Oral vaccines (Ty21a typhoid vaccine and rotavirus) can be administered simultaneously or at any interval before or after other live vaccines (injectable or intranasal) if indicated. Blood products available in the United States are unlikely to contain a substantial amount of antibody to yellow fever vaccine virus. Increasing the vaccine dose volume or number of vaccinations is not indicated or recommended. When feasible, the same brand of DTaP vaccine should be used for all doses of the vaccination series. If records cannot be located within a reasonable time, these persons should be considered susceptible and started on the age-appropriate vaccination schedule. A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons. Because of the theoretical risk to the fetus, women known to be pregnant generally should not receive live, attenuated virus vaccines (see Special Situations section). However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Health-care providers can be a pivotal source of science-based credible information by discussing with parents and patients the risks from and benefits of vaccines, which helps patients make informed decisions. Parents should be advised of state laws regarding entry to schools or child-care facilities, which might require that unvaccinated children be excluded from the facility during outbreaks. Of 463 VAERS reports of syncope during January 1, 2005, to July 31, 2007, a total of 41 listed syncope with secondary injury with information on the timing after vaccination, and the majority of these syncope reports (76%) occurred among adolescents.
Claimants also can prevail for conditions not listed in the reportable events table if they prove causation for covered vaccines.
Different vaccines should never be mixed in the same syringe unless specifically licensed for such use, and no attempt should be made to transfer between syringes. Even if the person coughs or sneezes immediately after administration or the dose is expelled any other way, the vaccine dose need not be repeated.
Inactivated vaccines containing an adjuvant should be injected into a muscle because administration subcutaneously or intradermally can cause local irritation, induration, skin discoloration, inflammation, and granuloma formation. Injection technique is the most important parameter to ensure efficient intramuscular vaccine delivery. If the subcutaneous and muscle tissue are bunched to minimize the chance of striking bone (95), a 1-inch needle is required to ensure intramuscular administration in infants aged ?1 month. However, local reactions or injuries are sometimes more frequent on delivery of vaccine by jet injectors compared with needle injection, depending on the inherent irritability of the vaccine and operator technique (102). Topical lidocaine-prilocaine emulsion should not be used on infants aged <12 months who are receiving treatment with methemoglobin-inducing agents because of the possible development of methemoglobinemia (114).
Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated. Repeating doses of vaccine administered by the intramuscular route when recommended to be by the subcutaneous route is not necessary. If less than a full recommended dose of a parenteral vaccine is administered because of syringe or needle leakage, the dose should be repeated. All vaccines should be inspected on delivery and monitored during storage to ensure that the recommended storage temperatures are maintained. Such single-purpose units sold for home use are less expensive alternatives to medical specialty equipment (123) and are preferable to combination units. AGIMO will consolidate agency information to provide a national picture of the size and complexity of the upgrade, and to develop solutions and materials to assist agencies with their transition to WCAG 2.0.
Institutions may choose to assess a portfolio of risks, as opposed to specific individual risks, which enables a holistic review of risk treatment decisions.
Information can be gleaned from historical data, theoretical analyses, and informed and expert judgements.
Qualitative analysis is often simpler, but also results in high uncertainty in the results. Such a plot can help establish acceptable or intolerable risk levels, and establish their respective actions. She is a member of the District of Columbia Bar and is admitted to practice before the U.S. The Division of Coverage, Reporting and Disclosure is generally responsible for interpretive matters relating to the coverage, reporting, disclosure, suspension of benefits, preemption, claims procedure, multiple employer welfare arrangements (MEWA), COBRA and other provisions of Parts 1, 2, 5 and 6 of Title I of ERISA. OEA coordinates three major education campaigns - the Retirement Savings Education Campaign, the Fiduciary Education Campaign and the Health Benefits Education Campaign. Person versus process praise and criticism: Implications for contingent self-worth and coping.
108-446, establishes the NIMAS as a national standard and requires states and local districts to adopt the NIMAS for providing textbooks and instructional materials to students who are blind or print-disabled. The report also includes revised content from previous ACIP recommendations on the following topics: adult vaccination (CDC.
These vaccination recommendations are intended for clinicians and other health-care providers who vaccinate patients. In October 2008, GRWG consulted ACIP to determine the best mechanism for approving the resulting document. ACIP also approved minor changes to the section on Special Situations and the section on Vaccination Records. Simultaneous administration also is critical when preparing for foreign travel and when a health-care provider is uncertain that a patient will return for additional doses of vaccine. No data exist about the immunogenicity of oral Ty21a typhoid vaccine when administered concurrently or within 30 days of live virus vaccines. Potential advantages of combination vaccines include 1) improved vaccine coverage rates (32), 2) timely vaccination coverage for children who are behind the schedule (33,34), 3) reduced shipping and stocking costs, 4) reduced costs for extra health-care visits necessitated by deferral of vaccination, and 5) facilitation of additional new vaccines into vaccination programs.
In the future, combination vaccines might include increasing numbers of components in different arrays to protect against these and other diseases.
Extra doses of tetanus-toxoid--containing vaccines might be appropriate for certain patients, including for children who previously received DT or Td vaccine and need protection from pertussis (in DTaP or Tdap) or for immigrants with uncertain vaccination histories.
Another study determined that the response to yellow fever vaccine is not affected by monovalent measles vaccine administered 1--27 days earlier (18). The length of time that interference with injectable live-virus vaccine (other than yellow fever) can persist after the antibody-containing product is a function of the amount of antigen-specific antibody contained in the product (56--58). If vaccination providers do not know or have available the type of DTaP vaccine previously administered to a child, any DTaP vaccine may be used to continue or complete the series. For example a dose of DTaP should be considered for a person in a community with a pertussis outbreak even if that person previously developed Guillain-Barre syndrome after a dose.
This precaution avoids causing diagnostic confusion between manifestations of the underlying illness and possible adverse effects of vaccination or superimposing adverse effects of the vaccine on the underlying illness.
The act does not require that a signature be obtained; however, documentation of consent might be recommended or required by certain state or local health authorities or school authorities. Establishing evidence for cause and effect on the basis of case reports and case series alone is usually not possible because health problems that have a temporal association with vaccination do not necessarily indicate causality.
Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. Introduction of low levels of vaccine viruses into the environment likely is unavoidable when administering LAIV; however, no instances have been reported of illness or attenuated vaccine virus infections among inadvertently exposed health-care providers or immunocompromised patients. Routes of administration are recommended by the manufacturer for each immunobiologic (Table 9). For the majority of infants, a 1-inch, 22- to 25-gauge needle is sufficient to penetrate the thigh muscle.
Jet injectors that use the same nozzle for consecutive injections without intervening sterilization were used in mass vaccination campaigns from the 1950s through the 1990s (102); however, these were found to be unsafe because of the possibility of bloodborne pathogen transmission (105--108) and should not be used.
Use of a topical refrigerant (vapocoolant) spray immediately before vaccination can reduce the short-term pain associated with injections and can be as effective as lidocaine-prilocaine cream (115). Similarly, doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated (120).
Using larger than recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents.
Vaccines should continue to be stored at recommended temperatures immediately on receipt until use. A combination refrigerator-freezer unit sold for home use might be adequate for storing limited quantities of vaccines if the refrigerator and freezer compartments have separate external doors. OEA staff provides logistical, clerical and technical support throughout the year to the ERISA Advisory Council and is responsible for the operation of the Agency’s Public Disclosure Room and handling Freedom of Information Act requests. For engaging with learning, UDL materials offer alternative pathways to success including choice of content where appropriate, varied levels of support and challenge, and options for recruiting and sustaining interest and motivation. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. ACIP concluded that the document could be approved and finalized incrementally, with a final vote on the entire document. In October 2009, ACIP voted to revise the entire General Recommendations on Immunization, which incorporated ACIP recommendations on adolescent vaccination (1996) and adult vaccination (1991) into the section on Vaccination Programs.
Subsequent exposure to such viruses usually results in a rapid anamnestic antibody response without viremia. Doses of any vaccine administered ?5 days earlier than the minimum interval or age should not be counted as valid doses and should be repeated as age appropriate. In the absence of such data, if typhoid vaccination is warranted, administration should not be delayed because of recent administration of live, attenuated virus vaccines (14).
The minimum age for administration of combination vaccines is the oldest minimum age for any of the individual components; the minimum interval between doses is equal to the greatest minimum interval of any of the individual components. The effect of nonsimultaneous administration of rubella, mumps, varicella, and yellow fever vaccines is unknown. Therefore, after an antibody-containing product is received, live vaccines (other than yellow fever, oral Ty21a typhoid, LAIV, zoster, and rotavirus) should be delayed until the passive antibody has degraded (Table 4).
For a child who needs 2 doses of influenza vaccine (TIV or LAIV), it is preferable to use the same type of vaccine for both doses. However, commercial serologic testing might not always be sufficiently sensitive or standardized for detection of vaccine-induced immunity (with the exception of hepatitis B vaccination at 1--2 months after the final dose), and research laboratory testing might not be readily available. After screening them for contraindications, persons with moderate or severe acute illness should be vaccinated as soon as the acute illness has improved. Providers should take appropriate measures to prevent injuries if a patient becomes weak or dizzy or loses consciousness.
This typically is no longer than the same clinic day (typically recommended as a maximum for inactivated vaccines). When syringes are filled, the type of vaccine, lot number, and date of filling must be labeled on each syringe, and the doses should be administered as soon as possible after filling.
The regulations also require maintenance of records documenting injuries caused by needles and other medical sharp objects and that nonmanagerial employees be involved in the evaluation and selection of safety-engineered devices before they are procured. The risk for acquiring vaccine viruses from the environment is unknown but is likely low; in addition, vaccine viruses are cold-adapted and attenuated and unlikely to cause symptomatic influenza.
Deviation from the recommended route of administration might reduce vaccine efficacy (90,91) or increase the risk for local adverse reactions (92--94). For neonates (first 28 days of life) and preterm infants, a ?-inch needle usually is adequate if the skin is stretched flat between the thumb and forefinger and the needle is inserted at a 90-degree angle to the skin (97).
Health-care practices should consider using a vaccination site map so that all persons administering vaccines routinely use a particular anatomic site for each different vaccine. A new generation of jet injectors with disposable cartridges and syringes has been developed since the 1990s. Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination.
MCV4 should be administered intramuscularly; however, revaccination is not necessary if a vaccine dose is administered subcutaneously (121). Inadequate vaccine storage also can result in the loss of thousands of dollars worth of vaccine inventory and the cost of inventory replacement. Before using the refrigerator for vaccine storage, the temperature should be allowed to stabilize and then be measured in various locations within the refrigerator compartment to document that a consistent temperature can be maintained within the compartment (Table 11) (124).
Agencies must identify the critical information and services required to be maintained on their websites.
Three votes were taken to approve various sections of the document, and one vote was taken to approve the entire document. The repeat dose should be spaced after the invalid dose by the recommended minimum interval (Table 1). Simultaneous administration of pneumococcal polysaccharide vaccine (PPSV) and inactivated influenza vaccine elicits a satisfactory antibody response without increasing the incidence or severity of adverse reactions (15).
With use of the combination Hib-hepatitis B vaccine, the minimum age of administration of the final dose is 12 months because of the minimum age requirement for the last dose of the Hib series (26). Considerations should include provider assessment,§ patient preference, and the potential for adverse events. If a dose of injectable live-virus vaccine (other than yellow fever and zoster) is administered after an antibody-containing product but at an interval shorter than recommended in this report, the vaccine dose should be repeated unless serologic testing is feasible and indicates a response to the vaccine.
However, if the child is eligible for either TIV or LAIV, and the type of vaccine used for the first dose is not available, either vaccine can be used for the second dose. Studies indicate that failure to vaccinate children with minor illnesses can impede vaccination efforts (74--76). After the patient is stabilized, arrangements should be made for immediate transfer to an emergency facility for additional evaluation and treatment.
With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (116).
Inactivated influenza vaccine is immunogenic when administered in a lower than standard dose by the intradermal route to healthy adult volunteers (122).
New units might need ?2 days of operation to establish a stable operating temperature; vaccine should not be stored in the unit until the unit maintains an appropriate and stable storage temperature.
Federal government agencies must have regard for Web Guide’s Online Content Requirements, the Information Publication Scheme12and other agency-specific content policies. At this final meeting, ACIP also discussed concerns about the lack of evidence that supports use of antipyretics before or at the time of vaccination for the prevention of fever. For example, if the first and second doses of Haemophilus influenzae type b (Hib) were administered only 14 days apart, the second dose would be invalid and need to be repeated because the minimum interval from dose 1 to dose 2 is 4 weeks. Simultaneous administration of PPSV and inactivated influenza vaccine is recommended for all persons for whom both vaccines are indicated. The repeat dose or serologic testing should be performed after the interval indicated for the antibody-containing product (Table 5).
For vaccines in general, vaccination should not be deferred because the brand used for previous doses is not available or is unknown (23,67).
Among persons whose compliance with medical care cannot be ensured, use of every opportunity to administer appropriate vaccines is critical. Vaccine providers, particularly when vaccinating adolescents, should consider observing patients (with patients seated or lying down) for 15 minutes after vaccination to decrease the risk for injury should they faint (77). In addition to administration errors, prefilling of syringes is a concern because FDA does not license administration syringes for vaccine storage.
The infant should receive the remaining recommended doses of rotavirus vaccine following the routine schedule. Several of the newer devices have been approved by FDA for sale in the United States (102).
However, the immunogenicity for persons aged ?60 years is inadequate, and varying the recommended route and dose is not recommended. State and territory agencies should comply with the website content guidelines applicable to their jurisdiction.
Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates---assessment and feedback of provider-based vaccination coverage information.
Consequently, CDC added information highlighting the lack of evidence for the use of antipyretics to the section on Methods for Alleviating Discomfort and Pain Associated with Vaccination. The repeat dose should be administered ?4 weeks after the invalid dose (in this case, the second).
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and trivalent inactivated influenza vaccine (TIV) can be administered simultaneously (16). Unless the parent or caregiver expresses a preference for MMRV vaccine, MMR and varicella vaccine should be administered for the first dose for children aged 12--47 months (35). These include persons with underlying medical conditions placing them at higher risk or who are likely to be at risk, including pregnant women, persons with asthma, and persons aged ?50 years (68).
Hepatitis B vaccine administered with yellow fever vaccine is as safe and immunogenic as when these vaccines are administered separately (17). When in doubt about the appropriate handling of a vaccine, vaccination providers should contact the manufacturer. A storage unit should be sufficiently sized so that vaccines can be placed away from the walls in the part of the unit best able to maintain the constant, required temperature. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years---linkage of vaccination and WIC services. This meeting served solely to update the work group regarding the discussions and vote of the October 2009 meeting and CDC deliberations on changes to the recommendations on the use of antipyretics. Measles and yellow fever vaccines have been administered safely at the same visit and without reduction of immunogenicity of either of the components (18,19). Combination units, with separate compartments of smaller size, can only be used to store limited quantities of vaccines. Agencies should complete this stage by compiling a list of websites and web services to be upgraded. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. Agencies have autonomy to decide whether they will self-assess for WCAG 2.0 conformance or require independent assessment.
Agencies are reminded that automated tools provide incomplete conformance information, and human assessment is also required.
This assessment should have regard for the current lifecycle of the website and its associated services, to ensure that WCAG 2.0 is applied during ‘refresh’ procedures. Current and planned content management systems, publishing processes and website content workflows also need to be reviewed, to ensure that the process of creating web content can be streamlined to meet accessibility requirements. It is likely that staff will need to undertake specific WCAG 2.0 training programs to enhance the skill set within their agencies. Risks will be calculated on multiple factors: the number of websites within the scope and the current WCAG conformance level of websites, along with current infrastructure and skill capabilities.
Agencies will also need to assess risk for websites they consider outside the scope for upgrade, noting planned actions (i.e. For example, mapping interfaces (the visual representation of spatial data) will require a project or working group to be developed to seek a solution for government. It also allows time for infrastructure upgrades to follow an agency’s regular refresh cycle, or to deploy new technologies and content management systems if necessary.
All content management systems associated with agency websites should be upgraded to ensure their outputs can meet WCAG 2.0. Through the use of effective content management systems, agencies may be able to rollout technical solutions across multiple websites in a simplified process. Agencies should ensure that their staff are adequately trained on the requirements of WCAG 2.0 and, where possible, that business managers gain an understanding of the business benefits of accessible websites.
To establish conformance, agencies will need to implement their own testing regime, and in some cases employ external professionals to assist with testing.AGIMO will investigate whole-of-government automated conformance testing tools.
It must be borne in mind, however, that automated testing tools can only interpret a limited range of criteria, which means that human judgment will also be needed in carrying out the tests.
This will require staff skilled in web accessibility who can understand and apply the guidelines.For federal agencies, conformance reports should be provided to AGIMO and may be subject to independent validation.



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