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Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
At the conclusion of the nineteenth century, one of the issues that attracted the attention of reformers in the South was road improvements. Populists who subscribed to the tenets of the good roads movement sought to provide farmers with better access to markets, make the cultural and employment opportunities of cities more available, and perhaps even halt the mass exodus of young people from the farms.
This is the fourth volume in an operational and chronological series covering the U.S. Marine Corps’ participation in the Vietnam War. This volume details the change in focus of the III Marine Amphibious Force (III MAF), which fought in South Vietnam’s northernmost corps area, I Corps. This volume, like its predecessors, concentrates on the ground war in I Corps and III MAF’s perspective of the Vietnam War as an entity. It also covers the Marine Corps participation in the advisory effort, the operations of the two Special Landing Forces of the U.S. Navy’s Seventh Fleet, and the services of Marines with the staff of the U.S. Military Assistance Command, Vietnam. There are additional chapters on supporting arms and logistics, and a discussion of the Marine role in Vietnam in relation to the overall American effort.
Detailed report of a 30-year study of the water quality of the Wabash River.
The working paper is divided into two main parts. The first part is a descriptive analysis of the illicit use of biological agents by criminals and terrorists. It draws on a series of case studies documented in the second part. The case studies describe every instance identifiable in open source materials in which a perpetrator used, acquired, or threatened to use a biological agent. While the inventory of cases is clearly incomplete, it provides an empirical basis for addressing a number of important questions relating to both biocrimes and bioterrorism. This material should enable policymakers concerned with bioterrorism to make more informed decisions. In the course of this project, the author has researched over 270 alleged cases involving biological agents. This includes all incidents found in open sources that allegedly occurred during the 20th Century. While the list is certainly not complete, it provides the most comprehensive existing unclassified coverage of instances of illicit use of biological agents.
No person or place is immune from disasters or disaster-related losses. Infectious disease outbreaks, acts of terrorism, social unrest, or financial disasters in addition to natural hazards can all lead to large-scale consequences for the nation and its communities. Communities and the nation thus face difficult fiscal, social, cultural, and environmental choices about the best ways to ensure basic security and quality of life against hazards, deliberate attacks, and disasters. Beyond the unquantifiable costs of injury and loss of life from disasters, statistics for 2011 alone indicate economic damages from natural disasters in the United States exceeded $55 billion, with 14 events costing more than a billion dollars in damages each. One way to reduce the impacts of disasters on the nation and its communities is to invest in enhancing resilience-the ability to prepare and plan for, absorb, recover from and more successfully adapt to adverse events. Disaster Resilience: A National Imperative addresses the broad issue of increasing the nation's resilience to disasters. This book defines "national resilience", describes the state of knowledge about resilience to hazards and disasters, and frames the main issues related to increasing resilience in the United States. It also provide goals, baseline conditions, or performance metrics for national resilience and outlines additional information, data, gaps, and/or obstacles that need to be addressed to increase the nation's resilience to disasters. Additionally, the book's authoring committee makes recommendations about the necessary approaches to elevate national resilience to disasters in the United States. Enhanced resilience allows better anticipation of disasters and better planning to reduce disaster losses-rather than waiting for an event to occur and paying for it afterward. Disaster Resilience confronts the topic of how to increase the nation's resilience to disasters through a vision of the characteristics of a resilient nation in the year 2030. Increasing disaster resilience is an imperative that requires the collective will of the nation and its communities. Although disasters will continue to occur, actions that move the nation from reactive approaches to disasters to a proactive stance where communities actively engage in enhancing resilience will reduce many of the broad societal and economic burdens that disasters can cause.