Health Care Financing Administration--Adoption of the National Bureau of Standards fire safety evaluation system for health care facilities. Final notice

The Department of Health, Education, and Welfare proposed extending the new Fire Safety Evaluation sSystem (FSES) to all hospitals participating in the Medicare and Medicaid programs in a Notice of comment period publishedon June 28, 1979 in the Federal Register (44 FR 37818). The Department also sought public comment on whether to apply the FSES to skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) in this same Notice. After a careful review and analysis of the public comments received, the Department has decided to adopt the FSES as a means of evaluating alternative arrangements used to achieve compliance with the provisions of the Life Safety Code for hospitals, skilled nursing facilities, and intermediate care facilities participating in the Medicare and Medicaid programs.     

Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule

This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions.     

Community residential care program and contract program for veterans with alcohol and drug dependence disorders--VA. Final rule

This document updates the Department of Veterans Affairs (VA) regulations concerning the Community Residential Care Program and the Contract Program for Veterans with Alcohol and Drug Dependence Disorders by incorporating by reference relevant portions of the latest editions of the National Fire Protection Association Life Safety Code entitled "NFPA 101, Life Safety Code" and "NFPA 101A, Guide on Alternative Approaches to life Safety." This is intended to ensure that buildings used for treatment and residential services for veterans meet appropriate fire and safety standards. Also, this document amends the regulations for such programs by delegating authority to each of the Veterans Integrated Service Network (VISN) Directors of the Veterans Health Administration to grant certain equivalencies or variances to building standards of the Life Safety Code. Further, this final rule does not adopt the portion of the proposed rule concerning the Adult Day Health Care Program since the Adult Day Health Care Program and the corresponding regulations are no longer in existence.     

Medicare and Medicaid programs; fire safety requirements for certain health care facilities; amendment. Final rule

This final rule adopts the substance of the April 15, 2004 tentative interim amendment (TIA) 00-1 (101), Alcohol Based Hand Rub Solutions, an amendment to the 2000 edition of the Life Safety Code, published by the National Fire Protection Association (NFPA). This amendment allows certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions. This final rule also requires that nursing facilities at least install battery-operated single station smoke alarms in resident rooms and common areas if they are not fully sprinklered or they do not have system-based smoke detectors in those areas. Finally, this final rule confirms as final the provisions of the March 25, 2005 interim final rule with changes and responds to public comments on that rule.     

Medicare and Medicaid programs; fire safety requirements for certain health care facilities; amendment. Interim final rule with comment period

This interim final rule with comment period adopts the substance of the April 15, 2004 temporary interim amendment (TIA) 00-1 (101), Alcohol Based Hand Rub Solutions, an amendment to the 2000 edition of the Life Safety Code, published by the National Fire Protection Association (NFPA). This amendment will allow certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions. This interim final rule with comment period also requires that nursing facilities install smoke detectors in resident rooms and public areas if they do not have a sprinkler system installed throughout the facility or a hard-wired smoke detection system in those areas.     

Fatality During Servicing of Fire Extinguisher

Fire extinguisher is an integral part of emergency responses to small fires. Different types of fire extinguisher exists; cartridge‐based fire extinguisher is commonly used. Despite their intended use for safety, such devices can become dangerous if not properly handled or maintained. This case report describes the death of a soldier from the explosion of a cartridge‐based fire extinguisher during routine servicing. The case is the first reported in the medical literature. A safety device like fire extinguisher can become dangerous if not handled with care and due steps should be taken for the maintenance of such devices before being operated in the public domain.     

Expanded phase out provisions of intermediate care facilities for the mentally retarded (ICFs/MR) correction plans--Health Care Financing Administration. Final rule

This regulation authorizes Intermediate Care Facilities For the Mentally Retarded (ICFs/MR) to negotiate revisions to their 1977 correction plans for Life Safety Code, living, dining, and therapy area deficiencies under certain circumstances. Under this regulation, HCFA is authorized to approve revised correction plans when facilities have completed at least 25 percent of their original plans and agree to phase out an increased number of beds in previously certified units not already scheduled for phase out under existing correction plans. The timetable for the phase out and the actual number of beds to be phased out will be negotiated with target figures established for each six-month period of the plan. The total time for the plan cannot exceed five years from the effective date of this rule. Facilities are still required to meet the July 18, 1982 deadline for those items in existing plans which include construction or renovation of units that will remain in use after the phase out is completed. The intent of this regulation is to stimulate an overall reduction in the number of certified beds in large residential facilities. We hope that it will forestall further expenditures of capital funds for renovation of existing facilities or construction of new units where an expanded phase out of units is feasible.     

Updating fire safety standards. Final rule; affirmation

This document affirms as final, without changes, a provision included in a final rule with request for comments that amended the Department of Veterans Affairs (VA) regulations concerning community residential care facilities, contract facilities for certain outpatient and residential services, and State home facilities. That provision established a five-year period within which all covered buildings with nursing home facilities existing as of June 25, 2001, must conform to the automatic sprinkler requirement of the 2009 edition of the National Fire Protection Association (NFPA) 101. This rule helps ensure the safety of veterans in the affected facilities.     

ASTM standards for fire debris analysis: a review

The American Society for Testing and Materials (ASTM) recently updated its standards E 1387 and E 1618 for the analysis of fire debris. The changes in the classification of ignitable liquids are presented in this review. Furthermore, a new standard on extraction of fire debris with solid phase microextraction (SPME) was released. Advantages and drawbacks of this technique are presented and discussed. Also, the standard on cleanup by acid stripping has not been reapproved.Fire debris analysts that use the standards should be aware of these changes.     

Ethylene oxide; certain pesticide products registered for the sterilization of equipment and supplies in hospitals and health care facilities; withdrawal of revised labeling notice--EPA. Withdrawal of notice

EPA issued a notice requesting registrants of pesticide products containing ethylene oxide (EtO) registered for certain uses in hospitals and health care facilities to submit applications to amend approved labeling. Elsewhere in this issue of the Federal Register, the Occupational Safety and Health Administration (OSHA) has promulgated comprehensive exposure standards for all occupational uses of EtO. Therefore, EPA has decided to withdraw the original notice in recognition of concerns regarding the potential preemption of the OSHA standards.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule

This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence.     

注册防火工程师执业与管理的构想与展望

文章假设我国已建立注册防火工程师制度,那么消防机构将已进行性能化建筑防火设计与评估的工程实行备案制度,不进行具体的建筑防火审查。注册防火工程师执业的机构形式有两种:大型设计院、研究所、高校所属的性能化防火设计研究所和社会性的火灾安全咨询服务公司。公安部消防局是注册防火工程师执业机构的主管部门,并对其进行行业与技术管理,如人员组成、软件设备、注册资金及收费标准、人员培训与业务指导以及建筑设计修改等。     

Regulating to ensure patient safety in hospitals: towards a comprehensive framework

This article critically examines the successes and failures of the current internal and external regulatory regimes for ensuring the delivery of patient safety in public hospitals. It argues that governments should develop a holistic approach to regulation through the enhancement of existing compliance mechanisms in conjunction with some formal regulation to ensure that public hospital systems-deliver high standards of service with minimal patient harm. It recommends that a Patient Safety Authority be established in order to assist with the monitoring of incidents and the enforcement of compliance with patient safety standards.     

论《食品安全法》对我国食品安全监管体制的影响

近几年来,我国食品安全问题不断,暴露出我国食品安全政府监管体制存在诸多弊端。本文探讨新《食品安全法》出台后,我国食品安全监管在监管体制、食品安全标准、免检制度、监管行为等几个方面的变化以及尚存在的问题。     

Medicare and Medicaid programs; conditions for coverage for end-stage renal disease facilities. Final rule

This rule finalizes the February 4, 2005 proposed rule entitled "Medicare Program; Conditions for Coverage for End-Stage Renal Disease Facilities." It establishes new conditions for coverage that dialysis facilities must meet to be certified under the Medicare program. This final rule focuses on the patient and the results of care provided to the patient, establishes performance expectations for facilities, encourages patients to participate in their plan of care and treatment, eliminates many procedural requirements from the previous conditions for coverage, preserves strong process measures when necessary to promote meaningful patient safety, well-being, and continuous quality improvement. This final rule reflects the advances in dialysis technology and standard care practices since the requirements were last revised in their entirety in 1976.     

Analysis of a soldered wire burnt in a fire

Fire investigators frequently encounter electrical wires with melted ends at fire scenes, which can provide useful information on the cause and development of the fire even when the melted ends result from the fires. A bead on a melted end of a wire was found in the area of origin of a massive fire that lasted for nearly a whole day, devastating a factory. The bead appeared to be the end of a wire soldered to a terminal. X-ray analysis showed that the bead is a tin-copper alloy. Although regular tin-lead solder was used in the factory, lead was not detected. This contradictory result stood in the way of fire investigation. Therefore, an unused wire soldered with tin-lead solder was heated in an electric furnace at 500 degrees C for 3 h for further examination. X-ray analysis of this wire showed that copper can be alloyed with tin while losing lead in a long-term heat in a fire.     

Application of computational fluid dynamics modelling in the process of forensic fire investigation: problems and solutions

Fire modelling has been gaining more and more interest into the community of forensic fire investigation. Despite an attractiveness that is partially justified, the application of fire models in that field of investigation rises some difficulties. Therefore, the understanding of the basic principles of the two main categories of fire models, the knowledge of their effective potential and their limitations are crucial for a valid and reliable application in forensic science. The present article gives an overview of the principle and basics that characterise the two kinds of fire models: zone models and field models. Whereas the first ones are developed on the basis of mathematical relation from empirical observations, such as stratification of fluid zones, and give a relatively broad view of mass and energy exchanges in an enclosure, the latter are based on fundamentals of fluid mechanics and represent the application of Computational Fluid Dynamics (CFD) to fire scenarii. Consequently, the data that are obtained from these two categories of fire models differ in nature, quality and quantity. First used in a fire safety perspective, fire models are not easily applied to assess parts of forensic fire investigation. A suggestion is proposed for the role of fire modelling in this domain of competence: a new tool for the evaluation of alternative hypotheses of origin and cause by considering the dynamic development of the fire. An example of a real case where such an approach was followed is explained and the evaluation of the obtained results comparing to traces revealed during the on-site investigation is enlightened.     

关于土地归属的初步讨论——以大陆法系传统、罗马法和俄罗斯法为视角

在以罗马法为基础的大陆法系传统中,关于土地归属的法律规定对俄罗斯法产生了一定的影响。分析在罗马法以及中世纪法中土地归属法律规定的复杂性,并且就资产阶级法典化过程中,通过个人所有权和他物权体系的构建,对土地归属问题复杂性的简化需要加以说明。此外,大陆法系传统概念在苏联时期俄罗斯法中所遭受的阻力,而所有权结构在俄罗斯联邦新民法典和土地法典中的扩张也值得重视。     

Patient safety and quality improvement. Notice of proposed rulemaking

This document proposes regulations to implement certain aspects of the Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act). The proposed regulations establish a framework by which hospitals, doctors, and other health care providers may voluntarily report information to Patient Safety Organizations (PSOs), on a privileged and confidential basis, for analysis of patient safety events. The proposed regulations also outline the requirements that entities must meet to become PSOs and the processes for the Secretary to review and accept certifications and to list PSOs. In addition, the proposed regulation establishes the confidentiality protections for the information that is assembled and developed by providers and PSOs, termed "Patient safety work product" by the Patient Safety Act, and the procedures for the imposition of civil money penalties for the knowing or reckless impermissible disclosure of patient safety work product.