Blacks are disproportionately likely to be arrested for sales offenses nizagara 50mg amex erectile dysfunction treatment after prostatectomy, so it is likely that harsher sentencing for sales contributes to the disparities in sentencing outcomes generic 50 mg nizagara free shipping erectile dysfunction korean red ginseng. Racial disparities in the incarceration of drug offenders also reflect legislative priorities. Because black Americans are more likely to be sentenced for federal crack offenses, they are disproportionately burdened by the higher crack sentences. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Sentencing Commission 2011, p. Race, Crime, and Punishment There are racial disparities at every stage of drug case processing in state and federal criminal justice systems. As the Seattle research illustrates, race influences perceptions of the danger posed by the different people who use and sell illicit drugs, the choice of drugs that warrant the most public concern, and the choice of neighborhoods in which to concentrate drug law enforcement resources. Yet race is a powerful lens that colors what we see and what we think about what we see. In the United States, images of crime, danger, drug offenders, and criminals are deeply racialized. Tonry (2011) and Provine (2007) summarize studies on the effects of racial attributions and stereotypes on people’s perceptions, attitudes, and beliefs and the ways race correlates with policy choices. Whites may no longer consciously believe in the inherent racial inferiority of blacks, but they nonetheless harbor unconscious racial biases (Rachlinski et al. In one typical study, police officers shown black and white photographs of male university students and employees thought more of the black than white faces looked criminal; the more stereotypically black the face was, the more likely the officers thought the person looked criminal (Eberhardt et al. Unconscious notions and attitudes are most likely to influence criminal justice decisions that have to be made in the face of uncertainty and inadequate information or in ambiguous or borderline cases. To recognize the influence of race on social psychology, unconscious cognitive habits, and “perceptual shorthand” (Hawkins 1981, p. Race helps explain the development and persistence of harsh drug laws and policies. White Americans tend to support harsher punishments more than do blacks, a predilection that has strong roots in racial hostilities, tensions, and resentments (Tonry 2011, p. Researchers have found that whites with racial resentments toward blacks are far more likely to support punitive anticrime policies and that whites are twice as likely as blacks to prefer punishment over social welfare programs to reduce crime (Unnever, Cullen, and Johnson 2008). Even assuming public officials who championed the war on drugs decades ago operated from the best of motives or were simply remarkably ignorant about the likely effects of their decisions, good intentions or ignorance can be no excuse today. No reasonable public official can believe it is a good thing for black America to have in its midst a large caste of second-class citizens—banished into prisons and then branded for life with a criminal record. The persistence of drug policies that disproportionately burden black Americans reflects factors similar to those that led to the adoption of harsh penal policies initially: punitive attitudes toward crime, fear of “the other,” misinformation about drugs and their effects, the belief that using drugs is immoral and wrong, and the lack of instinctive sympathy for members of poor minority communities. At a structural level, the drug war—as part of the criminal justice system—retains its historic function of perpetuating and reinforcing racial inequalities in the distribution of political, social, and economic power and privileges in the United States. White Americans have long used the criminal justice system to advance their interests over those of blacks; the difference today is that they may no longer be doing so consciously. Over a decade ago, observers of drug criminalization in the United States began labeling its impact on black Americans as the “new Jim Crow,” recognizing that drug law enforcement has the effect of maintaining racial hierarchies that benefit whites and disadvantage blacks. In her best-selling book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, Alexander (2010) contends that criminal justice policies and the collateral consequences to a criminal conviction today are—like slavery and Jim Crow in earlier times—a system of legalized discrimination that maintains a racial caste system in America: “today it is perfectly legal to discriminate against criminals in nearly all the ways that it was once legal to discriminate against African Americans…. As a criminal, you have scarcely more rights and arguably less respect, than a black man living in Alabama at the height of Jim Crow. She argues convincingly that drug policies have been and remain inextricably connected to white efforts to maintain their dominant position in the country’s social hierarchy. As Tonry says, “the argument is not that a self-perpetuating cabal of racist whites consciously acts to favor white interests, but that deeper social forces collude, almost as if directed by an invisible hand, to formulate laws, politics, and social practices that serve the interests of white Americans” (Tonry 2011, p. What will it take to change a quarter of a century of drug policies and practices that disproportionately and unjustifiably harm blacks? What will it take for Americans to condemn racial disparities in the war on drugs with the same fervor and moral outrage that they came to condemn the “old” Jim Crow? One part of the answer has to be public recognition that racial discrimination can exist absent from “racist” actors. The norm of racial equality has become descriptive and injunctive, endorsed by nearly every American. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs loathe to recognize or acknowledge structural racism because that would raise questions about their commitment to racial equality—and their willingness to give up the privileges of being white. White discomfort with even the very notion of structural inequality no doubt also is strengthened by conservative American political and moral cultures that stress individual responsibility. Implicit racial bias, racial self- interest, and conservative values combine to make it easy for whites to believe that black incarceration is a reflection of choices blacks have made and penal consequences they have merited. Whites rationalize or avoid seeing the inequities inherent in the war on drugs, assuming or persuading themselves “that the problem is not in the policies they and people like them set and enforce, but in social forces over which they have no control or in the irresponsibility of individual offenders” (Tonry 2011, p. The “myth of a colorblind criminal justice system” is widely influential in the United States because the language of police, judges, prosecutors, and public officials has been wiped clean of explicit racial bias (Roberts 1997, p. United States courts, unfortunately, have made it easier for white Americans to ignore racial disparities in twenty-first century America. Under current constitutional jurisprudence, facially race-neutral governmental policies do not violate the constitutional guarantee of equal protection unless there is both discriminatory impact and discriminatory intent. Supreme Court has decided that every lawsuit involving claims of racial discrimination directed at facially race-neutral rules would be conducted as a search for a “bigoted decision-maker”…. If such actors cannot be found—and the standards for finding them are tough indeed—then there has been no violation of the equal protection clause. In contrast, international human rights law prohibits racial discrimination unaccompanied by racist intent (Fellner 2009). Obviously, laws that make explicit distinctions on the basis of race (other than affirmative action policies) constitute prohibited discrimination. But so do race-neutral laws or law enforcement6 practices that create unwarranted racial disparities, even if they were not enacted or implemented by culpable actors who intentionally sought to harm members of a particular race (United Nations Committee on the Elimination of Racial Discrimination 2005; Zerrougui 2005). It has recommended that the United States “take all necessary steps to guarantee the right of everyone to equal treatment before tribunals and all other organs administering justice, including further studies to determine the nature and scope of the problem, and the implementation of national strategies or plans of action aimed at the elimination of structural racial discrimination” (United Nations Committee on Elimination of Racial Discrimination 2008, paragraph 20). Laws or practices that harm particular racial groups must be eliminated unless they “are objectively justified by a legitimate aim and the means of achieving that aim are appropriate and necessary” (United Nations Committee on the Elimination of Racial Discrimination 2008, paragraph 10). The operational and political convenience of making arrests in low-income minority neighborhoods rather than white middle-class ones may be an explanation but certainly not a justification. Even assuming the legitimacy of the goal of protecting minority neighborhoods from addiction and drug gang violence, the means chosen to achieve that goal—massive arrests of low-level offenders and high rates of incarceration—are hardly a proportionate or necessary response. No independent and objective observer believes the United States can arrest and incarcerate its way out of its “drug problem. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Criminology 44:105–37. National Corrections Reporting Program: Most Serious Offense of State Prisoners, by Offense, Admission Type, Age, Sex, Race, and Hispanic Origin, 2009. Imprisoning Communities: How Mass Incarceration Makes Disadvantaged Neighborhoods Worse. The Rest of their Lives: Life Without Parole for Child Offenders in the United States.
Clin- ical information systems must have a technical foundation that is reliable purchase nizagara 25 mg amex impotence urban dictionary, high performance cheap 100mg nizagara visa impotence ka ilaj, secure, supportable, and adaptable. Few things cripple a clinical information system as quickly as a slow or unreliable infrastructure. Limited ability to enhance applications or augment them with new technologies can result in a poor ﬁt be- tween an application and the clinical workﬂow and in a failure of the application to adapt as organizations and patient care evolve. Poorly Foreword ix designed applications may not weaken as rapidly as an infrastructure that crashes routinely, but they do weaken. Information technology is an extraordinarily potent contribu- tor to our collective efforts to improve the delivery of healthcare. All segments of the healthcare industry must work together and contribute for this vision to occur. He has the remarkable ability to clearly and insightfully write about exceptionally complex topics. He describes emerging information technologies and challenges to our ability to deliver superb healthcare. Jeff highlights the convergence of these technologies and these challenges and sets the stage for a new era of healthcare. This book will serve its readers well as they lead their organiza- tions into this new era. What I learned both encouraged and excited me, and you will ﬁnd the reasons for that excitement in the pages that follow. The Internet “bubble” created a tremendous stir in equity mar- kets, the media, and society in general before bursting ignomin- iously in 2000 and taking more than a trillion dollars of investors’ capital with it. In healthcare, an immense economic sector that moves very slowly, the Internet was like an unidentiﬁed ﬂying ob- ject that ﬂew in one window and out the other without even denting the walls, leaving observers wondering what all the fuss was about. As I surveyed the technology, however, I became convinced that several innovations would have a more powerful impact on reshap- ing healthcare institutions and the processes of medicine themselves than the Internet. Moreover, these innovations—computer-assisted molecular and cellular diagnosis, computerized clinical decision support and artiﬁcial intelligence, telemedicine (enabling diagnosis of and intervention in illness from a distance), wireless and mobile computing applications, as well as affordable connectivity through the broadband Internet—were converging in a single complex new tool, the so-called “electronic medical record. As it develops in the next decade, it will not be a historic record of what was done to patients (enabling providers to bill for their services) so much as a navigational tool for physicians and the care team to help them guide patients and their families to a healthier place. To forecast where these technologies are headed and how they will affect the major ac- tors in health system—hospitals, physicians, consumers, and health plans—seemed like a worthy subject for a book. It then explores how emerging information technologies will affect hospitals, physicians, consumers, and health plans and how their relationships will change as they take up and use these new tools. All these actors crave a more satisfying role in the healthcare xii Preface process and yet will not, in some unqualiﬁed way, embrace impor- tant changes that they do not understand or do not believe will help them. The book also examines the growing absence of ﬁt between our healthcare payment framework and other policies and the emerg- ing capacity to organize healthcare digitally. It discusses what poli- cymakers need to do to speed the transformation in the healthcare system and the leadership challenge involved in bringing about that transformation. The technologies discussed herein are real, and their potential for helping create a more respon- sive, safer, and more effective health system is enormous. Disciplining technology and those who create it to meet our needs is the ultimate task of leadership. To achieve the transformation in healthcare that society de- serves will require enlightened leadership—in the health professions and healthcare management and from government policymakers. It will also require a willingness on the part of healthcare practi- tioners and managers to understand and master the technologies themselves—to adapt them, play with them, and collaborate with those who create them—to make them easier to adopt and use. This book seeks to inspire a new generation of health- care professionals and managers to understand, master, and deploy these powerful new tools. Jeff Goldsmith May 2003 Preface xiii Acknowledgm ents Many people assisted in making this book possible. Neal Patterson, chairman and founder of Cerner Corporation, a pioneer- ing healthcare informatics ﬁrm, opened the door by inviting me to serve on Cerner’s board of directors. Gartner executives and analysts Jim Adams, Dave Garets (now of HealthLink), Janice Young, Thomas Handler, Wes Rishel, and Ken Kleinberg all contributed knowledge and ideas for this book. Christine Malcolm, formerly of Computer Sci- ences Corporation, now of Rush-Presybterian–St. On the hospital side, John Glaser, chief information ofﬁcer at Partners HealthCare in Boston; David Blumenthal, director at the Institute for Health Policy and Physician at The Massachusetts Gen- eral Hospital/Partners HealthCare System; and Michael Koetting, vice president of planning at the University of Chicago Hospitals, were kind enough to read the manuscript and offer valuable advice on how to make it clearer, sharper, and more relevant. By happy coincidence, the University of Virginia is a hotbed of medical informatics activity and thought. Several Charlottesville colleagues helped early in the process to shape the book’s premise and focus on physicians. Robin Felder, professor of pathology and director of the University of Virginia’s Medical Automation Re- search Center, helped me understand the rapid advances in remote sensing technology and their future role in preventive health. On the scientiﬁc front, a fellow Cerner board member, William Neaves, president of the Stowers Institute; Paul Berg, professor emeritus of Stanford University; and George Poste, former chief scientiﬁc ofﬁcer of Smith Kline Beecham, helped shed light on ad- vances in genetic diagnosis. Steven Burrill of Burrill and Company, a biotechnology investment bank, has produced superb analyses of the role of information technology in advancing genetic diagnosis and therapy. Finally, Anita Gupta ably assisted in the research on this book and the editing and preparation of this manuscript. Audrey Kaufman and Joyce Sherman of Health Administration Press provided valuable editorial comments and guidance. On his home page, in a special medical alert window, he found a reminder message from his physician, Dr. David, a 46-year-old computer software engineer, was in radiantly good health and had not seen his physician in 11 months. The reminder was part of a subscription agreement he had negotiated with her last year and was sent him automatically by Dr. Part of this agreement was a schedule of periodic monitoring of his health based on his genetic risk proﬁle of potential health risks, including periodic blood tests. David did not need to leave his chair to have his blood analyzed; he simply placed his foreﬁnger on a special touchpad attached to his ofﬁce computer. A tiny laser beam in the touchpad scanned the blood particles passing through a capillary in his ﬁnger and digitally scanned his blood. The stream of digital information from David’s ﬁnger was in- stantly transmitted to the clinical laboratory in Dr. Kumar’s hos- pital, Springﬁeld Memorial, through David’s broadband Internet connection. The identiﬁcation and routing of his bloodwork was preset by the hospital’s computer system. This and all of David’s xvii other medical information was protected by an elaborate security system designed to shield both the sample and test results from scrutiny by anyone except David and his doctors. In the hospital’s laboratory, a sophisticated image recognition software program automatically read the image of David’s blood, counting and categorizing the different blood cells and comparing them to a visual template of normal blood. Kumar received her alert while she was eating breakfast at home and called David to ask if she could drop by to talk with him on her way to the ofﬁce. These articles would bring her up to date on new research ﬁndings and innovative therapeutic alternatives for the disease.
When properly placed at the bedside the patient can stand buy online nizagara erectile dysfunction medication online pharmacy, or be stood with assistance purchase nizagara 25 mg free shipping sudden erectile dysfunction causes, pivoted and sat upon the chair. Arms on the chair will make - 166 - Survival and Austere Medicine: An Introduction movement easier for someone who has the ability to support himself or herself using their upper body but may interfere with their ability to transfer onto the chair. They can be readily improvised from a coffee can or jar though the manufactured version is designed with an angle to the neck so that urine does not spill when the device is used. A: While so-called emesis basins (kidney-shaped plastic or metal pans) are available they are of limited capacity and spill readily. Better suited is a basin of approximately 6 inches depth and rectangular in shape. It holds more and doesn’t tend to allow a forceful vomit to splash out of the container. Another alternative is a plastic bag such as a small dustbin or wastebasket liner. A 6 or 8-inch diameter embroidery hoop will hold it open and give the patient something to hang on to. To close it merely grasp the bag with one hand and twist the hoop around with the other. Once removed from the hoop frame it can be sealed using string or a metal twist-tie. The plastic bag has the advantage of being flexible and semi-spill proof, as well as easily disposed of. Another expedient holder is a wire coat hanger pulled open to form a diamond shape to which the plastic liner has been securely taped. A: Underpads or incontinence pads are reusable mats made of absorbent material – usually cotton with a moisture-proof backing – that are placed underneath the patient to catch and absorb urine. While they work well within their limits perspiration alone can render them ready for disposal, causing the expenditure of large quantities in a very short period of time. A: Sometimes referred to as an enema syringe or a douche bag, simply described it is a latex rubber or plastic bottle with a stopper that either seals it completely or allows attachment of a hose, which in turn is fitted to one of an assortment of tips designed for differing purposes. Used to administer an enema, for instance, one would fill it with the solution of choice such as warm water and soap suds, introduce the proper tip - 167 - Survival and Austere Medicine: An Introduction into the rectum, and allow the contents of the bag to flow into the rectum by gravity feed. A gentle, non-irritating soap without added antibacterial agents is all that is needed. You may also wish to consider using pre-moistened cloths (also known as baby wipes, etc). These are simply pre-wetted disposable cloths used to clean faeces, urine, and emesis. Large sizes are available for health care use but the smaller version made for cleaning up babies will also suffice. Good quality paper towels can used to fashion wipes by adding soap and water to a basin, tossing in the paper towels to absorb the mixture, and then wringing out the excess water and placing them in plastic bags for later use. You will use more gloves for purposes of cleaning up patients requiring hygiene assistance than you are ever likely to use for addressing wounds or performing other procedures. The bedpans, urinals and basins themselves should be cleaned with soap and water after use and set out to dry or they will be come a source of unwelcome odours. Pacing Yourself You will do your patient no good if you work to the point of exhaustion. Have someone else watch over the patient while you sleep if you can’t arrange to sleep when your patient does. If the patient’s condition is acute but not urgent and regular vital signs are called for set a schedule. For more serious cases whose condition may change regularly use the shorter interval, such as trauma cases or very acute illness. For a patient who is recovering usually every 8 hours is frequent enough unless there is an unexpected change, at which time you may want to reassess the current vital signs. Instead of placing the patient in bed fully clothed provide them with a modest cover. This facilitates faster access for dressing changes and elimination needs and also reduces the laundry load. Try arranging the schedule of cares so that you can accomplish several tasks in one visit to the bedside. If caring for several patients at once schedule their cares in blocks of time that allow progression from one individual to another once the bulk of the needed treatments have been completed. Place a hand bell or other audible signaling device where the person can reach if it they need something. This will allow you to tend to other patients or even to spend much-needed time away from the sickroom without the patient lacking for attention when required. For persons formally trained in nursing technique this may represent a major mental obstacle to overcome. Lack of the tools and on-call resources that are routinely at our disposal in a modern, working healthcare system can be frustrating at best, and disabling if we dwell upon what we do not have versus what is available. In providing nursing care in the austere environment we need to focus on the patient first and foremost. The one overriding consideration that needs to be reinforced is this: model your care around that necessary for the comfort and recovery of your patient(s) and not around any medical-legal model of what care should be for a given case. Here we have tried to provide a brief answer to some of the common question coupled with more detailed references for those who are interested. It has gained a reputation as street drug and as a Vet anaesthetic, but is also widely used in human medicine, and is an ideal anaesthetic agent for austere situations. It produces a state known as “dissociative anaesthesia” – meaning it produces conditions suitable for performing painful procedures and operations while the patient appears to be in a semi-awake state although unresponsive. A side effect of this anaesthetic state is relative preservation of airway reflexes, respiratory effort, and a stable cardiovascular profile. It can be administered by intramuscular or intravenous injection or intravenous infusion. It is contraindicated in patients with an allergy to it (rare), and should be used with care in patients with psychiatric history, and patients with severe head injuries. Its main side effect is “emergence agitation” as the patient is waking up from the anaesthetic they may hallucinate and become agitated – this can be minimised by waking the patient up in quite dark environment, and can be treated with benzodiazepines (Valium). It also causes an increase in respiratory secretions and can cause transient increase in muscle tone. Due to its ease of use and lack of airway or respiratory suppression it is the ideal drug for use in an austere environment. It has been used extensively in the third world and has an excellent safety profile in comparison to other anaesthetic agent. In the following surgical procedures we will assume that the medic knows how to prepare a patient for surgery and set up a surgical field B. The primary objective in the treatment of soft tissue injuries is localisation or isolation of deleterious effects of the injury. To best accomplish this objective, remove all foreign substances and devitalised tissues and maintain an adequate blood supply to the injured part.
Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www nizagara 25 mg without prescription impotence sentence examples. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www cheap 25 mg nizagara otc injections for erectile dysfunction forum. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. People from Asia and the Pacifc Islands comprise the larg- Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The committee will assess current prevention and control activities and identify priorities for research, policy, and action. The com- mittee will highlight issues that warrant further investigations and oppor- tunities for collaboration between private and public sectors. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. There is a lack of knowledge and awareness about chronic viral hepatitis on the part of health-care and social-service providers. There is a lack of knowledge and awareness about chronic viral hepatitis among at-risk populations, members of the public, and policy-makers. There is insuffcient understanding about the extent and seriousness of this public-health problem, so inadequate public resources are being allocated to prevention, control, and surveillance programs. That situation has created several consequences: • Inadequate disease surveillance systems underreport acute and chronic infections, so the full extent of the problem is unknown. To address those consequences, the committee offers recommendations in four categories: surveillance, knowledge and awareness, immunization, and services for viral hepatitis. Surveillance The viral hepatitis surveillance system in the United States is highly fragmented and poorly developed. As a result, surveillance data do not pro- vide accurate estimates of the current burden of disease, are insuffcient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate suffcient resources to viral hepatitis prevention and control programs. The federal government has provided few resources—in the form of guidance, funding, and oversight—to local and state health departments to perform surveillance for viral hepatitis. Additional funding sources for surveillance, such as funding from states and cities, vary among jurisdictions. The committee found little published information on or systematic review of viral hepatitis surveillance in the United States and offers the following recommendation to determine the current status of the surveillance system: Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. States should be encouraged to expand immunization-information Recommendations systems to include adolescents and adults. Private and public insurance coverage for hepatitis B vaccina- Chapter 2: Surveillance tion should be expanded. The federal government should work to ensure an adequate, a comprehensive evaluation of the national hepatitis B and accessible, and sustainable hepatitis B vaccine supply. The Centers for Disease Control and Prevention should develop infection should continue. The Centers for Disease Control and Prevention should support care, Medicaid, and the Federal Employees Health Benefts and conduct targeted active surveillance, including serologic Program—should incorporate guidelines for risk-factor screen- testing, to monitor incidence and prevalence of hepatitis B virus ing for hepatitis B and hepatitis C as a required core compo- and hepatitis C virus infections in populations not fully captured nent of preventive care so that at-risk people receive serologic by core surveillance. The Centers for Disease Control and Prevention, in conjunction and Hepatitis C with other federal agencies and state agencies, should provide • 3-1. The Centers for Disease Control and Prevention should work resources for the expansion of community-based programs that with key stakeholders (other federal agencies, state and local provide hepatitis B screening, testing, and vaccination services governments, professional organizations, health-care organiza- that target foreign-born populations. Federal, state, and local agencies should expand programs to hepatitis C educational programs for health-care and social- reduce the risk of hepatitis C virus infection through injection- service providers. At a minimum, the programs should include with key stakeholders to develop, coordinate, and evaluate inno- access to sterile needle syringes and drug-preparation equip- vative and effective outreach and education programs to target ment because the shared use of these materials has been at-risk populations and to increase awareness in the general shown to lead to transmission of hepatitis C virus. Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepati- Chapter 4: Immunization tis C. All infants weighing at least 2,000 grams and born to hepati- counseling to reduce alcohol use and secondary transmission, tis B surface antigen-positive women should receive single- hepatitis B vaccination, and referral for or provision of medical antigen hepatitis B vaccine and hepatitis B immune globulin in management. Innovative, effective, multicomponent hepatitis C virus preven- recommendations of the Advisory Committee on Immunization tion strategies for injection-drug users and non-injection-drug Practices should remain in effect for all other infants. All states should mandate that the hepatitis B vaccine se- control of hepatitis C virus transmission. Additional federal and state resources should be devoted to increasing hepatitis B vaccination of at-risk adults. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. States should be encouraged to expand immunization-information Recommendations systems to include adolescents and adults. Private and public insurance coverage for hepatitis B vaccina- Chapter 2: Surveillance tion should be expanded. The federal government should work to ensure an adequate, a comprehensive evaluation of the national hepatitis B and accessible, and sustainable hepatitis B vaccine supply. The Centers for Disease Control and Prevention should develop infection should continue. The Centers for Disease Control and Prevention should support care, Medicaid, and the Federal Employees Health Benefts and conduct targeted active surveillance, including serologic Program—should incorporate guidelines for risk-factor screen- testing, to monitor incidence and prevalence of hepatitis B virus ing for hepatitis B and hepatitis C as a required core compo- and hepatitis C virus infections in populations not fully captured nent of preventive care so that at-risk people receive serologic by core surveillance. The Centers for Disease Control and Prevention, in conjunction and Hepatitis C with other federal agencies and state agencies, should provide • 3-1. The Centers for Disease Control and Prevention should work resources for the expansion of community-based programs that with key stakeholders (other federal agencies, state and local provide hepatitis B screening, testing, and vaccination services governments, professional organizations, health-care organiza- that target foreign-born populations. Federal, state, and local agencies should expand programs to hepatitis C educational programs for health-care and social- reduce the risk of hepatitis C virus infection through injection- service providers. At a minimum, the programs should include with key stakeholders to develop, coordinate, and evaluate inno- access to sterile needle syringes and drug-preparation equip- vative and effective outreach and education programs to target ment because the shared use of these materials has been at-risk populations and to increase awareness in the general shown to lead to transmission of hepatitis C virus. Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepati- Chapter 4: Immunization tis C. All infants weighing at least 2,000 grams and born to hepati- counseling to reduce alcohol use and secondary transmission, tis B surface antigen-positive women should receive single- hepatitis B vaccination, and referral for or provision of medical antigen hepatitis B vaccine and hepatitis B immune globulin in management. Innovative, effective, multicomponent hepatitis C virus preven- recommendations of the Advisory Committee on Immunization tion strategies for injection-drug users and non-injection-drug Practices should remain in effect for all other infants.