Federal Register / Vol. 78, No. 26 / Thursday, February 7, 2013 / Notices 9051 

agree to submit to reasonable security 

measures. The meeting space is 

intended to accommodate public 

attendees. However, if the space will not 

accommodate all requests, the ASC may 

refuse attendance on that reasonable 

basis. The use of any video or audio 

tape recording device, photographing 

device, or any other electronic or 

mechanical device designed for similar 

purposes is prohibited at ASC meetings. 

Dated: February 1, 2013. 

James R. Park, 

Executive Director. 

[FR Doc. 2013–02732 Filed 2–6–13; 8:45 am] 

BILLING CODE P 

FEDERAL MARITIME COMMISSION 

[Docket No. 13–01] 

Order of Investigation and Hearing: 

United Logistics (Lax) Inc.—Possible 

Violations of the Shipping Act of 1984 

AGENCY: Federal Maritime Commission. 

DATES: The Order of Investigation and 

Hearing was served January 25, 2013. 

ACTION: Notice of Order of Investigation 

and Hearing. 

Authority: 46 U.S.C. 41302. 

SUPPLEMENTARY INFORMATION: On 

January 25, 2013 the Federal Maritime 

Commission instituted an Order of 

Investigation and Hearing entitled 

United Logistics (LAX) Inc.—Possible 

Violations of Sections 10(a)(1) and 

10(b)(2)(A) of the Shipping Act of 1984. 

Acting pursuant to Section 11 of the 

Shipping Act, 46 U.S.C. 41302, that 

investigation is instituted to determine: 

(1) Whether United Logistics (LAX) 

Inc. violated section 10(a)(1) of the 

Shipping Act, 46 U.S.C. 41102(a) by 

knowingly and willfully, directly or 

indirectly, obtaining transportation at 

less than the rates and charges 

otherwise applicable by the device or 

means of unlawfully accessing service 

contracts to which it was neither a 

signatory nor an affiliate; 

(2) whether United Logistics (LAX) 

Inc. violated section 10(b)(2)(A) of the 

Shipping Act, 46 U.S.C. 41104(2)(A), by 

providing transportation in the liner 

trade that was not in accordance with 

the rates, charges, classifications, rules, 

and practices contained in its published 

tariff; 

(3) whether, in the event violations of 

section 10 of the Shipping Act are 

found, civil penalties should be 

assessed against United Logistics (LAX) 

Inc. and, if so, the amount of the 

penalties to be assessed; 

(4) whether, in the event violations of 

section 10(b)(2)(A) of the Shipping Act 

are found, the tariff of United Logistics 

(LAX) Inc. should be suspended 

pursuant to section 13 of the Shipping 

Act, 46 U.S.C. 41108(a); 

(5) whether the Ocean Transportation 

Intermediary license of United Logistics 

(LAX) Inc. should be suspended or 

revoked pursuant to section 19 of the 

Shipping Act, 46 U.S.C. 40903; and 

(6) whether, in the event violations 

are found, an appropriate cease and 

desist order should be issued as 

authorized by section 14 of the Shipping 

Act, 46 U.S.C. 41304. 

The Order may be viewed in its 

entirety at http://www.fmc.gov/13-01. 

Karen V. Gregory, 

Secretary. 

[FR Doc. 2013–02819 Filed 2–6–13; 8:45 am] 

BILLING CODE 6730–01–P 

FEDERAL RESERVE SYSTEM 

Notice of Proposals To Engage in or 

To Acquire Companies Engaged in 

Permissible Nonbanking Activities 

The companies listed in this notice 

have given notice under section 4 of the 

Bank Holding Company Act (12 U.S.C. 

1843) (BHC Act) and Regulation Y, (12 

CFR part 225) to engage de novo, or to 

acquire or control voting securities or 

assets of a company, including the 

companies listed below, that engages 

either directly or through a subsidiary or 

other company, in a nonbanking activity 

that is listed in § 225.28 of Regulation Y 

(12 CFR 225.28) or that the Board has 

determined by Order to be closely 

related to banking and permissible for 

bank holding companies. Unless 

otherwise noted, these activities will be 

conducted throughout the United States. 

Each notice is available for inspection 

at the Federal Reserve Bank indicated. 

The notice also will be available for 

inspection at the offices of the Board of 

Governors. Interested persons may 

express their views in writing on the 

question whether the proposal complies 

with the standards of section 4 of the 

BHC Act. 

Unless otherwise noted, comments 

regarding the applications must be 

received at the Reserve Bank indicated 

or the offices of the Board of Governors 

not later than February 22, 2013. 

A. Federal Reserve Bank of Chicago 

(Colette A. Fried, Assistant Vice 

President) 230 South LaSalle Street, 

Chicago, Illinois 60690–1414: 

1. Baylake Corporation, Sturgeon Bay, 

Wisconsin; to engage de novo through 

its subsidiary, Admiral Asset 

Management, LLC, Green Bay, 

Wisconsin, in conducting registered 

investment advisory services, pursuant 

to section 225.28(b)(6). 

Board of Governors of the Federal Reserve 

System, February 4, 2013. 

Margaret McCloskey Shanks, 

Deputy Secretary of the Board. 

[FR Doc. 2013–02767 Filed 2–6–13; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: 

‘‘Improving Sickle Cell Transitions of 

Care through Health Information 

Technology Phase 1.’’ In accordance 

with the Paperwork Reduction Act, 44 

U.S.C. 3501–3521, AHRQ invites the 

public to comment on this proposed 

information collection. 

DATES: Comments on this notice must be 

received by April 8, 2013. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email at doris.lefkowitz,AHRQ.hhs.gov. 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Improving Sickle Cell Transitions of 

Care Through Health Information 

Technology Phase 1 

This project is the first phase in 

AHRQ’s effort toward the development 

of a health information technology (HIT) 

enabled tool designed to aid adolescents 

and young adults with sickle cell 

disease (SCD) during transitions of care. 

SCD is a serious, genetic blood disorder 

that affects approximately 70,000– 

100,000 Americans, including one out 

of every 500 African American and one 

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9052 Federal Register / Vol. 78, No. 26 / Thursday, February 7, 2013 / Notices 

out of every 36,000 Hispanic American 

births. Persons with SCD produce 

abnormal, ‘‘sickle-shaped’’ red blood 

cells that obstruct blood vessels, leading 

to life-long anemia, organ damage, 

increased potential for infections, 

chronic episodes of pain, and 

substantially shortened life spans. SCD 

has been noted to be understudied 

relative to its prevalence resulting in a 

lack of knowledge about the important 

variables and domains that determine 

health outcomes for patients. 

Furthermore, patients with SCD, 

typically young, minority, and often of 

lower income status, have had few 

opportunities to voice their needs and 

concerns about their health and health 

care. 

As recently as 30 years ago, children 

with SCD usually did not survive into 

adulthood. Now, as a result of advances 

in screening and treatment, more than 

90 percent of individuals with SCD 

reach adulthood, and life expectancy is 

typically into the fifth decade. Persons 

with SCD experience multiple 

transitions of care as a result of the 

chronicity of SCD, frequency of both 

acute and chronic events requiring care, 

as well as the advancements in life 

expectancy. Transitions of care occur 

when either the setting of care changes 

(e.g., from home-based to hospital-based 

care) or the focus of care changes (e.g., 

from pediatric-focused to adult-focused 

care). When transitions of care occur, a 

need to share medical history and other 

types of health information arises. 

Transitions of care are more likely to be 

successful when this health information 

is accurate, tailored to the type of 

transition taking place, and 

communicated effectively. 

Times of care transitions are 

particularly fraught for patients with 

SCD and currently, few patients have 

access to effective transition programs 

for SCD. In a 2010 survey of pediatric 

SCD providers, the majority claimed to 

have transition programs in place but 

they were often newly formed and 

without the ability to transfer care to 

adult providers with specific expertise 

in SCD. 

Preliminary evidence suggests that 

HIT can be helpful for SCD and similar 

conditions. In particular, a technologybased tool has already been used 

successfully by patients with SCD to 

help with some aspects of disease 

management. In one study, a handheld 

wireless device was used to implement 

a pain management protocol and found 

to result in high rates of participation 

and satisfaction. Technology-based tools 

or applications—‘‘apps’’—have also 

been effective in improving care 

transitions for other chronic diseases 

such as diabetes and HIV, which can 

serve as models for this tool. 

Improving transitions of care is the 

focus of AHRQ’s plans to respond to the 

Department of Health and Human 

Services’ (HHS’) SCD Initiative 

announced in 2011. The overall HHS 

SCD initiative, which is aligned with 

AHRQ’s mission, aims to improve the 

health of persons with SCD through 

various activities, including developing 

and disseminating evidence-based 

guidelines, increasing the availability of 

medical homes that provide SCD care, 

and supporting research in areas such as 

pain and disease management, all of 

which could also be supported through 

the use of an effective HIT enabled tool. 

The goals of this project are to: 

(1) Gain the necessary background 

knowledge including qualitative 

information from key stakeholders, to 

establish a set of requirements that 

would guide the design and 

development of a HIT-enabled tool in 

future phases of work that meets 

patients,’ families,’ and providers’ needs 

to aid adolescents and young adults 

with sickle cell disease during 

transitions of care. 

(2) Develop an understanding of the 

environmental context, current 

facilitators and barriers, health data use 

and needs of key stakeholders affected 

by sickle cell disease, including 

patients, families, and providers. 

This study is being conducted by 

AHRQ through its contractor, The 

Lewin Group, pursuant to AHRQ’s 

authority to conduct and support 

research on healthcare and on systems 

for the delivery of such care, including 

activities with respect to the quality, 

effectiveness, efficiency, 

appropriateness and value of healthcare 

services and health care technologies. 

42 U.S.C. 299a(a)(1), (2) and (5). 

Method of Collection 

To achieve the goals of this project, 

the following activities and data 

collections will be implemented: 

(1) Environmental Scan — AHRQ will 

execute a literature review to identify 

potentially relevant scientific literature 

and information from other literature 

and sources as well as complete a search 

for existing tools that aid transitions of 

care for persons with SCD or similar 

conditions. This will provide contextual 

background about the current state of 

the field with regards to tool 

development and use, identify key 

issues of patients with SCD related to 

care transitions, and understand the 

context of care delivered and health 

data information needs to inform the 

content, design and functionality of a 

tool. This activity does not impose a 

burden on the public and is not 

included in the burden estimates in 

Exhibit 1. 

(2) Focus Groups — AHRQ will 

facilitate ten focus groups of key 

stakeholder groups including: parents/ 

caregivers of patients with SCD; health 

care providers (e.g. SCD specialists, 

primary care physicians (PCPs), 

hospitalists and emergency room (ER) 

physicians); IT developers; SCD patients 

ages 9–13; SCD patients ages 14–17; 

SCD patients 18 and older; and SCD 

patients of mixed ages; to gather 

qualitative information on stakeholder 

experiences with SCD and care 

transitions, barriers to quality care, and 

use of technology to inform tool design 

and functionality. Each group will 

consist of 10 participants and will be 

asked to describe their particular 

experiences with health care transitions, 

communication practices, information 

needs and technology use in order to 

develop relevant ‘‘use cases’’ which will 

be used by investigators and tool 

developers for the later phases of the 

project. The in-person nature of focus 

groups allows for a more in-depth and 

targeted discussion, including 

participant experiences, impressions 

and priorities in a detailed fashion. 

(3) Demographic Questionnaire — 

AHRQ will implement a short 

demographic questionnaire at the start 

of each of the ten focus groups to collect 

basic demographic information to allow 

the team to contextualize findings from 

each focus group. Questionnaires are 

tailored to each focus group category: 

parents/caregivers of patients with SCD; 

providers, hospitalists and ER 

physicians); IT developers; SCD patients 

ages 9–13; SCD patients ages 14–17; 

SCD patients 18 and older; and SCD 

patients of mixed ages. 

(4) Key Informant Interviews — AHRQ 

will conduct eight key informant 

interviews with stakeholders such as 

State Medicaid representatives, 

attorneys with expertise in privacy and 

security issues, representatives from the 

Office of the National Coordinator for 

Health Information Technology (ONC), 

Office of Chief Scientist, and other 

relevant policy makers. Qualitative 

information gained will contribute to 

tool development recommendations 

particularly in terms of cost, issues 

related to reimbursement by payers, 

needs for proof of effectiveness, 

sustainability, and potential vehicles for 

facilitating and funding tool 

development and implementation. Five 

of these stakeholders will be Federal 

government employees and therefore are 

excluded from the burden estimates in 

Exhibit 1 below. 

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Federal Register / Vol. 78, No. 26 / Thursday, February 7, 2013 / Notices 9053 

The information gained from the 

focus groups and key informant 

interviews will be used to understand if 

and how a patient-centered, HITenabled tool can improve the health of 

individuals with SCD during care 

transitions. 

Focus groups as a form of qualitative 

research are an important vehicle for 

gathering and explicating insight from 

the field, especially if, as in this case, 

the important domains are not yet 

understood, and need to be outlined by 

respondents, rather than suggested by 

investigators. Thus active recruitment 

and qualitative techniques are a means 

to incorporate this necessary and 

important perspective into the 

derivation of effective interventions. 

The primary objective of the focus 

groups is to gather more richly nuanced 

information from sickle cell disease 

stakeholders. The in-person nature of 

focus groups allows for a more in-depth 

and targeted discussion, including 

participant experiences, impressions 

and priorities in a detailed fashion. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

research. The demographic 

questionnaire will be completed by each 

focus group participant and takes 6 

minutes to complete. All of the focus 

groups and key informant interviews 

will last 2 hours except for the IT 

developer focus group which will last 4 

hours. Each focus group will consist of 

10 persons. There will be two focus 

groups with providers, three with 

parents/caregivers, one group for IT 

developers, and one focus group with 

each of the four patient groups. Key 

informant interviews will be conducted 

with eight individuals. The total burden 

is estimated to be 236 hours annually. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total cost burden is 

estimated to be $7,646 annually. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses 

per 

respondent 

Hours per 

response 

Total burden 

hours 

Demographic Questionnaire ............................................................................ 100 1 6/60 10 

Provider Focus Groups .................................................................................... 20 1 2 40 

Parent/Caregiver Focus Groups ...................................................................... 30 1 2 60 

IT Developer Focus Group .............................................................................. 10 1 4 40 

Patients 9–13 Focus Group ............................................................................. 10 1 2 20 

Patients 14–17 Focus Group ........................................................................... 10 1 2 20 

Patients 18 & older Focus Group .................................................................... 10 1 2 20 

Patients mixed ages Focus Group .................................................................. 10 1 2 20 

Key Informant Interviews ................................................................................. 3 1 2 6 

Total .......................................................................................................... 203 na na 236 

* Five interview participants will be Federal government employees and therefore are excluded from the burden estimates. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate * 

Total 

cost burden 

Demographic Questionnaire ............................................................................ 100 10 a $26.89 $269 

Provider Focus Groups .................................................................................... 20 40 b 88.7 3,551 

Parent/Caregiver Focus Groups ...................................................................... 30 60 a 21.74 1,304 

IT Developer Focus Group .............................................................................. 10 40 d 44.27 1,771 

Patients 9–13 Focus Group ............................................................................. 10 20 e 0 0 

Patients 14–17 Focus Group ........................................................................... 10 20 e 0 0 

Patients 18 & older Focus Group .................................................................... 10 20 a 21.74 435 

Patients mixed ages Focus Group .................................................................. 10 20 e 0 0 

Key Informant Interviews ................................................................................. 3 6 f 52.72 316 

Total .......................................................................................................... 203 236 na 7,646

aBased on the mean wages for Physicians & Surgeons, All other (29–1069), All Occupations (00–0000), Software Developer (15–1132). 

Wages for children averaged in as $0. bBased on the mean wages for Physicians & Surgeons, All other (29–1069). 

cBased on the mean wages for All Occupations (00–0000). 

dBased on the mean wages for Software Developer (15–1132). 

e No wage data for children. 

fBased on the mean wages for Lawyers (23–1011), Social and Community Service Managers (11–9151), Medical and Health Services Managers (11–9111), and Computer and Information System Managers (11–3021). 

* National Compensation Survey: Occupational wages in the United States May 2011, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ 

http://www.bls.gov/oes/current/oes_nat.htm#15-0000. 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ health care 

research and health care information 

dissemination functions, including 

whether the information will have 

practical utility; (b) the accuracy of 

AHRQ’s estimate of burden (including 

hours and costs) of the proposed 

collection(s) of information; (c) ways to 

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9054 Federal Register / Vol. 78, No. 26 / Thursday, February 7, 2013 / Notices 

enhance the quality, utility, and clarity 

of the information to be collected; and 

(d) ways to minimize the burden of the 

collection of information upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: January 23, 2013. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2013–02549 Filed 2–6–13; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[Docket Number NIOSH–144] 

Issuance of Final Guidance Publication 

AGENCY: National Institute for 

Occupational Safety and Health 

(NIOSH) of the Centers for Disease 

Control and Prevention (CDC), 

Department of Health and Human 

Services (HHS). 

ACTION: Notice of issuance of final 

guidance publication. 

SUMMARY: The National Institute for 

Occupational Safety and Health 

(NIOSH) of the Centers for Disease 

Control and Prevention (CDC), 

announces the availability of the 

following publication: ‘‘NIOSH Criteria 

for a Recommended Standard: 

Occupational Exposure to Hexavalent 

Chromium’’ [2013–128]. 

ADDRESSES: This document may be 

obtained at the following link: Web site: 

http://www.cdc.gov/niosh/docs/2013- 

128/. 

FOR FURTHER INFORMATION CONTACT: 

Kathleen MacMahon, NIOSH, Robert A. 

Taft Laboratories, MS–C14, 4676 

Columbia Parkway, Cincinnati, OH 

45226, telephone (513) 533–8547. 

Dated: January 28, 2013. 

John Howard, 

Director, National Institute for Occupational 

Safety and Health, Centers for Disease Control 

and Prevention. 

[FR Doc. 2013–02743 Filed 2–6–13; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

National Institute for Occupational 

Safety and Health Respiratory 

Protection for Healthcare Workers: 

Stakeholder Meeting 

AGENCY: The National Institute for 

Occupational Safety and Health 

(NIOSH) of the Centers for Disease 

Control and Prevention (CDC), 

Department of Health and Human 

Services (HHS). 

ACTION: Notice of public meeting. 

SUMMARY: The National Institute for 

Occupational Safety and Health 

(NIOSH) of the Centers for Disease 

Control and Prevention (CDC) 

announces the following public 

meeting: ‘‘Stakeholder Meeting on 

Respiratory Protection for Healthcare 

Workers’’. 

Stakeholder Meeting Time and Date: 

8 a.m.–5:15 p.m. EDT, June 18, 2013. 

Place: CDC Tom Harkin Global 

Communications Center located at 1600 

Clifton Road, Building 19, Atlanta, 

Georgia 30333. This meeting will also be 

available by videoconference at select 

CDC locations. 

Purpose of the Meeting: This meeting 

is being held to exchange ideas and 

solutions to improve healthcare worker 

compliance with personal protective 

technologies (PPT), with a focus on 

respiratory protection. Stakeholder 

feedback is sought to (1) provide input 

to future updates of the NIOSH PPT 

program research agenda and (2) assess 

progress toward better respirators for 

healthcare workers. 

This meeting will include 

presentations and moderated roundtable 

discussions on ‘‘Improving the Evidence 

Base to Support Guidance on the 

Appropriate Level of Respiratory 

Protection’’, ‘‘Healthcare Worker 

Observational Studies of Respirator Use 

& New Educational Resources’’, 

‘‘Considerations for Extending 

Respirator Supplies During an Outbreak 

or Pandemic’’, ‘‘Standards & Test 

Methods for Improved Respirators for 

Healthcare Workers’’, and ‘‘Advances 

toward Improved Respirators for 

Healthcare Workers’’. 

Status: The meeting is open to the 

public, limited only by the capacity 

(100) of the conference room. 

Registration will be accepted on a first 

come first served basis. Participants are 

encouraged to consider attending by 

video conference, which will be 

provided at select CDC locations (to be 

announced). Registration for both in 

person and video conference attendance 

is available on the NIOSH NPPTL Web 

site, www.cdc.gov/niosh/npptl. 

Preregistration is required on or before 

May 31, 2013, even for remote attendees 

and US citizens. Non-US citizens need 

to register on or before May 18, 2013, to 

allow sufficient time for mandatory CDC 

facility security clearance procedures to 

be completed. An email confirming 

registration will be sent from NIOSH 

and will include details needed to 

participate. A government issued photo 

ID will be required to obtain entrance to 

any of the CDC locations. 

Background: The NIOSH PPT 

program publishes and periodically 

updates its research agenda on personal 

protective equipment (PPE) for 

healthcare workers (http:// 

www.cdc.gov/niosh/docket/archive/ 

docket129.html). The research agenda, 

last updated in 2010, describes the near 

term and long term strategy for the PPT 

program’s influenza pandemic research, 

development, and investigative testing 

activities. Recently, the Institute of 

Medicine (IOM) published a report 

(http://www.iom.edu/Reports/2011/ 

Preventing-Transmission-of-PandemicInfluenza-and-Other-Viral-RespiratoryDiseases.aspx) that assessed the nation’s 

progress on improving PPE for 

healthcare personnel exposed to 

infectious respiratory diseases and made 

recommendations to address research 

gaps. Furthermore, a chapter in the 

recent HHS 2009 H1N1 Influenza 

Improvement Plan (http://www.phe.gov/ 

Preparedness/mcm/h1n1-retrospective/ 

Documents/2009-h1n1- 

improvementplan.pdf) discusses 

research needs for respiratory protective 

devices as part of a broader non-vaccine 

medical countermeasures strategy. A 

key area of discussion at this 

stakeholder meeting will be progress on 

research gaps identified in the 2011 

IOM and 2012 HHS reports and how 

NIOSH can use this information to 

update the 2010 PPT research agenda. 

The current version of PPT program 

research agenda for healthcare worker 

PPE focuses on conducting research to 

design and promote the appropriate use 

of PPE. Compliance with appropriate 

respirator use practices is important 

because healthcare workers often wear 

them incorrectly or fail to use them at 

all. Poor compliance has been linked to 

safety culture, workload issues, time 

constraints, risk perception, 

effectiveness concerns, availability, 

discomfort, interference with patient 

care, and communication difficulties. 

One strategy taken to improve 

healthcare worker compliance is to 

develop better respirators. In this 

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