zilongwang/ReadingBank huggingface dataset:
STATUTORY NOTICE COUNTER-NOTICE REGARDING NON-EMERGENCY UNDERTAKER’S WHICH INTERFERE WITH AN ELECTRONIC COMMUNICATIONS NETWORK Paragraph 68(2) of Part 10 of Schedule 3A of the Communications Act 2003 This is a statutory notice pursuant to paragraph 68(2) of the electronic communications code, set out in Schedule 3A to the Communications Act 2003 (the “Code”). On [Insert date], you, [Insert name of undertaker], gave us, [Insert name of Code operator], a notice under paragraph 67(1) of the Code. That notice informed us of your intention to carry out non-emergency works at [Insert address] which would interfere with our electronic communications apparatus (the “Proposed Works”). The purpose of this notice is to inform you that we require you to make any alteration of our electronic communications apparatus that is necessary or expedient because of the Proposed Works both under our supervision and to our satisfaction. [OR - delete appropriate version of paragraph 3] 3. The purpose of this notice is to inform you that we intend to make any alteration of our electronic communications apparatus that is necessary or expedient because of the Proposed Works. CONSEQUENCES OF THIS NOTICE As a result of this notice, you must, in carrying out the Proposed Works, act in accordance with this counter-notice when altering our electronic communications apparatus and therefore carry out those alterations both under our supervision and to our satisfaction. You must also pay us: the amount of any loss or damage sustained by us in consequence of any alteration being made to our electronic communications apparatus (in carrying out the Proposed Works); and any expenses incurred by us in, or in connection with, supervising you when altering our electronic communications apparatus (in carrying out the Proposed Works). [OR - delete appropriate version of paragraph 4] 4. As a result of this notice, you must not alter our electronic communications apparatus (in carrying out the Proposed Works). You must also pay us: any expenses incurred by us in, or in connection with, making the alteration; and the amount of any loss or damage sustained by us in consequence of the alteration being made. [Insert date of Notice]
Patient Centered Care Cronenwett et al., 2007, p. 123 Finkelman & Kenner (2013), Chapter 9 Safety Cronenwett et al., 2007, p. 128 Finkelman & Kenner (2013), Chapter 12 National Patient Safety Goals Informatics Cronenwett et al., 2007, p. 129 Finkelman & Kenner (2013), Chapter 13 Quality Improvement Cronenwett et al., 2007, p. 127 Finkelman & Kenner (2013), Chapter 12 Teamwork & Collaboration Cronenwett et al., 2007, p. 125 Finkelman & Kenner (2013), Chapter 10 Evidence-based Practice Cronenwett et al., 2007, p. 126 Finkelman & Kenner (2013), Chapter 11
clinical letters and other electronic records patient/family/whānau input. Depth of the analysis Evidence that staff have been interviewed; if they have not been interviewed, it should be noted in the report. Evidence that the patient/family/whānau have been interviewed; if they have not been interviewed it should be noted in the report. Evidence all relevant documents have been accessed. References to indicate current best practice evidence is Expert opinion, if obtained, is noted. A common problem is the failure to establish all the facts including witness interviews and the patient/family/whānau view. The team must review and interpret all sources of information and interview all relevant staff involved in the event (with their permission). Identification of contributing factors Contributing factors (including human factors) are identified and documented in the report. The examination of contributing factors helps the team understand the underlying system causes of the incident and ultimately make decisions about recommendations. The contributing factors must be identified to understand why the event occurred.
Contact: Name Email x-IT-OPT. AGENCY Division/Program Contract ID: Contract Name/Contract Number ADPICS BPO No.: Contract Approved: (Enter original BPW approval information, i.e. date and item number) DoIT Item x-IT (mm/dd/yyyy) Contractor: Contractor Name, City and State Contract Description: (Enter short narrative describing contract) Option Description: (Enter which option is being exercised such as, “Request to exercise the second of three one-year renewal options.”) Original Contract Term: (Enter inclusive dates to include number/length of renewal options, i.e. 7/1/2007 – 6/30/2009 (W/1 one-year renewal option). Option Term: (Enter inclusive dates of the renewal, i.e. 9/1/2007 – 8/31/2008. Renewal option start and end dates must agree with the original Contract as modified (if applicable) and the ADPICS renewal BPO.) Original Contract Amount: (Enter base period amount of the original contract) Option Amount: (Enter dollar amount of the renewal option followed by the time duration, such as “(1 Year)”) Prior Modifications/Options: (Enter “None” or a discrete amount if there was any prior modification(s) and/or option(s) and “see Attachment” or “see Attachment X” (if there is more than 1 Attachment). When there was any prior modification(s) or option(s), create an attachment with prior modification/option renewal history. For each prior mod or option include: the amount, a brief description, and the period covered, including BPW item numbers and approval dates, if applicable.) Revised Total Contract Amount: (Enter the dollar total, which is the sum of the amounts of the original contract, plus all prior modifications/options, plus this option.) Original Procurement Method: Competitive Sealed Proposals, Competitive Sealed Bidding, Sole Source, etc. MBE Participation: Enter MBE participation % MBE Compliance: Enter MBE compliance %
x-IT-OPT. AGENCY (cont’d) Agency Remarks: (Describe the services that will continue to be provided if the renewal option is approved. Justify why the renewal option is recommended instead of re-soliciting to obtain better pricing through competition. Explain why it is in the best interest to exercise the option in terms of quality of service, good pricing or any other applicable factor. Provide statistical or anecdotal information to evidence either favorable pricing or high quality of performance under the contract. In addition to normal remarks, briefly state the plan for a new Contract if this is the last option being renewed and the service/IT activity will continue.) Fund Source: (General, Federal, Reimbursable, Special [state source]) Approp. Code: (Enter agency appropriation code; verify with DBM OBA Analyst) Resident Business: 15-xxxx-xxxx BOARD OF PUBLIC WORKS ACTION – THIS ITEM WAS: APPROVED DISAPPROVED DEFERRED WITHDRAWN WITH DISCUSSION WITHOUT DISCUSSION
Template Risk Management Plan for High Risk Activity In addition to occupational health and safety concerns, a child and youth risk management strategy should analyse the risk of ‘harm’ to children and young people. STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 Describe the activity Identify all elements of the from beginning to end Identify Risks Something that could happen that results in harm to a child or young person Analyse the Risk Likelihood/ Consequences Evaluate the Risk The level of risk Manage the Risk Assess the options Review Nominate who will review after the event/activity
Risk Register Id Description of Risk (including any identified ‘triggers’) Impact on Project (Identify consequences ) Assessment of Likelihood Assessment of Seriousness Grade (combined Likelihood and Seriousness) Change Date of Review Mitigation Actions (Preventative or Contingency) Responsibility for mitigation action(s) Cost Timeline for mitigation action(s) <n> <describe the risk and any relevant triggers that may cause the risk to be realised.> <Describe the nature of the risk and the impact on the project if the risk is not mitigated or managed> <Change in Grade since last review> <Date of last review> <Specify planned mitigation strategies: Preventative (implement immediately) Contingency (implement if/when risk occurs).> <Specify who is responsible for undertaking each mitigation action(s)> <Specify for action(s) to be by>
Value propositions Pricing plan Feature #2 Owner, contributors Feature description Use case and how-tos Value propositions Pricing plan Overview of sales enablement activities List of reference material for the deliverables Product flow and specs Product positioning Competitive landscape Launch day logistics ↓ Create a section below for each deliverable in full ↓
Suggested RFP Questions: Preference will be given for carriers and/or logistics providers who are registered as EPA SmartWay Transport Carrier, Logistics, or Multimodal Partners. For a list of partners, visit . [Used for option 1 or 3] Is your company a registered EPA SmartWay Transport Shipper Partner? Yes or No? [Used for option 1 or 2] If your company is registered as a SmartWay Carrier, Logistics, or Multimodal Partner, what are your grams of CO2 per ton-mile or grams of CO2 per mile ranking categories in the SmartWay Performance Rankings listing? Grams of CO2 per ton-mile rating (e.g., category 1, 2, 3, 4, or 5)? Grams of CO2 per mile rating (e.g., category 1, 2, 3, 4, or 5)?
8 Business Continuity Management An organisation must establish, implement and maintain a business continuity management program that addresses the security of public sector data. Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status 9 Contracted Service Providers An organisation must ensure that contracted service providers with access to public sector data, do not do an act or engage in a practice that contravenes the Victorian Protective Data Security Standards (VPDSS). Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status
10 Government Services An organisation that receives a government service from another organisation must ensure that the service complies with the Victorian Protective Data Security Standards (VPDSS) in respect to public sector data that is collected, held, used, managed, disclosed or transferred. Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status 11 Security Plans An organisation must establish, implement and maintain a protective data security plan to manage their security risks. Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status
14 Information Management An organisation must establish, implement and maintain information security controls in their information management framework. Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status 15 Information Sharing An organisation must ensure that security controls are applied when sharing public sector data. Not applicable Not implemented Partially implemented Fully implemented Key activities (in progress or planned): Standard Description action Compliance status
Joe Tremont Phone: 713-743-5861 Director for Environmental Health and Life Safety Fax: 713-743-8035 Chemical Name: STANDARD OPERATING PROCEDURES This is an SOP template and is not complete until: 1) lab specific information is entered into the box below 2) lab specific protocol/procedure is added to the protocol/procedure section and 3) SOP has been signed and dated by the PI and relevant lab personnel. According to the Safety Data Sheet (SDS) for special precautions must be taken when working with this chemical. This operating procedure briefly describes the use of the equipment and supplies maintained at the facility, procedures that must be followed, and the responsibilities of personnel when working in these facilities. Amend SOP to reflect changes in procedure, equipment, etc. Do not conduct experiments, even pilot studies, which are not described in this approved SOP. It is essential that all personnel follow the appropriate procedures outlined in this SOP. Please provide the SDS associated with this chemical. PI Acknowledgement Name: Department: PSID: Date: 1. PI Responsibilities (Please initial before each responsibility below.) The Principal Investigator is responsible for training employees the chemical. The training should include a discussion of the known and potential hazards and an explanation of the relevant policies, techniques and procedures including the proper use of personal protective equipment and containment equipment. Employees should be trained initially and then annually thereafter. Their knowledge, competence and practices should be evaluated and documented. Implement a safety program and include this information in the chemical hygiene plan.
9. Preparation of Chemicals Used ⎕Define all the components of the mixture: ⎕ Define dilution methods and procedures, include amounts: ⎕Provide final concentration on chemicals used: 10. Exposures (e.g. ingestion, skin contact, inhalation, etc.) ⎕Describe the methods to prevent exposures and or control routes of entry. See SDS and specific good laboratory practices. ⎕Describe first-aid measures for inhalation, skin/eye contact and ingestion. Information on SDS. ⎕Specify location of the nearest emergency eyewash station and safety shower. 11. In Case of Spills ⎕Describe precautions to take regarding a spill. See SDS. ⎕Small Spills - less than 5 ml: Describe small spill procedures and include how to dispose of material. ⎕Large Spills - more than 5 ml: Describe large spill procedures and include how to obtain assistance from EHLS and UH Police. ⎕List the contents and the location of the laboratory spill kit. 12. Animal Use “If Applicable” ⎕Provide protocol #___ _____________________________ ⎕Label cages with chemical agent, date of dosage and dosage amount. ⎕Place carcass in leak-proof red bags and transport to “Carcass” freezer. 13. EHLS Policy Requires EHLS policy requires that all chemical hazards must be clearly identified. If you have any questions regarding risk assessment and SOP development, contact the EHLS office 713-743-5858 or
Recommended improvements relating to specific source categories are presented in the relevant sector sections of this report. ERT Review Pollutants Reviewed SO2, NOx, NH3, PM10 & PM2.5, Cd, Hg, Pb, Dioxin, PAH 1990 – 2014 Code Name Reviewed Not Reviewed Recommendation Provided 1A1a Public electricity and heat production 1A1b Petroleum refining 1A1c Manufacture of solid fuels and other energy industries 1A2a Iron and steel 1A2b Non-ferrous metals 1A2c Chemicals 1A2d Pulp, Paper and Print 1A2e Food processing, beverages and tobacco 1A2f Stationary combustion in manufacturing industries and construction: minerals 1A2gviii Stationary combustion in manufacturing industries and construction: Other (please specify in the IIR) 1A3ei Pipeline transport 1A3eii Other (please specify in the IIR) 1A4ai Commercial/institutional: Stationary 1A4bi Residential: Stationary 1A4ci Agriculture/Forestry/Fishing: Stationary 1A5a Other stationary (including military) 1B1a Fugitive emission from fuels: Coal mining and handling 1B1b Fugitive emission from fuels: Solid fuel transformation 1B1c Other fugitive emissions from solid fuels Fugitive emissions oil: Exploration, production, transport 1B2aiv Fugitive emissions oil: Refining / storage Distribution of oil products 1B2b Fugitive emissions from natural gas (exploration, production, processing, transmission, storage, distribution and other) 1B2c Venting and flaring (oil, gas, combined oil and gas)
Strategy Action KPIs Responsibility Timing IP&R Ref What is the overarching strategy for disability inclusion? What are the specific actions council will take to deliver the strategy? There will likely be multiple actions related to each strategy. What will be the indicators of success? Who is responsible for delivering the action? What is the timeframe for delivering the action? Where is this mentioned in IP&R documentation? EXAMPLE 1: FOCUS AREA: ATTITUDES AND BEHAVIOURS Work with local disability organisations and the community to make events, activities and facilities accessible and inclusive Prepare inclusion and access guidelines for cultural and community events Participation rates of people with disability in council programs and events (Data: event feedback) Community Development Officer Short term (1-2 years) CSP Theme: An active cultural life DP Goal: Council and community programs, events and facilities encourage participation of people of all abilities, and celebrate and value diversity EXAMPLE 2: FOCUS AREA: LIVEABLE COMMUNITIES Progressively upgrade council owned assets to meet Access to Premises Standards or relevant best practice approach Review and upgrade council’s sub-district libraries to meet Standards All council libraries to meet minimum Access to Premises Standards (Data: building asset audit) Building Assets Manager Medium term (2-4 years) CSP An accessible community DP Goal: The environment is inclusive and accessible for people of all abilities EXAMPLE 3: FOCUS AREA: EMPLOYMENT
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives effective as of the day and year set forth herein. University of Utah School of Medicine (“Data Steward”) By: (Signature of “Data Steward”) J. Michael Dean, M.D., MBA Associate Dean By: (Signature of “Data Recipient”) N. Clay Mann, PhD, MS, MBA Professor State EMS Official (“Covered Entity”) Date: Date: By: (Signature) Name: (Please Print) Title: Date:
(Insert Agency Name) Information Technology Quick Reference Guide Goal Objective Initiative Brief Description Funding Mechanism Anticipated Completion Date Goal 1 Should clearly support the Agency mission and/or with the goals of the SCIO Objective 1.1 Measurable, statements of intent that should be derived from and directly linked to the corresponding goal. Initiative 1.1.1 A project or activity undertaken to achieve the stated objective. A description of the efforts to accomplish the objective. Ex. Expansion request, federal grant, existing funds Ex. FY2018 Initiative 1.1.2 Objective 1.2 Initiative 1.2.1 Initiative 1.2.2 Goal 2 Objective 2.1 Initiative 2.1.1 Initiative 2.1.2 Objective 2.2 Initiative 2.2.1 Initiative 2.2.2
[Specify any % of materials, if used and note steps to eliminate.] 7.18 3rd Party Certified Virgin Packaging and Marketing Materials (% by weight) 7.19 Environmentally Responsible Inks (% of materials printed) Packaging 7.20 Describe what your company does to encourage end user to reuse, recycle, or compost, including take-back services. [Note take-back volumes in pounds collected.] 7.21 Check Types of Packaging Material Used: Foil Plastic, Bulk Paper Cardboard Wood Glass Metal Waxed Paper Aseptic Natural Synthetic Fiber Other - please specify 7.22 In what forms are finished materials shipped? Check all that apply: Dry Bulk Liquid Bulk Tote Bags Tote Boxes Bags Foil Bags Metal Drums Mesh Bags Cardboard Drums Plastic Crates Cardboard Cases - please specify 8. LABOR Policy, Practices, Guidelines, and Goals 8.01 Policy, Practices, Guidelines and Goals: Please answer the following: a) What is your company’s current policy regarding Labor and fair working conditions? (Note: You may also provide document or URL.)
membership fees registration fees for existing events sponsorship of existing events salary costs My activity does not fit within the allocated time line Activity proposals will be accepted annually in October/November to support activities in the following financial year (July–June). Applicants will be advised of outcome by and can begin working with the EMCR Unit to deliver their activity (activities will be prioritised based on delivery date). We are interested in supporting a variety of high impact activities and will potentially consider flexibility in application and delivery timing if a strong case can be made. If you have any concerns about how your activity might fit within this timeline, please contact the EMCR Unit at to discuss. This may include (but not limited to): proposing an activity early in the delivery period, e.g. July proposing an activity to align with an existing activity where our timelines do not well with the existing event proposing an ongoing activity, e.g. establishing an EMCR group or on-going education program. The Fund can provide funding and support to establish these types of activities over the granting period including developing long term plan for ongoing financial and governance stability. Tips for successful proposal The EMCR Committee of Council will look favourably on proposals that include one or more of the following: smart solutions that address an issue in the field/discipline activities can demonstrate how they are able to provide benefit and opportunities to innovative ways to extend the of the activity to provide benefit to a large number of EMCRs limited spending on travel costs, with ideas to leverage the provided funding to support these components if required activities that can be held in various locations around Australia or have flexibility in location and timing activities that will be of low cost to EMCRs.
Day and activity analysis sheet for seminar: „Active time management and self management“ with Uwe Freund Date: _________________ Name: _______________________ Main goal: __________________________________________________ Achieved in the end of the day? Yes No Time Activity Pers. Phone Email Letter Time consumer? Disruption? Distraction? Necessary? Unique? Urgent? Self? What can I improve in the future? 06:00 06:10 06:20 06:30 06:40 06:50 07:00 07:10 07:20 07:30 07:40 07:50 08:00 08:10 08:20 08:30 08:40 08:50 09:00 09:10 09:20 09:30 09:40 09:50
Evaluation Title: Evaluation Completion Date: Date of Management Response: No. Management and Program Actions Needed Reason for Action Individual Responsible for Completing Action Budget Allocated (if applicable) Date for Completion of Action Status of Actions (as of date) 1 2 3 4 5
Estimated total time required: Allow for the fact that this work will be completed by a volunteer so will take longer than a paid staff member. Contact details: Location of project: About your organisation: Who or what do you help? How do you help? Are you small ($0-$200,000) medium ($200,000 - $2million) or large ($2million plus)? How many staff? Where do you operate? How will the project assist the organisation to achieve its strategic plan or mission? Project benefits An outline of what the benefits are to the organisation, individuals or stakeholders in delivering the project. Project description: Description of the project and what the volunteer will be responsible for doing. To whom will the volunteer report? What activities or tasks will the volunteer be responsible for? This project will include – This project will not include Define the boundaries of the project – Planning details should not be included at this stage. Project objectives / outcomes: What specific work outcomes or deliverables is the volunteer expected to produce? How will these be measured or evaluated? What are specific objectives for the project. NOTE: the objectives can be one line or a more detailed text.
9.4 List performance requirements from Clause 9 List Appendix or Standard the test method is found Product documentation 11 Product data/Installation and maintenance instructions Product documentation At any change to installation requirements TABLE A2 BATCH RELEASE TESTS Characteristic Clause Requirement Test method Frequency Materials 5 Materials Review materials parts lists and compliance certificates At any change in materials specification Design 8.1 General operation List Appendix or Standard where the test method is found At any change in the design 8.2 Inlet connection Design review Performance 9.1 Products in contact with water AS/NZS 4020 At any change in materials, formulation or design or every
Work Breakdown Structure WBS Dictionary WBS Id WBS Name Include (Completion Criteria) Complexity Estimated Effort Dependency Owner 1.0 Initiation 1.1 Business case Business case documented Low 16hrs None Name 1.2 Evaluation & Recommendation Case is fully evaluated by HRMS management team Low 8hrs 1.1 Name 1.3 Project Charter Charter signed written and approved Medium 16hrs 1.2 Name 1.4 Project Management Planning Includes the scope management plan, time management plan, Risk management plan, HR Plan High 70hrs 1.3, 2.3 Name
Costs Use this table to estimate how much it will cost to deliver this development based on the training listed above and with costs estimated for a five year period. We recommend that a lot of the training can be delivered together, with people from different roles. Days of training per person Number of people Cost each day Direct costs of the training Total cost Cost of updating annually % of their time spent supporting [name] Cost related to [name] over 5 years Costs in year one Notes [Name] [Name’s] family and friends
Information accommodation can be accessed via the EPAUP website: Amount of funding requested in total € Percentage of overall budget sought 100% 4. Educational Event Details The 20th Annual Meeting of European Pressure Advisory Panel – Interdisciplinary teamwork and technological innovations: A winning approach to pressure ulcer management Start date: 12/09/2018 End date: 14/09/2018 Location City: Rome Country: Italy Venue Name: Angelicum University Congress Center, Address: Pontifical University of Saint Thomas Aquinas, Rome, Italy Objective of the Educational Event: please provide a detailed description of scope, purpose and anticipated outcome of the programme. The conference is ‘Interdisciplinary teamwork and technological innovations: A winning approach to pressure ulcer management’ and incorporates: Innovations in pressure ulcer prevention and treatment Multidisciplinary approach in pressure ulcer prevention and treatment Neonatal and pediatric pressure ulcer management Incontinence-associated dermatitis Negative pressure therapy Biomechanics and aetiology Telemedicine for remote pressure ulcer management consultations Public and patient involvement in pressure ulcer prevention and treatment Role of nutrition in pressure prevention and treatment Dermatological, plastic, reconstructive surgery for pressure ulcers Medical device related pressure ulcers Repositioning for pressure ulcer prevention Dressing and dermal substitutes selection The full programme can be found: Targeted audience by the Educational Event International 5. HCPs Participation at the Educational Events Please describe the application procedure and criteria on which the beneficiaries of the grant will be selected ☐ Other – specify Please provide the name and/or position of the person who is responsible for selecting the HCPs to attend the Educational Events ☐ Manager submitting application ☐ - Specify name and position below: 6. Payment details: (may be completed after approval) Details of personnel responsible for financial controls over grant funds (e.g. applicant’s financial department) Name: Email address: Bank account details (This must be an account in the name of the body making the application and not an individual) Bank name: Bank country: Account holder: IBAN number: BIC or SWIFT Code: To be completed by the Manager submitting the application I declare that: This form was completed on behalf of the requesting organisation; The information provided in this form and supporting documents is true and accurate;
[Insert hospital name] ‘Who owns the timeline study’ data collection Admin data: Data recorded by: Patient sticker – no sticker record MRN Walk-in or ambulance: * Patient MRN: Timeline data. Steps in bold should be collected Step Event DTG Date Time Circle best fit or Comments 1 Arrival 2* Triage 3* Enters ED Location: Resusc Acute Sub-acute Fast Track 4* First seen Doctor or NP Doctor NP Physio 5 First seen decision making ED doctor A1 First Test request Pathology CT US Plain XRay A2 First Test results available B1 Specialist referral Specialty: Number of referrals: B2 First Specialist review 6 Admit or discharge decision 7 Bed request (admit only) 8 Bed ready (admit only) Ward: 9 Bed ready (admit only) 10 Bed & ward ready advised to ED 11 Patient transfer (ED) 12 Orderly called 13 Patient departs ED 1st test type” Number of Tests: Destination Ward: 1st specialist referral group: Number of referrals: Sheet reference number: Delays to patient journey and other comments:
Projected wider impact of the project Data management The quality and efficiency of the implementation Overview of the consortium Detailed project by work package WP1: Title The aim of this work package is to …. Task 1.1: The aim of this task is to ……… Activity number Activity description Partners (Lead in bold) A1.1.1 MXX AAA, BBB, CCC A1.1.2 MXX CCC, AAA, BBB A1.1.3 MXX BBB, AAA A1.1.4 MXX AAA, BBB, CCC
SUNY DOWNSTATE MEDICAL CENTER NYC + HH Kings County BROOKLYN, NY 11203 INFORMED CONSENT FORM TITLE OF RESEARCH STUDY: Location/Department: Principal Investigator: CAUTION: If the research is sponsored, please to see if the sponsor has a model informed consent template. If a model informed consent template is available, please use it instead of this template. Items in italics are general instructions and should be deleted and substituted as indicated. To the extent possible, technical, medical, and scientific concepts should be explained in lay terms that are understandable to someone who is educated to the 6th to 8th grade level. Avoid long sentences and medical/technical jargon, and define any technical terms clearly whenever they are used. If the definitions of technical terms are lengthy, describe in separate sentences. The PI is encouraged to use readability resources, such as: Add pictures, diagrams, tables, or charts if they will improve understanding. If applicable, change the title in header (e.g., PARENTAL PERMISSION, CONTROL GROUP INFORMED CONSENT, etc.). Introduction and Purpose We are asking for your permission to be in a research study. Indicate which site(s) are sponsoring the study. Remove KCHC logo from header and name below, if the research does not take place at KCHC. The is sponsored by the SUNY Downstate Medical Center and NYC Health + Hospitals Kings County. trial
Close relative or friend (initials) Who may you contact if you have any additional questions? Only use the number(s) for the location(s) where the research is being done. Always include the IRB number. questions about: May be directed to: The research Research related injury How to withdraw from a study ENTER NAME(S) Telephone: (718) XXX-XXXX Pager: (718) XXX-XXXX ENTER NAME(S) Telephone: (718) XXX-XXXX Pager: (718) XXX-XXXX Your rights Privacy rights How to withdraw from a study Concerns to be directed to an institutional representative who is not part of this research study Institutional Review Board: (718) 613-8480 Hospital Privacy Officer: (718) 270-4033 Interpreter or translation services Patient Relations Department: (718) CONTACT INFORMATION: Before signing this form, please provide your contact information: Address: ______________________________ ______________________________ ______________________________ ______________________________ Telephone: ___________________ (daytime) ___________________ (evening) **Email Address (optional): __________________________ ** Your e-mail address will not be used for insecure communications of protected health care information. Signatures Instructions: Use only the required boxes based on the research and delete all others. Minor edits to the language may be needed, depending on the exact nature of the study.
Template Curriculum Vitae Full Name, Institution website url Address Contact details (e-mail; telephone number) d.o.b Summary of Career MM/YYYY – MM/YYYY – Current position MM/YYYY – MM/YYYY – Position 2 MM/YYYY – MM/YYYY – Position 3 Summary of Education Qualification 1 – Dates, Institution Qualification 2 – Dates, Institution Publications Summary Total number of publications (H-Index where applicable), total number of patents Books/book chapters Research Area Summary/ Teaching and/or Outreach summary Five Relevant Publications • One • Two • Three • Four • Five Other Indicators of Esteem • Funding awards (Date awarded) • Prizes/awards/medals (Date awarded) • Invited lectureships/exchanges (Date awarded) • Organisation of meetings/conferences • Membership of editorial boards/advisory boards/societal committees/ industry bodies • Supervision of staff/students (as applicable)
XXX was observed XXX. During the home XXX provided information through the CVI Parent Interview Form. Results Color – Children with CVI often have a favorite color or a color that they will look at more than other colors. Movement – Children with CVI often look at objects that are moving slightly or are shiny. Shiny objects have a movement quality as light reflects off of them. Latency – Latency is the time between when an object is presented and when a looks. Visual fields – Children with CVI sometimes prefer or can look better at things presented in certain visual fields. Complexity – Children with CVI have difficulty with complexity. Complexity can be in the object (multiple colors and sounds); in the array (many objects at once or a visually cluttered background); or in the sensory environment (lots of background noise, trying to do difficult motor tasks while looking). Distance viewing – Visual novelty – Children with CVI often look at familiar and favorite toys better than novel ones because they have learned to look at those things. Light gazing – Children with CVI often stare compulsively into primary light sources or spend a lot of time not looking at anything in particular (non-purposeful gaze). Visual reflexive responses – Visual motor – Children with CVI often have trouble using their eyes and hands together. Summary of Results and Recommendations On a scale of 0 – 10 (with 0 = no vision responses and 10 = almost typical visual responses) XXX scored a XXX on the range. XXX has many characteristics that are typical of children with CVI and has trouble using XXX vision. The primary visual goal for XXX at this time is to build more consistent visual responses. The following are recommendations to help XXX improve XXX functional vision.
STUDENT INTEGRATIVE LEARNING CONTRACT – Areas of Learning: Academic Year Start Learning Objective I: Learning Objective II: Learning Objective : Provide culturally sensitive evidence-based individual counseling sessions to target population. Effectively facilitate group sessions with adolescents and adults. Effectively implement diagnostic assessments as a primary service delivery tool for clientele. Incremental Task Assignments: Incremental Task Assignments: Incremental Task Assignments: 1. Research target population- theories, best practices 1 Research what is known about target population, theories, and best practices 1. Research the history, role, purpose, function, goal, and impact of diagnostic assessments 2. Research the history of this population with agency 2 Research the history of groups in agency 2. Identify two assessments appropriate for client system 3. Shadow/Observe staff working with population 3 Shadow/Observe staff working with adolescents and groups in a group setting 3. Shadow/observe actively involved in diagnostic assessments 4. Conduct psychosocial assessment as needed 4 Facilitate adolescent groups – a minimum of one per week 4. Conduct two diagnostic assessments per week 5. Conduct relevant intervention 5 Facilitate adult groups- a minimum of one per week 5. Provide detailed oral & written reflections on processes of diagnostic assessments Student Initials: JN Field Instructor: SSW Faculty Liaison: TM
STUDENT INTEGRATIVE LEARNING CONTRACT – Areas of Learning: Academic Year Start Learning Objective I: Learning Objective II: Learning Objective : Design relevant and user-friendly electronic resources book for staff to effectively assist target population Design an evidence-based professional development training program for front-line staff Develop an organizational needs assessment that can be adapted annually to meet agency needs Competency: Competency: Competency: Incremental Task Assignments: Incremental Task Assignments: Incremental Task Assignments: 1. Research the history of electronic resources with this agency 1 Research the history of training programs with agency staff 1. Research the history of organizational needs assessment conducted at agency 2. Conduct a needs assessment with agency personnel on resources required to effectively support client systems 2 Conduct a needs assessment on the continuing education courses needed by staff to support client systems 2. Interview key staff & clients to determine specific categories 3. Research and identify target resources 3 Identify subject areas and subject area experts to facilitate training sessions 3. Draft assessment 4. Prepare a draft and electronically distribute project to field instructor and selected agency staff 4 Conduct a pilot 4. Gather & compile data 5. Integrate feedback and distribute resource 5 Gather feedback & refine training program 5. Present initial findings to instructor STUDENT INTEGRATIVE LEARNING CONTRACT – Areas of Learning:
This template provides a resource for you to developing your own unit and content questions. Feel free to change or add any enduring understanding, essential questions, and performance standards to meet your needs. Be sure they are aligned. Addressing Essential Questions Brief Description of Unit Activity Enduring Understanding Essential Questions Unit Questions Content Questions Performance Standards Responding: Individual aesthetic and empathetic awareness developed through engagement with art can lead to understanding and appreciation of self, others, the natural world, and constructed environments. How do life experiences influence the way you relate to art? How does learning about art impact how we perceive the world? What can we learn from our responses to art? VA:Re7.2.3 Speculate about processes an artist uses to create a work of art. Connecting: People develop ideas and understandings of society, culture and history through their interactions with and analysis of art. How does art help us understand the lives of people of different times, places, and cultures? How is art used to impact the views of a society. VA:Cn11.1.1 Understand that people from different places and times have made art for a variety of reasons. VA:Cn11.1.2 Compare and contrast cultural uses of art-work from different times and places.
Name of signatory: Date: , 201… Specification, Milestones Specification The Specification is detailed in the Appendix, page 43. The Specification is based on: the invitation and/or acceptance by AHDB for the supply of the Goods and/or Services, whether by tender or otherwise, and the Supplier’s offer but excluding any of the Supplier’s terms and conditions indicated to be imposed thereby except insofar as such terms and conditions do not conflict with any other provision of this Contract. Any amendment to the Specification agreed in accordance with this Contract shall be deemed to be included in the Appendix. Milestones The following milestones are agreed: Date Milestone - The remainder of this page is intentionally blank - Payment and Invoicing AHDB shall raise a Purchase Order following its receipt of this Contract signed by the Supplier, the serial number of which shall be notified to the Supplier. Subject to Condition 11.3.1 and any agreed amendment of this Contract in Writing, AHDB will pay the Supplier no more than £…, exclusive of VAT. Subject to paragraph 2.1.1 below and compliance with this Contract including any milestones in Schedule A, the Supplier shall invoice AHDB monthly in retard for the Goods and Services supplied. The Supplier shall invoice AHDB as follows for the Goods and Services supplied: Date Description Amount
Supporting Information Legislative Compliance This Guideline supports the University’s compliance with the following legislation: List the full titles and URLs of any applicable State or Federal legislation, including any relevant pinpoint references. If relevant, list any UNSW statutes/regulations that this Guideline relates to. Any variation to this Guideline must remain consistent with the parent statute or regulation. If none, insert “Nil”. Legislation listed here must be included in the UNSW Legislation Register. Contact the UNSW Compliance Manager for further advice when completing this section. Parent Document (Policy and Procedure) Include title and URLs of any Policy and Procedure that this Guideline supports. If none, insert ‘Nil’. Supporting Documents Include titles and URLs of templates or forms which directly support this Guideline. If none, insert ‘Nil”. Related Documents Include titles and URLs of any documents that relate to, but do not directly support, this Guideline. This may include other University Policies, Procedures and Guidelines, or non-University materials such as regulatory codes or standards. If none, insert ‘Nil’. Superseded Documents List all documents superseded by this Guideline. If none, insert ‘Nil’. File Number [For Governance Use] Definitions and Acronyms Insert Term Insert definition of terms used within this Guideline and expand any acronyms used. Add extra rows below as required. Insert Term Revision History Version Approved by Approval date Effective date Sections modified #.# [to be completed] [to be completed] [to be completed] [to be completed] Further Information This section is not published on the final PDF document. It is for website purposes only Keywords for search engine University-wide Guidelines will be housed within the Governance Repository. Include keywords to assist location using the ‘search’ function. FAQs and answers Include any Frequently Questions and answers to be included with the Guideline (in a separate tab or section) in the Governance Policy Repository
3 4 5 over to cost summary A B. Allowances (daily subsistence allowance (DSA), etc.; only for project team members hired solely for the project and under strict conditions) No. Function (specify function) Number of days DSA/day (in USD) QSF amount (in USD) Other resources 1 2 3 4 5 over to cost summary B C. Travel costs (only for project team members hired solely for the project and under strict conditions) No. Function (specify function) Nature of travel QSF amount (in USD) Other resources 1 2 3 4 5 Carry over to cost summary C D. Services Note. – if a consulting company (UPU or non-UPU) has been retained solely for this project, the consulting fees, travel costs and allowances can be financed under the QSF budget. Moreover, allowances and travel expenses incurred by DO staff recruited specifically for this project can also be financed under the QSF budget. No. Cost element QSF amount (in USD) Other resources 1 Consulting company: PTC or others consulting fees 2 Consulting company: allowances 3 Consulting company: travel costs 4 5 Carry over to cost summary D E. Equipment No. Item (specify the equipment or vehicles) Units per unit (in USD) QSF amount (in USD) Other resources
Section Title Page Number 1 Introduction 3 2 Evidence Base 3 3 Purpose 3 4 3 5 Responsibilities 3 6 Definitions 4 7 Risk Management 4 8 Describing the Care Required 4 9 Management of Skin and Soft Tissue Infections 4 10 Screening 5 11 Reducing the Risk of Spread 5 12 Equality and Diversity 6 13 Monitoring and Review 6 14 Further Guidance 6 15 References 6 16 Appendices 1: Quick Reference Guide – Management of PVL - SA 2: Application of Chlorhexidine / Octenisan bodywash 3: Patient Information 7 8 9 1: Introduction This guidance has been developed for use by healthcare staff in the primary care setting when a patient presents with suspected or diagnosed Panton Valentine Leukocidin – Staphylococcus aureus (PVL-SA). Staff should have access to appropriate guidance that will help effectively prevent and control infections. 2: Evidence Base This guidance has been devised on best practice and information sourced in the reference list. 3: Purpose The purpose of this guidance is to ensure that primary care within Nottinghamshire County; have sufficient information to effectively treat and manage patients with PVL-SA. 4: Scope
[Club name] Meeting agenda Date/time: Location: Chair: Minute taker: Objectives: For example: To discuss ideas for fundraising event Schedule: For example: 1:30 pm – Welcome 1:40 pm – Brainstorm ideas for fundraising 2:15 pm – Discuss logistics Who will be leading the fundraiser? Where will it happen? When will it happen? What will we need? Who do we need to talk to?
Conclusion We hope to welcome you at the Micro-CT User Meeting with an oral or poster presentation and look forward to receiving your submissions for our annual picture and movie contest, an opportunity to win great prices. References: Author, “title” Journal, Pages, year Author, “title” Journal, Pages, year
3.3 Ancillary Analyses Report any other analyses performed, including subgroup analyses and adjusted analyses, indicating those that were prespecified and those that were exploratory (though not necessarily in the level of detail of primary analyses). Consider putting the detailed results of these analyses on the supplemental online archive. Discuss the implications, if any, of the ancillary analyses for statistical error rates. 3.4 Participant Flow For experimental and quasi-experimental designs, there must be a description of the flow of participants (human, animal, or units such as classrooms or hospital wards) through the study. Present the total number of units recruited into the study and the number of participants assigned to each group. Provide the number of participants who did not complete the experiment or crossed over to other conditions and explain why. Note the number of participants used in the primary analyses. (This number might differ from the number who completed the study because participants might not show up for or complete the final measurement.) 3.5 Intervention or Manipulation Fidelity If interventions or experimental manipulations were used, provide evidence on whether they were delivered as intended. In experimental research, this might be the results of checks on the manipulation. In applied research, this might be, for example, records and observations of intervention delivery sessions and attendance records. 3.6 Baseline Data Be sure that baseline demographic and/or clinical characteristics of each group are provided. 3.6.1 Statistics and Data Analysis In studies reporting the results of experimental manipulations or interventions, clarify whether the analysis was by intent-ta-treat. That is, were all participants assigned to conditions included in the data analysis regardless of whether they actually received the intervention, or were only participants who completed the intervention satisfactorily included? Give a rationale for the choice. 3.6.2 Adverse Events If interventions were studied, detail all important adverse events (events with serious consequences) and/or side effects in each intervention group. Table 1. Table title (this is an example of table 1) capital stock Income of main business assets Pudong Development Bank 39.2 214.7 5730.7 Bank of China 459.4 3345.7 59876.9 Discription: table caption in front of table body and description below the table body. Avoid vertical rules. Be sparing in the use of tables and ensure that the data presented in tables do not duplicate results described elsewhere in the article.
Examples of structure Work Package Work package nb WP title Type of activity Participants Person time Start month End month 1 2 3 4 5 6 Detailed Cost and Budget Calculation Category Year 1 *) Year 2*) Year 3 *) Total Value Effort (PM) Personnel cost Other cost Subcontracting Total direct cost Indirect cost Total cost Requested contribution *)Calendar year Examples of structure Risk Assessment Risk Assessment Identified problem Consequence Likelihood Action (CVs and Budget are submitted separately, written in template)