CPH exam terminology 1101 Questions with Verified Answers,100% CORRECT

CPH exam terminology 1101 Questions with Verified Answers Acculturation - CORRECT ANSWER A gradual process through which an individual adopts the behavioral norms, attitudes and beliefs of a culture other than his ...

CPH exam terminology 1101 Questions with Verified Answers Acculturation - CORRECT ANSWER A gradual process through which an individual adopts the behavioral norms, attitudes and beliefs of a culture other than his own Adherence - CORRECT ANSWER Closely following or sticking to a plan or protocol. In the context of health promotion, the term refers to individuals taking their medications as prescribed (i.e. adherence to antiretroviral therapy) or following program protocols (i.e. sticking to a diet and exercise plan). Asset mapping - CORRECT ANSWER A component of community capacity assessment and community development that involves conducting an inventory of individual, group and community resources, often physically designating them on a geographical map. A capacity assessment offers an alternative to a needs-based approach to community health and "is a measure of actual and potential individual, group and community resources that can be inherent and/or brought to bear for health maintenance and enhancement." Once assets are "mapped," efforts are directed at mobilizing, strengthening and supplementing them while working to achieve a common vision. Behavioral capability - CORRECT ANSWER An individual's knowledge and skills related to a specific health behavior. In order for an individual to engage in a particular behavior, that individual must first know what the behavior is and how to successfully perform it. Behavioral capability is a key construct of the Social Cognitive Theory. Behavioral intention - CORRECT ANSWER Mental state in which the individual expects to take a specified action at some time in the future Behavioral objective - CORRECT ANSWER Statement of desired outcome that indicates who is to demonstrate how much of what action by when ." Behavioral risk - CORRECT ANSWER Typically modifiable behavior, like smoking or lack of physical activity, which puts an individual at risk for a negative health outcome Change agent - CORRECT ANSWER In the context of Diffusion of Innovations, a change agent is "an individual who influences clients' innovation-decisions in a direction deemed desirable by a change agency." The change agent's functions are often to develop a perceived need for change, facilitate information-exchange, identify a client's problems, develop a client's intentions to change, motivate the movement from intentions to action, support long-term adoption of the change, and help the client achieve self-reliance. Communication theories - CORRECT ANSWER In PH context, these are meant to describe how communication processes impact health behavior change and how communication strategies can be used strategically to motivate behavior change. Although there are a number of communication theories and concepts, four that are particularly relevant to public health include the knowledge gap, agenda setting, cultivation studies, and risk communication . The knowledge gap refers to the fact that individuals with more formal education tend to be more knowledgeable about many issues when compared to those with less formal education; therefore, "an increasing flow of information into a social system is more likely to benefit groups of higher socioeconomic status than those of lower SES," thereby contributing to health disparities and other inequities. Knowledge gaps can be modified by content and channel factors, social conflict and mobilization, community structure, and individual motivational factors. Agenda-setting refers to the ability of the mass media to influence public opinion and priorities, particularly in relation to politics and policymaking. Cultivation studies investigate "the impact the mass media have on our perceptions of reality." Community - CORRECT ANSWER Specific group of people, often living in a defined geographical area, who share a common culture, values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future. They exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them Community-based participatory research (CBPR) - CORRECT ANSWER Collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. Begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities Community capacity - CORRECT ANSWER Combined assets that influence a community's commitment, resources, and skills used to solve problems and strengthen the quality of life for its citizens Community organization - CORRECT ANSWER Set of procedures and processes by which a population and its institutions mobilize and coordinate resources to solve a mutual problem or to pursue mutual goals Consciousness raising - CORRECT ANSWER Process of "learning new facts, ideas and tips that support the healthy behavior change." Efforts to increase awareness about the causes and consequences of a disease or unhealthy behavior during a media campaign would be considered consciousness raising. Consciousness raising is a process of change included in the Transtheoretical model that is most appropriate for individuals in the earliest stages of change (precontemplation and contemplation). Cues to action - CORRECT ANSWER Strategies to activate one's readiness" to engage in a particular behavior or activity. A cue to action can be either an internal or external stimulus that motivates a person to act. Cues to action is a key construct in the Health Belief Model. Cultural competence - CORRECT ANSWER Design, implementation, and evaluation process that accounts for special issues of select population groups (ethnic and racial, linguistic) as well as differing educational levels and physical abilities Decisional balance - CORRECT ANSWER Relative weight an individual places on the perceived pros and cons of changing or engaging in a certain behavior. Typically, the pros of change need to outweigh the cons of change before an individual will be ready to take action and maintain a behavior change. Decisional balance is a key construct in the Transtheoretical model. Diffusion of innovations (DOIs) - CORRECT ANSWER Community-level theory that attempts to describe the rate and process of the adoption of new ideas and behaviors in a specific population or between populations. An innovation is defined as "an idea, practice or object that is perceived as new by an individual or other unit of adoption," while diffusion is defined as "the process by which an innovation is communicated through certain channels over time among the members of a social system." The process of diffusion occurs over the course of five stages: innovation development, dissemination, adoption, implementation, and maintenance. The adoption stage requires that an individual: 1) has knowledge of the innovation (has an awareness that the innovation exists, knowledge of how to use the innovation and how it works); 2) goes through a process of persuasion or attitude development, in which the individual discusses the innovation with others and forms a favorable or negative attitude toward it; 3) decides to adopt the innovation; 4) implements, or begins to use the innovation; and 5) goes through a process of confirmation, in which the individual integrates the innovation into his life and recommends it to others. In general, not everyone adopts an innovation at the same time. Diffusion of Innovations categorizes individuals into five groups, based on when they adopt an innovation: innovators are the first to adopt, followed by early adopters , then early majority adopters , followed by late majority adopters and finally laggards . The process of adoption in a population over time, as described by DOI, roughly follows a standard normal distribution: early majority adopters and late majority adopters are within one standard deviation of the mean; early adopters and laggards are within two standard deviations; and innovators are within three standard deviations of the mean. There are certain attributes of an innovation that determine the speed and extent of its diffusion. These attributes include: the relative advantage of the innovation over existing alternatives; its compatibility with the intended audience; its complexity , or ease of use; its trialability , or whether or not someone can try the innovation before deciding whether or not to adopt it; the observability or measurability of its results; its likely impact on social relations ; its reversibility ; its communicability , or how easily and clearly it can be understood; the time required to adopt the innovation; the level of risk or uncertainty associated with its adoption; the level of commitment required to use the innovation effectively; and the modifiability of the innovation over time. Early adopters - CORRECT ANSWER Those in the population who accept a new idea or practice soon after the innovators (but before the middle majority), and who tend to be opinion leaders for the middle majority Ecological approaches/levels - CORRECT ANSWER Recognize the multiple levels of influence on and the varying nature of determinants of health. They view health behavior as both affected by and affecting the physical and social environment (reciprocal determinism). They move beyond a "victim blaming," individual-level approach to health promotion, emphasizing the use of multiple strategies to impact determinants of health, partnerships between multiple sectors to enhance health promotion efforts, and targeting change at multiple levels of intervention. The levels of an ecological approach in health promotion include intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. Empowerment - CORRECT ANSWER Social action process that promotes participation of people, organizations and communities in gaining control over their lives in their community and larger society. With this perspective, empowerment is not characterized as achieving power to dominate others, but rather power to act with others to affect change." 6 "In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health Environment/environmental factors - CORRECT ANSWER Factors that influence an individual's behavior but are physically external to the individual. The environment/environmental factors are explicitly important in social ecological approaches to health education and health promotion, as well as in Social Cognitive Theory. Ethics in health promotion and health promotion research - CORRECT ANSWER Ethical principles in health education and health promotion practice and research are similar to those outlined in the Belmont Report and earlier ethical codes and include principles of respect for persons, beneficence, and justice. In health promotion practice and research, these ethical principles call for informed consent and voluntary participation, a commitment to preserve participant privacy, equitable inclusion in programs and research, a protection of vulnerable populations, and careful efforts to maximize benefits and minimize risks for participants. A unified code of ethics for the health education profession was adopted in 1999, outlining each health educator's responsibilities to the public, to the profession, to employers, in delivering health education, in conducting research and evaluation, and in professional preparation. The code of ethics is available at www.cnheo.org. Feedback - CORRECT ANSWER Information provided to individuals based on their individual characteristics or based on comparisons with others. Major types of feedback, in the context of health communication and communication technology, include personal feedback, normative feedback, and ipsative (or iterative) feedback Personal feedback - CORRECT ANSWER Refers to the information that respondents obtain about the answers they have provided Normative feedback - CORRECT ANSWER Refers to the information respondents obtain when comparing their responses with the responses of another group Ipsative (iterative) feedback - CORRECT ANSWER Refers to a comparison between a person's most recent status and that found at previous assessments Formative evaluation - CORRECT ANSWER Any combination of measurements obtained and judgments made before or during the implementation of materials, methods, activities or programs to discover, predict, control, ensure, or improve the quality of performance or delivery." This can include the combination of needs assessment, pilot testing, process evaluation, etc. Formative research - CORRECT ANSWER Assesses the nature of the problem, the needs of the target audience, and the implementation process to inform and improve program design. Formative research is conducted both prior to and during program development to adapt the program to audience needs Common methods of formative research - CORRECT ANSWER Literature reviews, reviews of existing programs, and surveys, interviews, and focus group discussions with members of the target audience." Gatekeeper - CORRECT ANSWER Individual who formally or informally controls aspects of a community and/or access to a priority population. Gatekeepers are typically very knowledgeable of a community and how it functions. In community health, gaining the cooperation of the community gatekeeper(s) can improve the feasibility, quality and acceptability of community interventions and programs Hardiness - CORRECT ANSWER Positive coping influence characterized by "high levels of perceived control, commitment to succeed, and a propensity to see stressful life events as challenging." Challenging, in the context of hardiness, reflects an individual's ability to view stressful situations and experiences as an opportunity for growth and development and not as a threat. Hardy individuals are less likely to experience illness as a result of stressful events Harm reduction - CORRECT ANSWER Intermediate approach to behavior change that emphasizes adopting a lower risk alternative to a high risk behavior when an individual is either unwilling or unable to stop the high risk behavior. Needle exchange programs that facilitate the use of sterile injection equipment in order to reduce the transmission of HIV among injection drug-users are an example of harm reduction. Health belief model (HBM) - CORRECT ANSWER Individual-level, value-expectancy health behavior theory developed in the 1950s by social psychologists in the U.S. Public Health Service in efforts to explain why people did not seek preventive health and screening services. The theory was first used in relation to a free Tuberculosis screening program, but has since been applied to numerous health behaviors. The HMB maintains that an individual will engage in behavior to prevent, screen for or control disease or negative health outcomes if they 1) perceive themselves to be at risk for that disease; 2) believe that the disease has potentially serious consequences; 3) believe that a recommended (and available) behavior is effective in reducing their risk for or the consequences of the disease; and 4) believe that the perceived barriers or costs of engaging in that behavior are fewer than the perceived benefits. Internal or external cues to action can motivate a person to take action. Self-efficacy was added as a construct to the HBM in the late 1980s. Health disparities - CORRECT ANSWER Differences in the incidence, prevalence, mortality, burden of diseases or other adverse health conditions that exist among specific groups within the general population. "A chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny." Health Insurance Portability and Accountability Act (HIPAA) - CORRECT ANSWER A statute passed in 1996 in efforts to improve the efficiency of healthcare delivery by mandating and standardizing the electronic exchange of health information and to provide Federal protections to preserve the privacy of protected, individually identifiable health information. Under HIPAA's Privacy Rule, an individual has the right to see and correct his health records, to know how information from those health records is being used and shared, and to deny permission for those health records to be used for certain purposes. In many cases, an individual must provide written permission for certain individuals or groups to be able to received information from his personal health records, unless that information is needed to provide continuity of care or is required to be reported for public health surveillance purposes Impact evaluation - CORRECT ANSWER Assessment of program effects on intermediate objectives including changes in predisposing, enabling, and reinforcing factors, behavioral and environmental changes, and possibly health and social outcomes Information-motivation-behavior (IMB) - CORRECT ANSWER General model that holds that information, motivation, and behavioral skills are the primary determinants of health-related behaviors. Individuals who are well informed, highly motivated, and who have the necessary behavioral skills are more likely to engage in a specific health-related behavior. The specific types of information, motivational strategies and behavioral skills necessary to lead to behavior change are expected to vary between subpopulations and between behaviors. Behaviorally relevant information is considered "a necessary but not a sufficient condition" for risk reduction behavior. In general even a well-informed and behaviorally skilled individual must be highly motivated in order to engage in a specific health-promoting behavior and to maintain it over time. Institutionalization - CORRECT ANSWER Involves "permanently" incorporating program activities into the routines and structure of an organization or community in order to maximize the long-term benefits of your program and to ensure its sustainability following staffing changes, the termination of formal activities and/or grant funding, etc. Intervention mapping - CORRECT ANSWER Program planning framework intended to facilitate the development of theory- and evidence-based health promotion programs. Following a thorough review of the literature and an appropriate needs assessment, the process of intervention mapping includes five steps: "1) creating matrices of proximal program objectives from performance objectives and determinants of behavior and environmental conditions; 2) selecting theory-based intervention methods and practical strategies; 3) designing and organizing programs; 4) specifying adoption and implementation plans; and 5) generating an evaluation plan." In step one, a list of performance objectives are generated that define the desired behavioral and environmental outcomes of the program; personal (internal) and external determinants of the behavioral and environmental outcomes are specified; if determinants vary by sub-population, the target population is differentiated; and, finally, performance objectives and determinants are linked in a matrix format, often by level (i.e. individual vs. organizational) and by sub-population, if applicable. Each cell in the resulting matrices will contain either a learning objective (linking a performance objective with a personal determinant) or a change objective (linking a performance objective with an external determinant) that defines what individuals need to learn or what changes need to take place in the environment as a result of the program. In step 2, a list of theoretical intervention methods (i.e. community planning) and a list of possible strategies for delivering those methods (i.e. community forums or meetings) are developed, based on the identified proximal objectives. In step 3, the selected strategies are operationalized into deliverable program components and delivery mechanisms (i.e. channel selection), and program materials are developed and pre-tested. During step 4, a "linkage system" between program users and developers is created so that the program can be modified to meet the needs of the users; adoption and implementation performance objectives are developed; determinants of adoption and implementation are specified; and an implementation plan is developed. Finally, step 5 involves developing an evaluation model, including a plan for process evaluation. Intervention message - CORRECT ANSWER Program-specific message delivered to an individual or group that is designed to increase awareness of a health problem, motivate behavior change, address perceived barriers to engaging in a health behavior, or something else related to the goals and objectives of the program. Theory-based and tailored intervention messages are typically the most effective. Lay health advisor (or lay health worker or community health worker) - CORRECT ANSWER Member of the target community that is trained to administer health promotion messages and program activities. Lay health advisors are often used to overcome language barriers, to enhance the cultural relevance of health promotion programs, to facilitate access to and understanding of a community among program planners, to help connect members of the target population with services, etc. Locus of control - CORRECT ANSWER Generalized belief that circumstances and rewards are under one's own (internal locus of control) or others' control (external locus of control). Mediating factors - CORRECT ANSWER Factor that partially or completely explains the relationship between a predictor and a behavior or outcome. A mediating factor is independently related to the outcome of interest and to the predictor of interest, thereby acting as a link between the two. For example, in the Theory of Reasoned Action, a person's behavioral intention acts as a mediating factor between his attitude and subjective norms and his behavior. Mission statement - CORRECT ANSWER Brief statement that defines the purpose and focus and sometimes the vision and values of an organization or program. Typically, all program planning, program activities, partnerships, etc. should be made to reflect to the mission statement to ensure that they are in line with the overall purpose and goals of the program or organization. Mixed methods - CORRECT ANSWER Strategic and systematic combination of qualitative and quantitative research methods. The combination of methods often works to overcome the limitations of quantitative or qualitative methods used in isolation, to improve the validity of findings, and/or to provide a more comprehensive understanding of a problem or phenomenon. Motivational interviewing - CORRECT ANSWER Directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence ." 17 Motivational interviewing emphasizes drawing out an individual's internal motivations to change; allowing an individual to express and resolve her own ambivalence towards a behavior; and avoiding direct persuasion, confrontation and argumentation. The individual is viewed as the expert, while the primary role of the interviewer is to facilitate the individual's expression of goals and the discovery of an acceptable resolution to the ambivalence. In theory, an individual's ambivalence is the principle barrier to behavior change. National health objectives - CORRECT ANSWER U.S. Department of Health and Human Services has coordinated a process to develop a set of national health objectives to direct public health efforts each decade since 1980, starting with the publication of Promoting Health/Preventing Disease: Objectives for the Nation. The current set of national health objectives is contained in Healthy People 2010: Understanding and Improving Health . Healthy People 2010 contains 467 national health objectives that cover 28 primary focus areas. Needs assessment - CORRECT ANSWER Process of determining, analyzing and prioritizing needs, and in turn, identifying and implementing solution strategies to resolve high priority needs." Meant to assist program planners in identifying a priority population, their specific needs, subgroups of the population with the greatest needs, the most significant problems facing the priority populations and subgroups, what is currently being done and/or what has been done in the past to effectively address their needs, etc. Generally viewed as the first step in health promotion program planning and depends on both secondary and primary data collection gathered through a variety of qualitative and quantitative methods. Normative beliefs - CORRECT ANSWER Reflect individuals' beliefs about whether important referent individuals, or people whose opinion they value, approve or disapprove of a particular behavior. Normative beliefs, along with an individual's motivation to comply with the opinions and values of the referent individuals, form a person's subjective norms. Normative beliefs and subjective norms are constructs of the Theory of Reasoned Action/Theory of Planned Behavior. Opinion leaders - CORRECT ANSWER Individuals who are well respected in a community and can accurately represent the views of the priority population." They are typically demographically similar to the priority population, knowledgeable about community issues and concerns, early adopters of innovations, and capable of persuading others to engage in a particular behavior. Organizational change - CORRECT ANSWER Process through which organizations "innovate new goals, programs, technologies, and ideas" in order to improve organizational efficiency and effectiveness Seven Stages of the Stage Theory of Organizational Change - CORRECT ANSWER 1) Sensing unsatisfied demands on the system; 2) search for possible responses; 3) evaluation of alternatives; 4) decision to adopt a course of action; 5) initiation of action within the system; 6) implementation of the change; and 7) institutionalization of the change Outcome evaluation - CORRECT ANSWER Assessment of the effects of a program on the ultimate objectives, including changes in health and social benefits or quality of life Outcome expectations - CORRECT ANSWER Anticipatory outcomes of a behavior," or what an individual perceives is the likely result of engaging in a specific behavior. Outcome expectations develop from previous experience, through observing others, hearing about specific behaviors or situations from others, or from emotional or physical responses to a behavior. Outcome expectations are a construct of the Social Cognitive Theory. Perceived barriers - CORRECT ANSWER Individual's beliefs about the negative consequences of or challenges associated with engaging in a particular health behavior. Perceived barriers can be physical, emotional, psychological, economic, etc. Typically, the perceived benefits of a behavior must outweigh the perceived barriers for a person to adopt that behavior. "Perceived barriers" is a key construct of the Health Belief Model. Perceived benefits - CORRECT ANSWER Individual's beliefs about the efficacy of a particular behavior in reducing the perceived threat associated with a particular disease or outcome. An individual would not be expected to adopt a specific health behavior without believing it would effectively reduce his perceived threat of disease. "Perceived benefits" is a key construct of the Health Belief Model. Perceived Response efficacy - CORRECT ANSWER Belief whether the recommended action is effective in preventing or reducing risk for a health problem. It is important to note that ether low perceptions of self (self efficacy), or low perceptions of the recommended action (response efficacy) may lead to maladaptive behavior. For example, people may not feel confident that they can reduce their intake of fried foods (self efficacy) or they may not feel confident that reducing their intake of fried foods will lower their risk of heart attack (response efficacy). The implication for prevention is to ensure that health education supports both the belief in one's ability to change lifestyle behaviors as well as the belief that lifestyle changes are effective in reducing risks. Perceived self-efficacy - CORRECT ANSWER Individual's beliefs about and confidence in his ability to perform a certain behavior or take action. Self-efficacy influences what behaviors we choose to perform, the amount of effort we expend on performing those behaviors, how long we persist in performing a behavior, and how we feel about particular behaviors. Self-efficacy is developed through direct or vicarious experience, verbal or social persuasion, and physiological reactions/feedback. Perceived self-efficacy is a concept common to many theories of Health Behavior, but is most directly related to Social Cognitive Theory. Perceived severity - CORRECT ANSWER Individual's beliefs about how serious a disease or its physical and social consequences are. "Perceived severity" is a key construct of the Health Belief Model. Perceived susceptibility - CORRECT ANSWER Individual's beliefs about how vulnerable, or at risk, he or she is to getting a particular disease or of being affected by a particular health outcome. "Perceived susceptibility" is a key construct of the Health Belief Model. Perceived threat - CORRECT ANSWER Combination of perceived severity and perceived susceptibility. An individual's beliefs about his perceived susceptibility to a disease and the perceived severity of that disease combine to form his overall beliefs about the level of threat that disease poses for him. Pilot testing - CORRECT ANSWER Implementing a program or program components on a smaller scale, in a setting similar to where the program will be fully implemented and with a population similar to the planned target population. Pilot testing allows program planners to identify and correct problems with the intervention strategies before they are fully implemented. Policy advocacy - CORRECT ANSWER Actions or endeavors individuals or groups engage in in order to alter public opinion in favor or in opposition to a certain policy." Population-based - CORRECT ANSWER Community health methods that are used to help change behavior in groups of people." Population-based approaches use a defined community or population as their organizing principle for preventive action over individuals, and they focus on addressing population-level processes that influence health. Population-based approaches include policy development and advocacy, organizational change, community development and empowerment. PRECEDE-PROCEED framework - CORRECT ANSWER Most well-known health program planning model. In PRECEDE-PROCEED a program planner begins by identifying the desired outcome of the program and working backwards to discover strategies for reaching that outcome. PRECEDE stands for p redisposing, reinforcing and enabling constructs in educational/ecological diagnosis and evaluation, and includes various stages of assessment and planning. PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development and deals mainly with program implementation and evaluation. 9 Phases of PRECEDE-PROCEED - CORRECT ANSWER Phase 1, social assessment and situational analysis, involves engaging the target population to identify general indicators of quality of life. Phase 2, epidemiological assessment, includes identifying specific health goals or problems that contribute to or interact with the social goals or problems identified in phase 1. Phase 3, behavioral and environmental assessment, involves identifying and prioritizing behavioral and environmental determinants of the specific health problems identified in phase 2. Phase 4, educational and ecological assessment, includes identifying and prioritizing predisposing, reinforcing and enabling factors that are related to the behavioral and environmental determinants. " Predisposing factors include a person's or population's knowledge, attitudes, beliefs, values and perceptions that facilitate or hinder motivation for change." Reinforcing factors are "the rewards received and the feedback the learner receives from others following adoption of a behavior." " Enabling factors are those skills, resources or barriers that can help or hinder the desired behavioral changes as well as environmental changes." Phase 5, intervention alignment and administrative and policy assessment, involves "intervention matching, mapping, and patching" to determine which program components and activities are needed to target the factors identified in the previous stages and determining whether or not the program has the policy, organizational and administrative capacity to do them. In phase 6, implementation occurs. Phase 7 includes process evaluation, phase 8 includes impact evaluation, and phase 9 includes outcome evaluation. Primary data - CORRECT ANSWER Data gathered directly by the individual using it to answer a specified research question or to gather information on a specific population or health problem. This includes data collected first-hand through survey research, focus groups, interviews, etc. Process evaluation - CORRECT ANSWER Any combination of measurements obtained during the implementation of program activities to control, assure, or improve the quality of performance or delivery Processes of change - CORRECT ANSWER Covert and overt activities that people use to progress through the stages" of change in the transtheoretical model (TTM). There are ten processes of change that have been identified in conjunction with the development of the TTM: consciousness raising, dramatic relief, self-reevaluation, environmental reevaluation, self-liberation, helping relationships, counter-conditioning, contingency management, stimulus control, and social liberation. Different processes of change are used by individuals in different stages of change to progress towards action and maintenance. In the early stages, people tend to rely more on the cognitive, affective and evaluative processes (consciousness raising, dramatic relief, environmental reevaluation and self-reevaluation) while in the later stages the emphasized processes of change focus on making commitments, seeking support, contingency planning and other behavioral processes (counter-conditioning, helping relationship, stimulus control, reinforcement management). Protective factors - CORRECT ANSWER Factors that decrease the likelihood of negative health outcomes and risk behaviors Psychosocial determinants - CORRECT ANSWER Determinants of health that reflect the interaction between the social environment and an individual's development, beliefs and behaviors. Psychosocial factors are thought to not only mediate the effects of social and structural factors on individual health outcomes, but also to be influenced by the social structures and contexts in which they develop. Coping skills or social support following a stressful experience are examples of psychosocial determinants. Qualitative research - CORRECT ANSWER Utilizes methods that results in the collection of non-numeric data that are not highly categorized or defined prior to data collection. Open-ended surveys, focus groups, in-depth interviews, observational and case studies typically result in qualitative data. Quantitative research - CORRECT ANSWER Utilizes methods that result in the collection of numerical and typically predefined data. Statistical methods are employed to analyze and interpret quantitative data. Closed-ended surveys are an example of quantitative research. Quasi-experimental design - CORRECT ANSWER Research design that does not use randomization in assigning units (individuals) to conditions or treatments. Quasi-experiments depend on self-selection or administrator selection to assign individuals to conditions but they are otherwise structurally similar to a randomized experimental design. Reciprocal determinism - CORRECT ANSWER Dynamic interaction of the person, behavior, and the environment in which the behavior is performed." In other words, the concept of reciprocal determinism emphasizes that health behaviors and individuals are not only influenced by the physical and social context in which they exist, but also that such individuals and their behavior influences the environment. Reciprocal determinism is a key construct of the Social Cognitive Theory and in ecological approaches to health promotion. Relapse prevention - CORRECT ANSWER Self-control program designed to help individuals to anticipate and cope with the problem of relapse in the habit-changing process." According to the Relapse Prevention Model, which is based on social-cognitive psychology, relapse is influenced by both immediate determinants and covert antecedents to high-risk situations. Immediate determinants of relapse include high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect (the individual's emotional response to an initial lapse and what he attributes that lapse to). Covert antecedents to high-risk situations—lifestyle factors (i.e. stress and lifestyle imbalance) or cognitive factors such as cravings and urges—can increase the likelihood of relapse by increasing an individual's exposure to high-risk situations and/or by decreasing the individual's motivations to resist a lapse in behavior. The Relapse Prevention model outlines various intervention strategies for identifying, preventing, or avoiding the determinants and antecedent causes. Risk communication - CORRECT ANSWER Engaging communities in discussions about environmental and other health risks and about approaches to deal with them. Risk communication also includes individual counseling about genetic risks and consequent choices Secondary data - CORRECT ANSWER Pre-existing data collected by somebody other than the individual using it. Secondary data is often used in conducting needs assessments and/or to supplement primary data. Secondary prevention - CORRECT ANSWER Preventive measures that are directed at the early diagnosis and treatment of injuries and diseases to limit disability and prevent the development of complications and more serious disease. Screening tests and self-exams for breast cancer are examples of secondary prevention strategies. Self-report (data) - CORRECT ANSWER Generated by having respondents report about themselves. Self-report data are common in sociaorgal and behavioral sciences, but their validity is often questioned because of potential bias Social capital - CORRECT ANSWER Degree of social cohesion which exists in communities. It refers to the processes between people which establish networks , norms, and social trust, and facilitate co-ordination and co-operation for mutual benefit." Social capital is "usually characterized by four interrelated constructs: trust, cooperation, civic engagement, and reciprocity. Social cognitive theory (SCT) - CORRECT ANSWER Health behavior theory that describes the reciprocal influence and dynamic interaction between an individual's personal factors, the environment, and specific health behaviors. Major constructs of the SCT include environments , situations (an individual's cognitive perceptions of the environment that may affect his behavior), behavioral capability , outcome expectations , outcome expectancies (the value an individual places on an expected outcome), self-regulation (ability to engage in goal-directed behavior), observational learning, reinforcements, perceived self-efficacy , emotional coping responses, and reciprocal determinism . The SCT maintains that personal factors within individuals—their behavioral capability, self-efficacy, outcome expectations and expectancies, coping mechanisms, and self control—are key determinants of behavior and both influence and are influenced by the environment. The environment is important partially because it provides models for and opportunities for observational learning and reinforcement, increasing the likelihood that certain behaviors are performed. Based on the concept of reciprocal determinism any change in the person, environment or behavior results in a situational change, necessitating a reevaluation of the interaction between the three. Social ecology - CORRECT ANSWER Study of the influence of the social context on behavior, including institutional and cultural variables Social ecology framework - CORRECT ANSWER Approach to health education that goes beyond individual behavior change to examine and modify the social, political, and economic factors impacting health behavior decisions." The social ecological framework (see also ecological approach/levels) recognizes the individual, interpersonal, community, organizational and policy-level influences on health. Social marketing - CORRECT ANSWER Application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society." 4 Social marketing emphasizes the 4 P's of product, price, place and promotion. Social network - CORRECT ANSWER Web of social relationships that surround individuals." Social network structures can be described both in terms of dyadic characteristics and characteristics of the network as a while. Dyadic characteristics include reciprocity, intensity, and complexity in interpersonal relationships. Network characteristics include levels of homogeneity, geographic dispersion, and density. Stages of change - CORRECT ANSWER Temporal progression towards behavior change that individuals go through over time. The stages of change are part of the Transtheoretical model, in which five stages of change are defined: precontemplation (no intention to take action in the next six months); contemplation (thinking about taking action in the next six months); preparation (intending to take action in the next month and has taken some behavioral steps toward change); action (has adopted behavior change for less than six months); and maintenance (has adopted behavior change for longer than six months). Although there is technically a sixth stage of change—termination (no longer tempted to engage in old behavior and has complete self-efficacy)—defined for use in the Transtheoretical model, very few people seem to reach this stage. Stereotyping - CORRECT ANSWER Making generalizations or assumptions about an individual based on a characteristic or attribute that individual shares with a larger group Stress and coping - CORRECT ANSWER Stress is the experience of psychological or emotional distress in response to an event or experience. Stress can produce physiological changes in the body that may be associated with illness and disease. Coping consists of "an individual's ongoing efforts to manage specific external and internal demands that are appraised as taxing or exceeding personal resources Structural intervention - CORRECT ANSWER Focuses on influencing or changing the social, political, physical or economic environment to facilitate healthy behaviors or behavior change in large groups of people. Subjective norm - CORRECT ANSWER Individual's "belief about whether most people approve or disapprove" of a particular behavior. Subjective norms directly influence a person's intentions to engage or not engage in that behavior. Subjective norm is a key construct of the Theory of Reasoned Action/Theory of Planned Behavior Subpopulation - CORRECT ANSWER Group, or subset, of people within a population that share a common characteristic. Subpopulations within intended audiences are often defined in order to facilitate understanding of the group and to be able to better tailor messages to fit their needs and behaviors Summative evaluation - CORRECT ANSWER Application of design, measurement and analysis methods to the assessment of outcomes of a program or specific interventions within a program." Outcome and impact evaluation are collectively referred to as summative evaluation Theoretical construct - CORRECT ANSWER Building blocks or primary elements of a theory that have been developed or adopted for use in that particular theory. Constructs are understood only within the context of the theories they are associated with. For example, perceived susceptibility, perceived severity, and perceived barriers are constructs of the Health Belief Model. Theory - CORRECT ANSWER Set of interrelated constructs, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations Theory of planned behavior (TPB) - CORRECT ANSWER Extension of the Theory of Reasoned Action that takes into consideration an individual's perceived control over engaging in a particular behavior, in addition to his attitudes towards and subjective norms surrounding that behavior. Perceived behavioral control was added in efforts to account for factors beyond the individual's control that potentially influence his behavioral intentions and, ultimately, behavior. People may expend more energy and try harder to perform a behavior when they perceive that they have high behavioral control, or are capable and have sufficient resources to engage in that behavior and overcome any barriers. Perceived behavioral control is a function of control beliefs (beliefs about the presence or absence of resources and barriers to performing a behavior) and perceived power (beliefs about the influence of each perceived resource or barrier on the difficulty of engaging in the behavior). Theory of reasoned action (TRA) - CORRECT ANSWER Most important determinant of a behavior is an individual's behavioral intention , or "perceived likelihood of performing the behavior." An individual's behavioral intention is influenced directly by that person's attitude toward the behavior and subjective norms . Attitude toward a behavior is a function of a person's behavioral beliefs (beliefs about the likely outcomes and attributes of a particular behavior) and his evaluation of behavioral outcomes (the value that he places on the likely outcomes and attributes). Again, subjective norms are formed by a person's normative beliefs and motivations to comply . Transtheoretical model of change (TTM) - CORRECT ANSWER Model of individual health behavior that integrates processes of change and theoretical principles from multiple leading theories across several disciplines. The TTM is a stage-based model that takes into account an individual's readiness to change and views behavior change as a process that occurs over time and not as a finite event. Intervention messages and strategies are based on appropriate processes of change and are developed and matched to an individual's readiness to change. There are five main stages of change (see stages of change) and ten processes of change (see processes of change) that have been empirically linked in the TTM. In addition to the concepts of stages and processes of change, the TTM also asserts that, in order for an individual to take action and maintain a behavior change, that person must perceive that the benefits, or pros, of change outweigh the cons ( decisional balance ). Situational self-efficacy —the confidence one feels in his or her ability to resist relapsing and engaging in an unhealthy or high-risk behavior in specific, tempting situations—is the final key construct of the TTM. Voucher - CORRECT ANSWER Coupon or document that can be exchanged for a service, incentive or something else as decided by the distributor. Vouchers are used in health promotion to encourage individuals to participate in programs, to link individuals to and to coordinate services between program partners, as incentives, etc. Accumulation - CORRECT ANSWER The collection of some quantity over time. Examples of accumulation include water in a bathtub, savings in a bank account, inventory . In the STELLA modeling software, the accumulator is also referred to as a Stock or Level. Aggregation - CORRECT ANSWER The incorporation of numerous distinct system components into one variable . Aggregation is done for simplicity when combination generates the same behavior of interest as representing the components separately. Amplification - CORRECT ANSWER A system response that is greater than is seemingly implied by input causes. Amplification occurs in information-feedback systems when policies adjust levels to values that change with varying flow rates. It is associated with delays , order/inventory processes, forecasting, etc. Asymptotic growth/decay - CORRECT ANSWER Goal-seeking behavior produced by negative feedback . The stock of the system moves towards the goal, slowing down as it approaches the goal. Auxiliary equation/variable - CORRECT ANSWER An equation that takes the present value of variables (levels, constants, or other auxiliary variables) to compute the present value of an auxiliary variable. Auxiliary variables are part of a rate equation connecting a level to a rate. Auxiliary equations embody unit consistency and are symbolized by a circle in a flow equation. Balancing loop - CORRECT ANSWER A loop that seeks equilibrium — it tries to bring stocks to a desired state and keep them there. It limits and constrains, and is also called a negative loop . When a balancing process has a long delay, the response may overcorrect, often leading to instability, the opposite of what is intended. The Beer Game - CORRECT ANSWER A "laboratory replica" of a real organization that involves a production/distribution system. The players at each position make decisions about placing orders, and find from practice the problems that originate from traditional ways of thinking and interaction. Behavior over time diagram - CORRECT ANSWER A system dynamics tool that shows how certain variables change over time. Several variables can appear on the same graph for comparison. Boundary - CORRECT ANSWER Border enclosing only the parts of system structure needed to generate the behavior of interest. In other words, the system boundary excludes all components not relevant to the problem behavior of the system. Also called system boundary Causal loop diagram - CORRECT ANSWER Diagram representing a closed loop of cause-effect linkages (causal links) which is intended to capture how the variables interrelate. The five steps of constructing a causal loop diagram are: 1. Choose variables; 2. Link variables with arrows pointing from cause to effect; 3. Assign a direction of effect (same or opposite) to each link; 4. Indicate delays; 5. Assign polarity to overall loop. Closed system - CORRECT ANSWER A system that functions without any exogenous variables generated outside the model. The system internally generates the values of all the variables through time by their interactions Cloud - CORRECT ANSWER An origin or ending place of a flow that is outside the boundary of the system. In other words, the cloud represents an input or output of the system that is inconsequential to its behavior of interest. In a population system, clouds might represent origin of the inflow "birth rate" and destination of death rate that determine a "population" stock. Where babies come from and where dead bodies go may not be dynamically important and thus represented by clouds. Compounding - CORRECT ANSWER Phenomenon that occurs when the stock serves as the basis for generating its own inflow, producing exponential growth. The behavior is also said to be self-reinforcing. Connector - CORRECT ANSWER The building blocks that carry information from one element in a model to another element. "Information" may be a constant, an algebraic relationship, a graphical relationship (contained by converters or table functions), or a quantity (e.g. how many dollars in your savings account). "Information" flows through connectors to converters ( auxiliary variable ) or flows (rates), but not to stock s. Conserved flow - CORRECT ANSWER A flow that moves a quantity of material between two distinct stocks so that the total amount of material in that part of the system is unchanged. There is only so much material and it is divided between the two stocks. Non-conserved flows, on the other hand, flow from or to a cloud that has no limit in the quantity it can supply or absorb. Converter - CORRECT ANSWER A term used in the STELLA software. Generally known as auxiliary variables. They are usually represented in diagrams by circles. Converters do not accumulate flows and do not have memory, but rather are recalculated from scratch each time calculations are performed. Three types of converters define constants, algebra, or graphs. Conveyor - CORRECT ANSWER A type of stock that represents a space into which material flows and stays for a fixed amount of time, then exits. Its associated parameters determine transit time which represents how long material stays in the conveyor. Material that flows in at a given time is not mixed with material that had flowed in earlier — whatever entered first will also leave first. Counterintuitive behavior - CORRECT ANSWER A surprising result of policies devised to remedy a problem. Often the presumed "solutions" result in counter-productivity. Thus as troubles increase, efforts are intensified which actually worsen the problem. See policy resistance, fixes that fail Decision function - CORRECT ANSWER Also known as a rate equation. It is a policy statement that determines how the levels are related to the decisions (rates). Delay - CORRECT ANSWER A phenomenon where the effect of one variable on another does not occur immediately. Delays result from decisions often requires a long period of time to be effective. Delays can result in overshoot or oscillation Dimensional analysis - CORRECT ANSWER A process that checks for unit consistency in equations. The saying "one can't add apples and oranges" shows why dimensional analysis is necessary. Dimensional inconsistency is a sign of an incorrect equation Disaggregation - CORRECT ANSWER The opposite of aggregation. Disaggregation is done to separate variables that do not have similar effects on system behavio Doubling time - CORRECT ANSWER Length of time it takes an exponentially growing quantity to double in size. If a rate flowing into a level equals a multiplier times the level, then doubling time equals approximately 0.7 divided by the multiplier. Associated with exponential growth Dynamic model - CORRECT ANSWER A model that deals with relationships that varies with time DYNAMO - CORRECT ANSWER An equation-based simulation language for system dynamics modeling on MS Windows computers Endogenous variable/view - CORRECT ANSWER Opposite of exogenous, meaning internal. An endogenous view approaches a problem searching for its causes and cures within some boundary. Endogenous variables affect and are affected by the rest of the system. Equilibrium - CORRECT ANSWER A situation in a dynamic system where the inflows and corresponding outflows balance, and the levels cease to change Exogenous variable/view - CORRECT ANSWER The opposite of endogenous . An exogenous view considers systems under the influence of outside events that are not part of the internal dynamics of the system. An exogenous variable is an outside variable that affects but is not affected by the behavior of the system Exponential growth/decay - CORRECT ANSWER Behavior that occurs when the rate of growth depends on the size of the stock at that point in time. As the stock gets larger, its growth gets progressively faster. Or, for decay, as the stock gets smaller, the decay gets progressively slower. Exponential growth/decay has a doubling time . Associated with positive feedback, or a half-life associated with decay Feedback system - CORRECT ANSWER A closed system influenced by its past behavior. Feedback systems have feedback loop structure that consists of closed paths of cause and effect. They are self-regulating and can be either a positive feedback system or a negative feedback system Fish Banks Game - CORRECT ANSWER A management flight simulator. The Fish Banks Game consists of a group of players acting as competing fishermen trying to maximize profits. The game passes on to its participants the lessons of tragedy of commons , S-shaped growth , and limits to growth . Fixes that fail - CORRECT ANSWER A situation where a "fix" has immediate positive results but eventually makes the problem worse. The underlying structure of the system that caused the problem in the first place does not change. Similar to policy resistance and counterintuitive behavior Flow - CORRECT ANSWER Movement of a quantity from one level to another Generic structure - CORRECT ANSWER A structure that can be applied across different settings due to fundamentally same underlying structures and relationships. Goal-seeking behavior - CORRECT ANSWER Behavior that results from a balancing loop which drives a system toward a specified goal. The farther the system from the goal, the quicker it changes towards that goal, the equilibrium homeostasis point, and as it approaches the goal, the growth/decay slows down. Associated with negative feedback Graphical function diagram - CORRECT ANSWER A diagram that relates movement in one variable to movement in another. The input and output variables are placed on the axes of a graph, and the relation plotted Half-life - CORRECT ANSWER The amount of time it takes for a stock to go halfway towards its goal. It is the converse of doubling time in positive feedback . Half-life is approximated by 0.7 times the time constant, or 0.7 divided by the decay fraction. Associated with goal-seeking behavior Homeostasis - CORRECT ANSWER Control through the operation of negative feedback loops — homeostasis is reached when the goal is attained and stable equilibrium achieved Impulse - CORRECT ANSWER Theoretically, a signal of zero width but finite area. Practically, in models, a signal (rate of flow) of specified area lasting for one solution interval and occurring at a specified time Inventory - CORRECT ANSWER A frequently-used stock in modeling economic systems. When production is greater than consumption, the excess production goes into inventory Learner-centered learning - CORRECT ANSWER Innovative learning style in which the teacher is no longer a dispenser of knowledge but rather a colleague. The teacher is a facilitating participant who sets directions and introduces opportunities. Students working in small groups acquire their own knowledge without having it spoon-fed to them. Such classrooms make acquisition of facts and information a consequence of needing inputs to reach an objective Level - CORRECT ANSWER An accumulation in a system. It represents the accumulated difference between inflow and outflow rates, illustrating the results of action within the system over time. Levels are conserved quantities that can be changed only by moving contents in and out Leverage point - CORRECT ANSWER A policy which can yield large changes in a system. Limits to growth - CORRECT ANSWER A resource constraint, an external or internal response to growth. A growth caused by reinforcing feedback processes begins to slow and eventually come to a halt at the limit, and may even reverse itself and collapse. For instance, population growth is limited by space, water and resources essential for survival. Linear system - CORRECT ANSWER A system in which different behavior models can be superimposed without interacting with one another Loop dominance - CORRECT ANSWER A system in which one loop is stronger. In a system with multiple loops, magnitudes and algebraic signs of variables determine what kind of behavior, positive or negative feedback is dominant at any given time. If the system exhibits exponential growth , then the positive loop is dominant. If asymptotic behavior is evidenced, the negative loop has dominance. S-shaped growth is a common behavior of a system in which loop dominance shifts with time Mental model - CORRECT ANSWER A model representing the relationships and assumptions about a system held in a person's mind. Mental models are often correct in system structure, but frequently draw wrong conclusions about system behavior. Negative feedback - CORRECT ANSWER Feedback that works to cancel deviations from a goal. It exhibits goal-seeking behavior. The control decision attempts to adjust a system level to a value given by a goal introduced from outside the loop Open-loop thinking - CORRECT ANSWER Approaching a problem without applying the concept of feedback Order - CORRECT ANSWER The number of levels a system has. For instance, a "second-order" system has two level variables Oscillation - CORRECT ANSWER Behavior exhibited by a second-order or higher-order system in which the stock value moves sinusoidally over time. Three types of oscillation include sustained, where the amplitude is always constant; expanding, where the amplitude increases over time; and dampened, where the amplitude decreases over time Overshoot and collapse - CORRECT ANSWER A system that grows beyond a sustainable condition, reduces the basis for sustained existence, and then collapses below the level that might have been sustained. Example: fishing rates that exceed the replenishment rate resulting in a collapse of the fishing populatio Parameters - CORRECT ANSWER Numerical values that describe relationships in a system and are considered constant, at least during the computation span of one model run. Parameters are shown by a circular converter in STELLA and by other symbols in other software Period of oscillation - CORRECT ANSWER The time duration of each cycle in oscillatory behavior from the analogous part of one wave to another Polarity (feedback loops) - CORRECT ANSWER Positive or negative sign of a causal loop . Positive loops are called reinforcing, and negative loops are called balancing. Policy analysis - CORRECT ANSWER Analysis employed to evaluate the causes of undesirable behavior in a system. It allows the model-builder to compare how a system would react to different policies through simulation Positive feedback - CORRECT ANSWER Feedback that contains reinforcing loops which produce exponential change. Change in one direction results in more and more change in the same direction. Positive feedback produces growth that would be out of control if it weren't for limits to growth Queue - CORRECT ANSWER Waiting lines, an explicit line build-up as opposed to a pile-up implied by a reservoir. In the STELLA software, they are used in conjunction with a conveyor to represent batches of material waiting to enter a process or activity Ramp function - CORRECT ANSWER A way to designate the value of a variable to change linearly over time Rate - CORRECT ANSWER Definition of the present, instantaneous flow to and from a level in a system. Rates represent activity, while levels represent the state to which the system has been brought by the activity. Rates are determined by the levels of a system according to rules defined by the decision functions. In turn, rates cause levels to change Reinforcing loop - CORRECT ANSWER Loop that occurs when an action causes change that accelerates that action, reinforcing the effect of the original action. Associated with positive feedback Reservoir - CORRECT ANSWER The type of stock that is analogous to a tub with water flowing in and draining out. In many ways it is the simplest of stocks. When something flows into a tub, it is mixed into any "stuff" that is already in the tub so that it cannot be distinguished from earlier or later inflows Sensitivity analysis - CORRECT ANSWER Analysis used to determine how "sensitive" a model is to changes in specific parameters, or policies, or structures. If the behavior of a model changes drastically, that suggests a critically important factor, or high sensitivity. Conversely, if a large change results in little change in behavior, that factor is not likely to be central to the dynamics in question, that is, it shows low sensitivity Shifting the burden to the intervener - CORRECT ANSWER A system behavior where an intervener acts to improve a system and the effort fails because the system lacks incentive to continue its own effort to take the action Simulation - CORRECT ANSWER Conducting dynamic experiments on a model instead of on the real system Smoothing - CORRECT ANSWER Filtering out the superimposed short-term fluctuations in order to detect underlying, significant changes in data. There is formal (numerical processing of data into averages) and intuitive smoothing Solution interval - CORRECT ANSWER The amount of time elapsed between successive computer calculations of flows accumulating into stocks . Also known as computation interval or DT (for Delta Time). It is measured in units of time and must be short enough so that its value does not affect the computed results, but also long enough to avoid unnecessary waste of computation time. S-shaped growth - CORRECT ANSWER Growth that exhibits behavior in the shape of the letter "S." It expands rapidly at first, and then slows down as stock approaches its maximum value. S-shaped growth is caused by a shift in loop dominance from positive to negative feedback Stability - CORRECT ANSWER Behavior exhibited by a system that returns to its initial condition after being disturbed. In an unstable system, a disturbance is amplified, leading increased growth or oscillation. A stable oscillation is one at constant amplitude, as in a clock pendulum Steady-state - CORRECT ANSWER A behavior pattern that is repetitive with time and in which the behavior in one time period is of the same nature as any other period STELLA - CORRECT ANSWER Visual diagram-based simulation software for system dynamics models. It is the education-geared version of the ithink software Step input - CORRECT ANSWER An input (usually for testing purposes) that suddenly changes and then remains at the new value. Stock - CORRECT ANSWER An element of a system that is accumulating or draining over time. Stocks are the memory of a system and are only affected by flows. Also known as levels , they are signified by rectangles in system dynamics diagrams Structural diagram - CORRECT ANSWER Diagram that gives an overview of the structural elements that produce system behavior by showing the stocks and flows . Also known as flow diagrams Structure - CORRECT ANSWER The building blocks and interval connections of a system. It is the way in which system elements are organized or interrelated System - CORRECT ANSWER A collection of parts that interact to function as a whole. A system is almost always defined with respect to a specific purpose. Systems often contain circular patterns of cause and effect called feedback loops System dynamics - CORRECT ANSWER A field for understanding how things change through time. System dynamics deals with how the internal feedback -loops within the structure of a system create behavior. Computer simulation models are used to achieve better understanding of system behavior over time. With a better comprehension of systems, one can redesign structure or policies to improve the behavior. The field of system dynamics was created by Jay Forrester beginning in 1956 Systems archetypes - CORRECT ANSWER A system dynamics structure that is common to many systems. See also generic structures. Systems thinking - CORRECT ANSWER Thought process that involves 1) seeing interrelationships ( feedback loops ) instead of linear cause-effect chains, and 2) seeking processes of change over time rather than snapshots. Systems thinking involve understanding many concepts of system dynamics , most notably, feedback . It helps thinkers see things on three levels: events, patterns of behavior, and system structure Table function - CORRECT ANSWER Feature used to formulate a non-linear relationship when it is necessary to use an auxiliary variable that is not a simple algebraic function of other variables. The function is a graph that can be sketched to capture the relationship at hand. A table function can be represented with a graphical function diagram Tragedy of commons - CORRECT ANSWER The structure in which each person pursues action beneficial only to oneself, then eventually the system cannot support all the activity and everyone experiences diminishing results. The commons is the resources everyone calls upon, but does not take care to replenish. It is a systems archetype that surfaces in many socioeconomic systems. The Fish Banks Game is an excellent example of tragedy of commons behavior. Transient - CORRECT ANSWER A dynamic response that does not persist Unit-conversion - CORRECT ANSWER A modeling function that allows for units of a certain variable to change as that variable is altered. Example: cloth (square meters) is made into clothing (articles). Validity - CORRECT ANSWER Judgment of a model's suitability for a particular purpose. A model is valid when it accomplishes what is expected of it Vicious cycle - CORRECT ANSWER Reinforcing, amplifying process that yields undesirable results Virtuous cycle - CORRECT ANSWER Process that reinforces in desired directions Coaching - CORRECT ANSWER A method of directing, instructing and training a person or group of people, with the aim to achieve some goal or develop specific skills Coercive power - CORRECT ANSWER Authority or power that is dependent on fear, suppression of free will, and/or use of punishment or threat, for its existence. Collaboration - CORRECT ANSWER to work jointly with others or together especially in an intellectual endeavor Contingency theory of leadership - CORRECT ANSWER In contingency theory of leadership, the success of the leader is a function of various contingencies in the form of subordinate, task, and/or group variables. The effectiveness of a given pattern of leader behavior is contingent upon the demands imposed by the situation. These theories stress using different styles of leadership appropriate to the needs created by different organizational situations CQI: (continuous quality improvement) - CORRECT ANSWER an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems : it focuses on "process" rather than the individual; it recognizes both internal and external "customers"; it promotes the need for objective data to analyze and improve processes Emotional intelligence - CORRECT ANSWER Emotional intelligence concerns the ability of a person to perceive, assimilate, understand, and manage their own emotions. Research suggests that this can be a good indicator of future role performance Ethical leadership - CORRECT ANSWER knowing your core values and having the courage to live them in all parts of your life in service of the common good Expectancy theory of leadership - CORRECT ANSWER a view that people will be motivated to behave in particular ways if they believe that doing so will bring them rewards they both seek and value. Expectancy theory was first applied in the context of the workplace by Victor Vroom in the 1960s. He defined the concepts of valence and expectancy to explain how people decide to act. Valence refers to somebody's perception of the value of the reward or outcome that might be obtained if he or she performs a task successfully Management - CORRECT ANSWER The guidance and control of action required to execute a program. Also, the individuals charged with the responsibility of conducting a program Mentoring - CORRECT ANSWER To serve as a trusted counselor or teacher, especially in occupational settings. Path-goal theory of leadership - CORRECT ANSWER The Path-Goal Theory of Leadership was developed to describe the way that leaders encourage and support their followers in achieving the goals they have been set by making the path that they should take clear and easy Referent power - CORRECT ANSWER Influence over others, acquired from being well liked or respected by them. Reward power - CORRECT ANSWER Extent to which an entity can control the dispensing of rewards or benefits. Strategic planning - CORRECT ANSWER Process to determine or re-assess the vision, mission, and goals of an organization and then map out objective (measurable) ways to accomplish the identified goals. Strategic planning typically focuses on results to be achieved in a 3, 5, 7, or 10 year time span as contrasted with tactical or operational planning which typically focuses on results to be achieved in a one year or less. Strategic plans should be updated through an annual process with major re-assessments occurring at the end of the 3, 5, 7, or 10 year planning horizon. α-radiation - CORRECT ANSWER A very damaging but low-penetrating form of ionizing radiation. It can be stopped by a sheet of paper and cannot penetrate human skin. However, if an alpha-emitting isotope is inhaled or ingested, it will cause highly concentrated local damage. β-radiation - CORRECT ANSWER High-energy, electrons (beta particles) emitted from certain radioactive material classified as ionizing radiation. Can pass through 1 to 2 centimeters of water or human flesh and can be shielded by a thin sheet of aluminum. Beta particles are more deeply penetrating than alpha particles but cause less localized damage γ-radiation - CORRECT ANSWER Penetrating electromagnetic waves or rays emitted from nuclei during radioactive decay, similar to x-rays. Dense materials such as concrete and lead are used to provide shielding against this type of ionizing radiation Allergy - CORRECT ANSWER An immune system hypersensitivity to an outside substance (an allergen) that can be mild or life-threatening. Antibiotic - CORRECT ANSWER A medication to treat or prevent infection from bacteria. Antibody - CORRECT ANSWER A substance formed by the body to help defend it against infection Antigen - CORRECT ANSWER Any substance that causes the body to produce natural antibodies B-cell lymphocyte - CORRECT ANSWER A type of immune cell that makes proteins called antibodies, which bind to microorganisms and other foreign substances, and help fight infections. A B lymphocyte is a type of white blood cell. Also called B cell Bioaccumulation - CORRECT ANSWER Occurs when an organism absorbs a toxic substance at a rate greater than that at which the substance is lost, and is common for persistent organic pollutants. Bioactivation - CORRECT ANSWER The metabolic activation of xenobiotic compounds into reactive , toxic compounds. Biotechnology - CORRECT ANSWER The use of biological processes to solve problems or make useful products. Biotransformation - CORRECT ANSWER The use of enzymes in chemical synthesis to produce chemical compounds of a desired stereochemistry Carcinogenesis - CORRECT ANSWER The process by which normal cells are transformed into cancer cells to cause clinical cancer Deoxyribonucleic acid (DNA) - CORRECT ANSWER The molecules inside cells that carry genetic information and pass it from one generation to the next. Also called deoxyribonucleic acid Genetic engineering - CORRECT ANSWER The technology entailing all processes of altering the genetic material of a cell to make it capable of performing the desired functions , such as producing novel substances Genetics - CORRECT ANSWER Inherited; having to do with information that is passed from parents to offspring. through genes in sperm and egg cells Genome - CORRECT ANSWER The complete genetic material of an organis Genotype - CORRECT ANSWER Genetic makeup of an individual or group Halogenated hydrocarbon - CORRECT ANSWER An aliphatic or aromatic hydrocarbon in which one or more hydrogen atoms are substituted by a halogen, such as chlorine. Often these chemicals bioaccumulate Heavy metal - CORRECT ANSWER The term heavy metal refers to a group of toxic metals including arsenic, chromium, copper, lead, mercury, silver, and zinc. Heavy metals often are present at industrial sites at which operations have included battery recycling and metal platin Host - CORRECT ANSWER A cell that is infected by a virus or another type of microorganism Immunity - CORRECT ANSWER The condition of being protected against an infectious disease. Immunity can be caused by a vaccine, previous infection with the same agent, or by transfer of immune substances from another person or animal Infection - CORRECT ANSWER Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body's natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system Inorganic substance - CORRECT ANSWER Considered to be of mineral, not biological, origin Integrated pest management - CORRECT ANSWER A pest control strategy that uses a variety of complementary strategies including: mechanical Latency period - CORRECT ANSWER The time between when an exposure occurs and when its effects are detectable as an injury or illness Leukocyte - CORRECT ANSWER A type of immune cell. Most leukocytes are made in the bone marrow and are found in the blood and lymph tissue. Leukocytes help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are leukocytes. Also called WBC and white blood cell. Lipophilic substance - CORRECT ANSWER Able to dissolve, be dissolved in, or absorb lipids (fats) Oncogene - CORRECT ANSWER A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens Organic substance - CORRECT ANSWER complex carbon-containing substance; often produced by a living organism PM 2.5 particles < 2.5 μm (micrometers, aerodynamic diameter) - CORRECT ANSWER Particulate matter airborne particles, a common type of air pollution - Smaller than a human hair, that can penetrate the respiratory system as far as the deep lung (alveolar region). Airborne levels of particles of this size are regulated by the US EPA. Exposure to this type of air pollution has been associated with adverse health effects including respiratory, cardiovascular, and adverse birth outcomes. PM 10 particles < 10 um (micrometers, aerodynamic diameter) - CORRECT ANSWER Particulate matter airborne particles, a common type of air pollution - Smaller than a human hair that can penetrate the respiratory system as far as the tracheobronchial region. These particles are also regulated by the US EPA but the focus is shifting to PM2.5. Persistent organic pollutants (POPs) - CORRECT ANSWER Persistent Organic Pollutants (POPs) are chemical substances that persist in the environment, bioaccumulate through the food web, and pose a risk of causing adverse effects to human health and the environment. Phenotype - CORRECT ANSWER Observable characteristics resulting from interaction between an organism's genetic makeup and the environment Polymorphism - CORRECT ANSWER A common variation or mutation in DNA. Prion - CORRECT ANSWER A disease-causing agent that is neither bacterial nor fungal nor viral and contains no genetic material. A prion is a protein that occurs normally in a harmless form. By folding into an aberrant shape, the normal prion turns into a rogue agent. It then co-opts other normal prions to become rogue prions. SNP (single nucleotide polymorphism) - CORRECT ANSWER A common type of change in DNA (molecules inside cells that carry genetic information) sequences between individuals. Single nucleotide polymorphisms occur when a single nucleotide (building block of DNA) is replaced with another. These changes may cause disease, and may affect how a person reacts to bacteria, viruses, drugs, and other substances. Also called SNP. T-cell lymphocyte - CORRECT ANSWER A type of immune cell that can attack foreign cells, cancer cells, and cells infected with a virus. T lymphocytes can also help control immune responses. A T lymphocyte is a type of white blood cell. Also called T cell and thymocyte. Teratogen - CORRECT ANSWER An agent that results in an alteration in the fetus leading to a birth defect. A teratogen may interfere with growth or a specific developmental process and does not have to be also a mutagen. Threshold dose - CORRECT ANSWER The minimum dose that will produce a detectable degree of any given effect. Ultraviolet radiation - CORRECT ANSWER Invisible rays that are part of the energy that comes from the sun. Ultraviolet radiation also comes from sun lamps and tanning beds. It can damage the skin and cause melanoma and other types of skin cancer. Ultraviolet radiation that reaches the Earth's surface is made up of two types of rays, called UVA and UVB rays. UVB rays are more likely than UVA rays to cause sunburn, but UVA rays pass deeper into the skin. Scientists have long thought that UVB radiation can cause melanoma and other types of skin cancer. They now think that UVA radiation also may add to skin damage that can lead to skin cancer and cause premature aging. For this reason, skin specialists recommend that people use sunscreens that reflect, absorb, or scatter both kinds of ultraviolet radiation. Also called UV radiation. Vaccination - CORRECT ANSWER Treatment with a vaccine. Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. A vaccine can help the body recognize and destroy cancer cells or microorganisms Vector-borne disease - CORRECT ANSWER Result from an infection transmitted to humans and other animals by blood-feeding anthropods, such as mosquitoes, ticks, and fleas. Examples include West Nile virus, dengue fever, viral encephalitis and malaria Academic Medical Center (AMC) - CORRECT ANSWER preeminent institutions in the American health care system—are interrelated entities comprising a medical school, its affiliated hospitals and outpatient centers, and a faculty practice plan (FPP). Their unique missions are to provide undergraduate and graduate medical education and training, conduct basic science and clinical research on new medical practices and technologies, furnish state-of-the-art medical care for patients with complex illnesses, and care for the poor and medically indigent access (to health care services) - CORRECT ANSWER ability to obtain personal health services to achieve the best possible health outcomes when needed balanced by the health system's resource limitations. may be influenced by many factors, including travel, distance, waiting time, available resources, availability of a source of care and the health status of the population served accountability (corporate governance) - CORRECT ANSWER set of processes, customs, policies, laws and institutions affecting the way a corporation is directed, administered or controlled. includes the relationships among the many stakeholders involved and the goals for which the corporation is governed accounts receivable management - CORRECT ANSWER management of the money that is owed to a venture for goods and services that have been purchased from it or that have been committed as a grant or donation. Accounts receivable are included on the balance sheet under current assets accreditation - CORRECT ANSWER evaluative process in which a healthcare organization undergoes an examination of its policies, procedures and performance by an external organization ("accrediting body") to ensure that it is meeting predetermined criteria. It usually involves both on- and off- site surveys Joint Commission - CORRECT ANSWER independent, not-for-profit organization, CMS Manual System acute health care - CORRECT ANSWER short-term medical treatment, usually in a hospital, for patients having an acute illness (psychological or physical) or injury or recovering from surgery advance directive - CORRECT ANSWER written or spoken statement about a person's future medical care. It lets your doctor, family and others know how a person prefers to be treated if that person is unable to tell their doctor, family and others. two main types of advance directives - CORRECT ANSWER living will and power of attorney for health care adverse selection - CORRECT ANSWER insurance companies term to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $40 agency principal theory - CORRECT ANSWER the principal-agent problem treats the difficulties that arise under conditions of incomplete and asymmetric information when a principal hires an agent. Various mechanisms may be used to try to align the interests of the agent with those of the principal, such as piece rates/commissions, profit sharing, efficiency wages, the agent posting a bond, or fear of firing. The principal-agent problem is found in most employer/employee relationships, for example, when stockholders hire top executives of corporations agency theory - CORRECT ANSWER ubiquitous agency relationship, one party (the principal) delegates work to another (the agent), who performs that work. Agency theory is concerned with resolving two problems that can occur in agency relationships. The first is the agency problem that arises when (a) the desires or goals of the principal and agent *conflict* and (b) it is 8difficult or expensive* for the principle to verify what the agent is actually doing. The problem here is that the principal cannot verify that the agent has behaved appropriately. The second is the problem of *risk sharing* that arises when the principal and agent have different attitudes towards risk ambulatory care - CORRECT ANSWER outpatient care that does not involve an overnight hospital stay antitrust regulation - CORRECT ANSWER Sherman Antitrust Act, July 2, 1890, was the first US government statute to limit cartels and monopolies. It is the first and oldest of all U.S., federal, antitrust laws Sherman Antitrust Act provides - CORRECT ANSWER "Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal". The Act also provides: "Every person who shall monopolize, or attempt to monopolize, or combine or conspire with any other person or persons, to monopolize any part of the trade or commerce among the several States, or with foreign nations, shall be deemed guilty of a felony [. . . ]" The Act put responsibility upon government attorneys and district courts to pursue and investigate trusts, companies and organizations suspected of violating the Act. The Clayton Act (1914) extended the right to sue under the antitrust laws to "any person who shall be injured in his business or property by reason of anything forbidden in the antitrust laws." Under the Clayton Act, private parties may sue in U.S. district court and should they prevail, they may be awarded treble damages and the cost of suit, including reasonable attorney's fees. arbitration - CORRECT ANSWER legal technique for the resolution of disputes outside the courts, wherein the parties to a dispute refer it to one or more persons (the "arbitrators", "arbiters" or "arbitral tribunal"), by whose decision (the "award") they agree to be bound. Arbitration in the United States and in other countries often includes alternative dispute resolution (ADR), a category that more commonly refers to mediation (a form of settlement negotiation facilitated by a neutral third party). It is more helpful, however, simply to classify arbitration as a form of binding dispute resolution, equivalent to litigation in the courts, and entirely distinct from the various forms of non-binding dispute resolution, such as negotiation, mediation, or non-binding determinations by experts. assisted living facility - CORRECT ANSWER industry term for multifamily housing with congregate and personal care services. Assisted living goes by many names, including personal care, residential care, congregate care and in some areas, board and care. The services offered vary widely, but frequently include as core services, meals, housekeeping and transportation and often some assistance with laundry, grooming, medication management and other functions of daily living. Special care units in some facilities care for individuals with cognitive impairment and respiratory assistance needs. Unless an assisted living facility is a component of a continuing care or "life-care" community, it does not offer the health care services of a nursing or long-term care facility. For safety reasons most states require residents to self-evacuate their personal living quarters (with or without ambulatory equipment) in the event of an emergency. The federal government does not establish standards for assisted living as it does for nursing homes who participate in the federal Medicare program. average length of stay (ALOS) - CORRECT ANSWER in hospitals is a statistical calculation often used for health planning purposes. There is current belief that the type of reimbursement system or health insurance plan now plays a more significant role in the patient length of stay in hospitals. Therefore, with increased interest in the average length of a hospital stay, a review of this calculation in a "Tools of the Trade" article seems very appropriate METHOD 1 to calculate ALOS - CORRECT ANSWER (TOTAL DISCHARGE DAYS (length of stay) / TOTAL DISCHARGES) = AVERAGE LENGTH OF STAY (IN DAYS) METHOD 2 to calculate ALOS - CORRECT ANSWER (TOTAL INPATIENT DAYS OF CARE / TOTAL ADMISSIONS) = AVERAGE LENGTH OF STAY (IN DAYS) bad debt expense - CORRECT ANSWER portion of receivables that can no longer be collected, typically from accounts receivable or loans. Bad debt in accounting is considered an expense two methods to account for bad debt - CORRECT ANSWER Direct write off method and Allowance method direct write off method - CORRECT ANSWER (Non - GAAP) receivable which is not considered collectible is charged directly to the income statement (Generally Accepted Accounting Principles) allowance method - CORRECT ANSWER (GAAP) estimate is made at the end of each fiscal year of the amount of bad debt. This is then accumulated in a provision, which is then used to reduce specific receivable accounts as and when necessary Baldrige National Quality Award - CORRECT ANSWER created by Public Law 100-107, signed into law on August 20, 1987. responsive to the purposes of Public Law 100-107, led to the creation of a new public-private partnership. Principal support for the program comes from the Foundation for the Malcolm Baldrige National Quality Award, established in 1988. The Award is named for Malcolm Baldrige, who served as Secretary of Commerce from 1981 until his tragic death in a rodeo accident in 1987. His managerial excellence contributed to long-term improvement in efficiency and effectiveness of government. findings and purposes section of Public Law 100-107 states - CORRECT ANSWER 1. The leadership of the United States in product and process quality has been challenged strongly (and sometimes successfully) by foreign competition, and our Nation's productivity growth has improved less than our competitors' over the last two decades 2. American business and industry are beginning to understand that poor quality costs companies as much as 20 percent of sales revenues nationally and that improved quality of goods and services goes hand in hand with improved productivity, lower costs, and increased profitability. 3. Strategic planning for quality and quality improvement programs, through a commitment to excellence in manufacturing and services, are becoming more and more essential to the well-being of our Nation's economy and our ability to compete effectively in the global marketplace. 4. Improved management understanding of the factory floor, worker involvement in quality, and greater emphasis on statistical process control can lead to dramatic improvements in the cost and quality of manufactured products. 5. The concept of quality improvement is directly applicable to small companies as well as large, to service industries as well as manufacturing, and to the public sector as well as private enterprise. 6. In order to be successful, quality improvement programs must be management-led and customer-oriented, and this may require fundamental changes in the way companies and agencies do business. 7. Several major industrial nations have successfully coupled rigorous private-sector quality audits with national awards giving special recognition to those enterprises the audits identify as the very best; and 8. A national quality award program of this kind in the United States would help improve quality and productivity by: Helping to stimulate American companies to improve quality and productivity for the pride of recognition while obtaining a competitive edge through increased profits; Recognizing the achievements of those companies that improve the quality of their goods and services and providing an example to others; Establishing guidelines and criteria that can be used by business, industrial, governmental, and other organizations in evaluating their own quality improvement efforts; and Providing specific guidance for other American organizations that wish to learn how to manage for high quality by making available detailed information on how winning organizations were able to change their cultures and achieve eminence." bargaining unit - CORRECT ANSWER group of employees with a clear and identifiable community of interests who are (under U.S. law) represented by a single labor union in collective bargaining and other dealings with management. Examples would be "non-management professors"; "law enforcement professionals"; "blue-collar workers"; "clerical and administrative employees" barriers to entry - CORRECT ANSWER obstacles in the path of a firm which wants to enter a given market, in economics and especially in the theory of competition. hindrances that an individual may face while trying to gain entrance into a profession or trade. It also, more commonly, refers to hindrances that a firm may face (or even a country) while trying to enter a market, industry or trade grouping. restrict how competitive a market is barriers to exit - CORRECT ANSWER obstacles in the path of a firm which wants to leave a given market or industrial sector. often cost the firm financially to leave the market and may prohibit it doing so. if significant; a firm may be forced to continue competing in a market as that is the least bad alternative. Belmont Report - CORRECT ANSWER On July 12, 1974, the National Research Act was signed into law, there-by creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and to develop guidelines, which should be followed to assure that such research is conducted in accordance with those principles. In carrying out the above, the Commission was directed to consider: (i) the boundaries between biomedical and behavioral research and the accepted and routine practice of medicine, (ii) the role of assessment of risk-benefit criteria in the determination of the appropriateness of research involving human subjects, (iii) appropriate guidelines for the selection of human subjects for participation in such research and (iv) the nature and definition of informed consent in various research settings. The Belmont Report attempts to summarize the basic ethical principles identified by the Commission in the course of its deliberations. It is the outgrowth of an intensive four-day period of discussions that were held in February 1976 at the Smithsonian Institution's Belmont Conference Center supplemented by the monthly deliberations of the Commission that were held over a period of nearly four years. It is a statement of basic ethical principles and guidelines that should assist in resolving the ethical problems that surround the conduct of research with human subjects. By publishing the Report in the Federal Register, and providing reprints upon request, the Secretary intends that it may be made readily available to scientists, members of Institutional Review Boards, and Federal employees benchmarking - CORRECT ANSWER process used in management and particularly strategic management, in which organizations evaluate various aspects of their processes in relation to best practice, usually within their own sector. This then allows organizations to develop plans on how to adopt such best practice, usually with the aim of increasing some aspect of performance. may be a one-off event, but is often treated as a continuous process in which organizations continually seek to challenge their practices. In simple terms, it is the process where organizations compare their process with that of a better process and try to improve the standard of the process the organization follows to improve quality of the system, product or services. beneficence - CORRECT ANSWER ethical principle discussed in the Belmont Report that entails an obligation to protect persons from harm. The principle of beneficence can be expressed in two general rules: (1) do not harm; and (2) protect from harm by maximizing possible benefits and minimizing possible risks of harm. biomedical ethics - CORRECT ANSWER examination of the ethics of all biomedical research, medicine, and health care. Six core values commonly applied to medical and biomedical ethics are beneficence, non-malfeasance, autonomy, justice, dignity, and truthfulness and honesty (the concept of informed consent). bonds (payable) - CORRECT ANSWER formal written promise to pay interest every six months and the principal amount at maturity break-even analysis - CORRECT ANSWER used to determine if it would be profitable to sell a proposed product, as opposed to attempting to modify an existing product instead so it can be made lucrative OR to analyze the potential profitability of an expenditure in a sales-based business break-even point (BEP) - CORRECT ANSWER point at which cost or expenses and revenue are equal - there is no net loss or gain, and one has "broken even" budget variance (analysis) - CORRECT ANSWER analyzing the difference between the financial value of something (such as cost or revenue) as estimated in the budget, and the actual financial value capital budgeting - CORRECT ANSWER planning process used to determine whether firm's long-term investments such as new machinery, replacement machinery, new plants, new products, and research and development projects are worth pursuing Formal methods used in capital budgeting - CORRECT ANSWER Net present value, Profitability index, Internal rate of return, Modified Internal Rate of Return, and Equivalent annuity capital expenditures - CORRECT ANSWER expenditures creating future benefits, incurred when a business spends money either to buy fixed assets or to add to the value of an existing fixed asset with a useful life that extends beyond the taxable year capitation (rate) - CORRECT ANSWER method of payment to a provider of medical services according to the number of members in a health benefit plan that the provider contracts to treat. The plan sponsor agrees to pay a uniform periodic fee for each member. (cost per person) case mix index - CORRECT ANSWER average diagnosis-related group weight for all of a hospital's Medicare volume. It can be used to adjust the average cost per patient (or day) for a given hospital relative to the adjusted average cost for other hospitals by dividing the average cost per patient (or day) by the hospital's calculated CMI. The adjusted average cost per patient would reflect the charges reported for the types of cases treated in that year. cash flow - CORRECT ANSWER amount of cash being received and spent by a business during a defined period of time, sometimes tied to a specific project catastrophic coverage - CORRECT ANSWER type of insurance designed to cover catastrophes such as tornados, major accidents, or health emergencies certification - CORRECT ANSWER confirmation of certain characteristics of an object, person, or organization. This confirmation is often, but not always, provided by some form of external review, education, or assessment. One of the most common types of certification in modern society is professional certification, where a person is certified as being able to competently complete a job or task, usually by the passing of an examination. There are two general types of professional certification: some are valid for lifetime, once the exam is passed. Others have to be recertified again after a certain period of time. charge master - CORRECT ANSWER comprehensive and hospital-specific listing of each item that could be billed to a patient, payers or other health care provider. charitable care - CORRECT ANSWER services provided to patients who do not have the ability to pay for the care and the hospital or health care organization does not charge for that care or service. Can also be considered unreimbursed care or unpaid bills (bad debt). collective bargaining - CORRECT ANSWER process whereby workers organize collectively and bargain with employers regarding the workplace. In various national labor and employment law contexts collective bargaining takes on a more specific legal meaning. In a broad sense, however, it is the coming together of workers to negotiate their employment. community hospital - CORRECT ANSWER based on the American Hospital Association definition, includes all non-Federal short-term general and special hospitals whose facilities and services are available to the public. Special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; and other specialty services. community rating (health insurance) - CORRECT ANSWER insurer using community rating to set insurance premiums ignores any differences in expected costs among insured groups or people. If an insurer uses community rating, but people know and use their expected costs to decide whether or not to buy insurance, then only the sickest people may wind up signing up for insurance. conflict management - CORRECT ANSWER long-term management of intractable conflicts. It is the label for the variety of ways by which people handle grievances — standing up for what they consider to be right and against what they consider to be wrong. Conflict management is NOT the same as conflict resolution. The latter — conflict resolution — refers to resolving the dispute to the approval of one or both parties, whereas the former — conflict management — concerns an ongoing process that may never have a resolution. Continuous Quality Improvement (CQI) - CORRECT ANSWER culture, strategies and methods necessary for continual improvement in meeting and exceeding customers' expectations co-optation - CORRECT ANSWER election where members of a committee (or similar group) vote in order to fill a vacancy on that committee or group. Where a small committee is originally elected using a method of proportional representation a co-option may be thought unsuitable as the newly elected member will not necessarily represent the interests of the group represented by the vacating member. co-payment or copay - CORRECT ANSWER capped contribution defined in the policy and paid by an insured person each time a medical service is accessed. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maximums. cost-benefit analysis - CORRECT ANSWER formal discipline used to help appraise, or assess, the case for a project or proposal, which itself is a process known as project appraisal; and an informal approach to making decisions of any kind. Under both definitions the process involves, whether explicitly or implicitly, weighing the total expected costs against the total expected benefits of one or more actions in order to choose the best or most profitable option. cost containment - CORRECT ANSWER occurs when an insurance company attempts to reduce the benefit payment or costs associated with the health plan. cost sharing - CORRECT ANSWER insurance and medical costs not paid for by the insurance company; the insured share of the cost of insurance. Costs can be shared between an employee and their employer for health insurance or between the insurance company and the insured. cost shifting - CORRECT ANSWER allocation of unpaid costs of care delivered to one patient population through above-cost revenue collected from other patient populations cost-to-charge ratio - CORRECT ANSWER rate setting methodology using a ratio of costs of services and procedures to charges of those services or procedures in the hospital setting covered lives - CORRECT ANSWER number of individuals and dependents enrolled a health insurance plan. If an actual number is not available, a formula can be used to derive the number of covered lives from those eligible for the health insurance plan. data warehousing - CORRECT ANSWER central warehouse or repository for data collected by a business or enterprise. A data warehouse allows for select extraction, access and analysis. debenture - CORRECT ANSWER certificate of acceptance of loans which is given under the company's stamp and carries an undertaking that the debenture holder will get a fixed return (fixed on the basis of interest rates) and the principal amount whenever the debenture matures. demand management - CORRECT ANSWER art or science of controlling economic demand to avoid a recession. The term is also used to refer to management of the distribution of, and access to goods and services on the basis of needs. designated funds - CORRECT ANSWER contributions which the donor has designated to a specific voluntary agency(ies), federation(s), or general option(s). diagnostic-related group (DRG) - CORRECT ANSWER system to classify hospital cases into one of approximately 500 groups, expected to have similar hospital resource use, developed for Medicare as part of the prospective payment system. assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, and the presence of complications or comorbidities. DRGs have been used since 1983 to determine how much Medicare pays the hospital, since patients within each category are similar clinically and are expected to use the same level of hospital resources. disproportionate share hospital (DSH) - CORRECT ANSWER The US government provides special funding to hospitals who treat significant populations of indigent patients through the DSH programs. There are primarily two DSH programs: Medicare Disproportionate Share Hospital program and the Medicaid Disproportionate Share Hospital program. There is also a Disproportionate Share Hospital program for pharmacies known as the 340B program. diversity management - CORRECT ANSWER long-term strategy and process intended to create and maintain a positive work environment where the similarities and differences of individuals are valued so that all can reach their potential and maximize their contributions to an organization's strategic goals and objectives do not resuscitate (DNR) order - CORRECT ANSWER type of advance directive that requests not to have cardiopulmonary resuscitation (CPR) if a person's heart stops or if he or she stops breathing. If a DNR order is not in place hospital staff will attempt to help all patients in either situation. efficiency (resource utilization) - CORRECT ANSWER production of a maximum amount of health services output with a given amount of resources or the production of a given amount of health services with a minimum amount of resources. implies that there is no waste in the use of resources to produce and deliver health services. does not indicate whether or to what extent outputs delivered are effective electronic health record (EHR) - CORRECT ANSWER electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. automates access to information and has the potential to streamline the clinician's workflow. ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting employee assistance program (EAP) - CORRECT ANSWER employee benefit programs offered by many employers, typically in conjunction with a health insurance plan. intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being. include assessment, short-term counseling and referral services for employees and their household members. employment-at-will - CORRECT ANSWER doctrine of American law that defines an employment relationship in which the employer or employee can break the relationship with no liability provided there was no express contract for a definite term governing the employment relationship and that the employer does not belong to a collective bargain (i.e. a union). Several exceptions to the doctrine exist, especially if unlawful discrimination is involved regarding the termination of an employee. endowment - CORRECT ANSWER resources or property donated to an institution, individual, or group as a source of income Equal Employment Opportunity Commission (EEOC) - CORRECT ANSWER US government agency dedicated to uphold Title VII of the Civil Rights Act of 1964, which prohibits discrimination in employment on the basis of race, color, national origin, and sex equity (health care ethics) - CORRECT ANSWER absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. ethical principle; it also is consonant with and closely related to human rights principles. equity theory of pay (Adams' Equity Theory) - CORRECT ANSWER attempts to explain relational satisfaction in terms of perceptions of fair/unfair distributions of resources within interpersonal relationships. first developed in 1963 by John Stacy Adams, a workplace and behavioral psychologist, who asserted that employees seek to maintain equity between the inputs that they bring to a job and the outcomes that they receive from it against the perceived inputs and outcomes of others evidence-based practice - CORRECT ANSWER approach that attempts to specify the methods professionals or other decision-makers make decisions by identifying such evidence that there may be for a practice, and rating it according to its scientific rigor. The goal is to eliminate unsound or excessively risky practices in favor of those that outcomes based on the evidence available. evidence-based public health - CORRECT ANSWER development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models existence, relatedness, and growth (ERG) theory of motivation - CORRECT ANSWER extension of Maslow's hierarchy of needs. Alderfer suggested that needs could be classified into three categories, rather than five. These three types of needs are existence, relatedness, and growth. Existence needs are similar to Maslow's physiological and safety need categories. Relatedness needs involve interpersonal relationships and are comparable to aspects of Maslow's belongingness and esteem needs. Growth needs are those related to the attainment of one's potential and are associated with Maslow's esteem and self-actualization needs. expectancy theory - CORRECT ANSWER explains the processes that an individual undergoes to make choices. In organizational behavior study, a motivation theory first proposed by Victor Vroom of the Yale School of Management. predicts that employees in an organization will be motivated when they believe that putting in more effort will yield better job performance; better job performance will lead to organizational rewards, such as an increase in salary or benefits; and these predicted organizational rewards are valued by the employee in question experience rating - CORRECT ANSWER statistical procedure used to calculate a premium rate based on the loss experience of an insured group. Applied in group insurance, it is the opposite of manual rates. The premiums paid are related to actual claims and expense experience expected for that specific group. fee-for-service reimbursement - CORRECT ANSWER Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. FFS plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used filibuster - CORRECT ANSWER "talking out a bill", is a form of obstruction in a legislature or other decision-making body. An attempt is made to infinitely extend debate upon a proposal in order to delay the progress or completely prevent a vote on the proposal taking place financial ratios - CORRECT ANSWER ratio of selected values on a business' financial statements. Financial ratios can be used to evaluate the overall financial condition of a corporation or other organization general purpose financial statements - CORRECT ANSWER balance sheet, statement of operations, changes in net assets, cash flow objective of general purpose financial statements - CORRECT ANSWER provide information about the financial position, financial performance, and cash flows of an entity that is useful to a wide range of users in making economic decisions. To meet that objective, financial statements provide information about an entity's - assets; liabilities; equity; income and expenses, including gains and losses; other changes in equity 5 P's of strategy - CORRECT ANSWER Mintzberg, Ahlstrand, Lampell used to define strategy: Plan Ploy Pattern Position Perspective fixed (plant) assets - CORRECT ANSWER non-current asset, also known as property, plant, and equipment (PP&E), is a term used in accountancy for assets and property which cannot easily be converted into cash 4 P's (of marketing) - CORRECT ANSWER in the early 1960's, Professor Neil Borden at Harvard Business School identified a number of company performance actions that can influence the consumer decision to purchase goods or services. Professor E. Jerome McCarthy, also at the Harvard Business School in the early 1960s, suggested that the Marketing Mix contained 4 elements: product, price, place and promotion. free rider - CORRECT ANSWER in economics, collective bargaining, psychology and political science, "free riders" are actors that consume more than their fair share of a resource, or shoulder less than a fair share of the costs of its production. gag rules - CORRECT ANSWER limits or forbids the raising, consideration or discussion of a particular topic by members of a legislative or decision-making body gatekeeper - CORRECT ANSWER used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, organizations that use those techniques or provide them as services to other organizations, or systems of financing and delivering health care to enrollees organized around managed care techniques and concepts global rate (reimbursement) - CORRECT ANSWER risk-adjusted rate given by insurance providers based several factors such as age, sex, complications and comorbidities green (high-performance) facilities - CORRECT ANSWER design and construction of efficient, cost-effective, durable, and environmentally sound buildings and landscapes grievance process - CORRECT ANSWER uniform process to address a grievance (complaint or issue) by an employee put in place by an employer without escalating to litigation gross national product (GNP) - CORRECT ANSWER total dollar value of all final goods and services produced for consumption in society during a particular time period, usually a calendar year. Its rise or fall measures economic activity based on the labor and production output within a country health care rationing - CORRECT ANSWER denial or delay of a treatment or procedure as a method to deter the increases in health care costs and/or utilization; can be done on an individual basis through individual choice or on a bureaucratic or organizational level by implementing policies limiting services based on several factors including utilization and cost. health care systems - CORRECT ANSWER public and/or private organization used to deliver health care, systems vary globally and the World Health Organization states the goals of a health care system are to provide good health, responsiveness to the expectations of a population, and fair financial contribution. health disparities - CORRECT ANSWER gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. health maintenance organization (HMO) - CORRECT ANSWER health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee Health Plan Employer Data and Information Set (HEDIS) - CORRECT ANSWER consists of 71 measures across eight domains of care developed and maintained by the National Committee f or Quality Assurance (NCQA). Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service. Employers, consultants, and consumers use HEDIS data, along with accreditation information, to help them select the best health plan for their needs. To ensure the validity of results, all data are rigorously audited by certified auditors using a process designed by NCQA health policy triangle - CORRECT ANSWER triangle of cost, quality and accessibility of health care hierarchy of needs (Maslow) - CORRECT ANSWER theory in psychology that Abraham Maslow proposed in his 1943 paper A Theory of Human Motivation. depicted as a pyramid consisting of five levels: the four lower levels are grouped together as being associated with Physiological needs: survival needs, safety and security, love and belonging, and self-esteem, while the top level is termed growth needs associated with psychological needs such as self actualization. horizontal integration - CORRECT ANSWER microeconomics and strategic management, the term describes a type of ownership and control. It is a strategy used by a business or corporation that seeks to sell a type of product in numerous markets hospice care - CORRECT ANSWER end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family indemnity insurance - CORRECT ANSWER fee-for-service insurance with a high degree of choice for the insured; can be obtained by the individual or through a group Independent Practice Association (IPA) - CORRECT ANSWER an association of independent physicians, or other organization that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis informed consent - CORRECT ANSWER a process, not just a form. Information must be presented to enable persons to voluntarily decide whether or not to participate as a research subject. It is a fundamental mechanism to ensure respect for persons through provision of thoughtful consent for a voluntary act. The procedures used in obtaining informed consent should be designed to educate the subject population in terms that they can understand. Therefore, informed consent language and its documentation (especially explanation of the study's purpose, duration, experimental procedures, alternatives, risks, and benefits) must be written in "lay language", (i.e. understandable to the people being asked to participate). The written presentation of information is used to document the basis for consent and for the subjects' future reference. The consent document should be revised when deficiencies are noted or when additional information will improve the consent process Institutional Review Board (IRB) - CORRECT ANSWER under FDA regulations, an IRB is an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects. In accordance with FDA regulations, an IRB has the authority to approve, require modifications in (to secure approval), or disapprove research. This group review serves an important role in the protection of the rights and welfare of human research subjects purpose of IRB review - CORRECT ANSWER assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research. To accomplish this purpose, IRBs use a group process to review research protocols and related materials (e.g., informed consent documents and investigator brochures) to ensure protection of the rights and welfare of human subjects of research. integrated health delivery system - CORRECT ANSWER network of health care providers and organizations which provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the clinical outcomes and health status of the population served interpersonal quality (of health care) - CORRECT ANSWER measurement of the quality of the interaction between patient and provider on an "interpersonal level" meaning the level of communication, courtesy, and respect for the patient by the provider joint venture - CORRECT ANSWER entity formed between two or more parties to undertake economic activity together. The parties agree to create a new entity by both contributing equity, and they then share in the revenues, expenses, and control of the enterprise leadership styles (task-oriented versus people-oriented) - CORRECT ANSWER task oriented leadership focuses on the outcome of the job and the "tasks" needed to achieve the outcome versus people-oriented leadership that focuses on a participation based model that organizes and supports developing people in the organization learning organization - CORRECT ANSWER organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together. characterized by total employee involvement in a process of collaboratively conducted, collectively accountable change directed towards shared values or principles. leverage (debt financing) - CORRECT ANSWER using given resources in such a way that the potential positive or negative outcome is magnified. It generally refers to using borrowed funds, or debt, so as to attempt to increase the returns to equity licensure - CORRECT ANSWER refers to the granting of a license in the US, usually to work in a particular profession or to obtain a privilege such as to practice medicine, nursing or allied health professions. Many privileges and professions require a license, generally the state government, in order to ensure that the public will not be harmed by the incompetence of the practitioners linking pin theory of management (Likert) - CORRECT ANSWER an idea developed by Rensis Likert in which an organization is represented as a number of overlapping work units in which members of one unit are leaders of another. In this scheme, the supervisor/manager has the dual task of maintaining unity and creating a sense of belonging within the group he or she supervises and of representing that group in meetings with superior and parallel management staff. These individuals are the linking pins within the organization and so they become the focus of leadership development activities. living will - CORRECT ANSWER type of advance directive that usually covers specific directives as to the course of treatment that is to be taken by caregivers and/or providers should the individual be unable to give informed consent due to incapacity long-term care - CORRECT ANSWER includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes long-term debt - CORRECT ANSWER usually referencing assets owed, but the term can cover other obligations. In the case of assets, debt is a means of using future purchasing power in the present before a summation has been earned. Long-term usually indicates debt carried for longer than one year. managed care organization (MCO) - CORRECT ANSWER manage managed care plans which are health insurance plans that contract with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network. How much of your care the plan will pay for depends on the network's rules. Restrictive plans generally cost you less. More flexible plans cost more. There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only pay for care within the network where you choose a primary care doctor who coordinates most of your care; Preferred Provider Organizations (PPO) usually pay more if you get care within the network, but they still pay a portion if you go outside; and Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care market concentration - CORRECT ANSWER function of the number of firms and their respective shares of the total production (alternatively, total capacity or total reserves) in a market market share - CORRECT ANSWER strategic management and marketing, is the percentage or proportion of the total available market or market segment that is serviced by a company Medicaid - CORRECT ANSWER Title XIX of the Social Security Act is a Federal/State entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. This program, known as Medicaid, became law in 1965 as a cooperative venture jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in furnishing medical assistance to eligible needy persons. Medicaid is the largest source of funding for medical and health-related services for America 's poorest people Medical Savings Account (MSA) - CORRECT ANSWER special account owned by an individual used to pay for current and future medical expenses usually used in conjunction with a high deductible health plan. created by the Medicare bill signed by President Bush on December 8, 2003 and are designed to help individuals save for future qualified medical and retiree health expenses on a tax-free basis Medicare - CORRECT ANSWER federally funded entitlement health insurance program that covers people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) Medicare Part A - CORRECT ANSWER helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people do not pay a monthly premium for Part A Medicare Part B - CORRECT ANSWER helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most beneficiaries pay a monthly premium for Part B Medicare Advantage (Part C) - CORRECT ANSWER The Balanced Budget Act of 1997 required that Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the compensation and business practices changed for insurers that offer these plans, and "Medicare+Choice" plans became known as "Medicare Advantage" (MA) plans. Medicare Advantage plans may offer additional benefits to beneficiaries but they also charge additional premiums or may offer additional benefits with lower premiums or contribute to a reserve fund. The goals of Medicare Advantage are to maximize plan choices, especially in rural areas, offer better benefits for lower costs, and to introduce more competition into Medicare managed care plans Medicare Part D - CORRECT ANSWER Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Medicare Part D added Prescription drug coverage that is considered insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later Medigap insurance - CORRECT ANSWER health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan does not cover. If a beneficiary is enrolled in the Original Medicare Plan and has a Medigap policy, then Medicare and the Medigap policy will pay both their shares of covered health care costs merger and acquisition - CORRECT ANSWER refers to the aspect of corporate strategy, corporate finance and management dealing with the buying, selling and combining of different companies that can aid, finance, or help a growing company in a given industry grow rapidly without having to create another business entity monopolistic markets - CORRECT ANSWER competitive market, where there are a large number of independent firms which have a very small proportion of the market share moral hazard - CORRECT ANSWER prospect that a party insulated from risk may behave differently from the way it would behave if it were fully exposed to the risk. arises because an individual or institution does not bear the full consequences of its actions, and therefore has a tendency to act less carefully than it otherwise would, leaving another party to bear some responsibility for the consequences of those actions net assets (equity) - CORRECT ANSWER assets minus liabilities for an entity net income (excess revenues over expenses) - CORRECT ANSWER equal to the income that a firm has after subtracting costs and expenses from the total revenue. Net income can be distributed among holders of common stock as a dividend or held by the firm as retained earnings non-operating revenue - CORRECT ANSWER include all types of income that an organization receives that are not part of its main line of business. In other words, revenues or gains resulting from something other than normal business operations such as Interest Income, Dividends, Commissions, Rental Income, Gain On Sale Of Assets or Other Gains oligopolistic markets - CORRECT ANSWER market form in which a market or industry is dominated by a small number of sellers (oligopolists) open system - CORRECT ANSWER system that is capable of self-maintenance on the basis of throughput of resources from the environment; the system continuously interacts with its environment organic model - CORRECT ANSWER organization has a very low degree of job specialization with a broad knowledge of many different jobs with very little top-level authority and a high degree of self-control and coordination between peers mechanistic model - CORRECT ANSWER organizations that are described as extremely stable with a high degree of specialization and imposition of rules with a high level of authority organizational culture - CORRECT ANSWER attitudes, experiences, beliefs and values of an organization that are shared by people and groups in an organization and that control the way they interact with each other and with stakeholders outside the organization organized interest group - CORRECT ANSWER organized collection of people who seek to influence decisions, political or otherwise outcome measures - CORRECT ANSWER method of assessing the extent to which a program has achieved its intended result; used as both a planning and evaluation tool. consist of factors such as changes in skills, knowledge, behavior, or satisfaction outlier - CORRECT ANSWER observation that is numerically distant from the rest of the data. Statistics derived from data sets that include outliers may be misleading path-goal theory of leadership - CORRECT ANSWER states that a leader's function is to clear the path toward the goal of the group, by meeting the needs of subordinates. The model was developed jointly by Martin Evans and Robert House patient advocate - CORRECT ANSWER person who speaks on behalf of a patient in order to protect their rights and help them obtain needed information and services. The role of patient advocate is frequently assumed by nurses, social workers, and other healthcare providers. Some hospitals, health insurance companies, and other healthcare organizations employ people specifically to assume this role patient safety - CORRECT ANSWER relatively recent initiative in healthcare, emphasizing the reporting, analysis and prevention of medical error and adverse health events. In 1996 the Institute of Medicine began its initiative entitled, Crossing the Quality Chasm: The IOM Health Care Quality Initiative focused on assessing and improving the nation's quality of care. The seminal reports that have come from that initiative are To Err is Human; Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001) patient satisfaction measure - CORRECT ANSWER quantitative measure used to gather data to assess patient satisfaction within an organization. Measures can include issues such as how well patients feel providers listen to them, whether patients felt respected by providers and staff, or whether patients understood the instructions given them upon leaving a facility patient service revenues - CORRECT ANSWER revenue recorded on the accrual basis at full established charges, regardless of the amounts (if any) providers expect to collect. Differences between established charges and the amounts expected to be collected are recorded in the accounting records on the accrual basis as "deductions from revenue" or "operating expenses," and are classified as bad debts, contractual adjustments, charity services, and other allowances Patient's Bill of Rights - CORRECT ANSWER 1998 - Title I; Health Insurance Bill of Rights - Subtitle A: Access to Care - Requires any group health plan, or health insurance coverage offered by a health insurance issuer, providing emergency services benefits to cover emergency services furnished- (1) without the need for any prior authorization determination; (2) whether or not the health care provider furnishing such services is a participating health care provider; and (3) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), or the Internal Revenue Code, and other than applicable cost-sharing) pay-for-performance system - CORRECT ANSWER quality-based purchasing, also known as pay-for-performance is the use of payment methods and other incentives to encourage quality improvement and patient-focused high-value care. There are many models for financial and non-financial incentives used in pay-for-performance programs or strategies, and pay-for-performance programs should be viewed as only one component of a broader strategy of promoting health care quality peer (professional) review organization - CORRECT ANSWER 1982, Congress established the Medicare Utilization and Quality Control Peer Review Program, which was incorporated into Title XI of the Social Security Act. The purpose of the Program, as stated in Section 1862(g), is to improve the efficiency, effectiveness, economy, and quality of services delivered to Medicare beneficiaries. Initially, during the Program's first phase, case review by physician peers was the primary method of accomplishing its purpose Peer Review Organizations (PROs) - CORRECT ANSWER reviewed cases referred by beneficiaries and providers and selected via sampling to identify instances in which professional standards were not met, and required providers to implement corrective action plans or referred them for sanction proceedings where appropriate. Although case review may have resulted in improvement by individual providers, the improvement was not systematic or measurable, and the reliability of case review determinations was questionable. In the early nineties, in part in response to the recommendations of a report by the Institute of Medicine (IOM), the Program made a major change in its method. Case review was supplemented by the collection of data for quality measures, and where there was opportunity for improvement, PROs (renamed Quality Improvement Organizations or QIOs several years ago) offered technical assistance to providers. During this second phase of the Program, improvement on quality measures occurred. However, the impact of QIO activities on these improvements was not clear, and in 2003, the MMA mandated a review by the IOM of the Program's effectiveness. CMS Report to Congress per diem - CORRECT ANSWER per day or for each day per diem rate - CORRECT ANSWER rate established by an organization that is paid by day; can include hospital stays or rates for travel perfect competition - CORRECT ANSWER economic model that describes a hypothetical market form in which no producer or consumer has the market power to influence prices. According to the standard economical definition of efficiency (Pareto efficiency), perfect competition would lead to a completely efficient outcome per member per month (PMPM) - CORRECT ANSWER method to express utilization in a dollar amount for a managed care organization Physician-Hospital Organization (PHO) - CORRECT ANSWER organization that includes hospitals and physicians contracting with one or more Health Maintenance Organizations, insurance plans, or directly with employers to provide health care services Point-of-service (POS) plan - CORRECT ANSWER allows beneficiaries to choose a provider that is or is not within a healthcare plan. The POS plan provides more choice but if providers chosen outside the network or plan are chosen it can result in higher out-of-pocket costs political action committee (PAC) - CORRECT ANSWER two distinct types of political committees registered with the FEC: separate segregated funds (SSFs) and non-connected committees. Basically, SSFs are political committees established and administered by corporations, labor unions, membership organizations or trade associations. These committees can only solicit contributions from individuals associated with connected or sponsoring organization. By contrast, non-connected committees--as their name suggests--are not sponsored by or connected to any of the aforementioned entities and are free to solicit contributions from the general public portability - CORRECT ANSWER The Health Insurance Portability and Accountability Act (HIPAA) offers protections for millions of American workers that improve portability and continuity of health insurance coverage. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage practice guidelines (clinical) - CORRECT ANSWER systematically developed statements and recommendations to assist practitioner and patient decisions about appropriate health care for specific clinical conditions. The Clinical Practice Guidelines were developed with the support of the Agency for Health Care Policy and Research (AHCPR), an agency established in December 1989 under Public Law 101-239, as part of the U.S. Department of Health and Human Services now known as the Agency for Healthcare Research and Quality. A series of 19 Clinical Practice Guidelines was published over a 4-year period, 1992-1996 Preferred Provider Organization (PPO) - CORRECT ANSWER care plan that: (a) has a network of providers that have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan; (b) provides for reimbursement for all covered benefits regardless of whether the benefits are provided with the network of providers; and (c) is offered by an organization that is not licensed or organized under State law as an HMO. A PPO typically offers more choice at a greater cost premium revenues - CORRECT ANSWER payments received by health insurance companies and health plans from individuals and groups who purchase a specified package of health insurance coverage benefits preventive health care - CORRECT ANSWER using services that prevent disease as opposed to treating disease. There is increasing evidence that many barriers to the routine delivery of preventive care can be overcome through a formal system for delivering clinical preventive services. The Agency for Healthcare Research and Quality's (AHRQ's) "A Step-by-Step Guide to Delivering Clinical Preventive Services: A Systems Approach" describes easy-to-follow, logical steps to take providers through the process. Delivering evidence-based clinical preventive services can help keep people healthy and save lives. Yet, research shows that even the most effective and accepted preventive services are not delivered regularly in the primary care setting price leadership - CORRECT ANSWER observation made of oligopic business behavior in which one company, usually the dominant competitor among several, leads the way in determining prices, the others soon following prior approval - CORRECT ANSWER when health insurance providers and/or managed care organizations require advance approval before reimbursement is approved for a service, prescription or procedure professional bureaucracy - CORRECT ANSWER structural configuration that is common in universities and a variety of other organizations including hospitals, accounting firms, and social work agencies. In these organizations, professionals tend to exercise major autonomy and carry out the major activities of the organization, while administrators remain in charge of secondary activities and execute specific tasks progressive discipline - CORRECT ANSWER a system of discipline where the penalties increase upon repeat occurrences. This term is often used in an employment or human resources context where rather than terminating employees for first or minor infractions, there is a system of escalating responses intended to correct the negative behaviour rather than to punish the employee Prospective Payment System (PPS) - CORRECT ANSWER method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, DRGs for inpatient hospital services) protected health information - CORRECT ANSWER under the US Health Insurance Portability and Accountability Act (HIPAA), is any information about health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history quality (of health care) - CORRECT ANSWER assures that medically necessary and appropriate care is being rendered in an efficient and effective manner, and that such care meets quality standards and community standards of practice. Research has shown that science-based measures can be used to assess quality for various conditions and for specific types of care. For example, quality health care is, Doing the right thing (getting the health care services you need) - (a)At the right time (when you need them) (b)In the right way (using the appropriate test or procedure) (c)To achieve the best possible results. Providing quality health care also means striking the right balance of services by, (a)Avoiding underuse (for example, not screening a person for high blood pressure) (b)Avoiding overuse (for example, performing tests that a patient doesn't need) (c)Eliminating misuse (for example, providing medications that may have dangerous interactions) quality-adjusted life year (QALY) - CORRECT ANSWER unit of health care outcomes that adjusts gains (or losses) in years of life subsequent to a health care intervention by the quality of life during those years. QALYs can provide a common unit for comparing cost-utility across different interventions and health problems. Units analogous to quality-adjusted life year:disability-adjusted life years (DALYs) and healthy-years equivalents (HYEs) quality assurance - CORRECT ANSWER policy, procedures, and systematic actions established in an enterprise for the purpose of providing and maintaining a specified degree of confidence in data integrity and accuracy throughout the life cycle of the data, which includes: -input -update -manipulation -output Quality Improvement Organization (QIO) - CORRECT ANSWER under the direction of the Centers for Medicare & Medicaid Services (CMS), the Quality Improvement Organization (QIO) Program consists of a national network of 53 QIOs, responsible for each U.S. state, territory, and the District of Columbia. QIOs work with consumers and physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly patients from underserved populations. The Program also safeguards the integrity of the Medicare Trust Fund by ensuring that payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care quality of life (QOL) - CORRECT ANSWER in public health and medicine the concept of health-related quality of life refers to a person or group's perceived physical and mental health over time reasonable accommodation - CORRECT ANSWER Title I of the Americans with Disabilities Act of 1990 (ADA) requires an employee to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, unless to do so would cause undue hardship. In general, an accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities. three categories of reasonable accommodations - CORRECT ANSWER (1) modifications or adjustments to a *job application process* that enable a qualified applicant with a disability to be considered for the position such qualified applicant desires (2)modifications or adjustments to the *work environment*, or to the manner or circumstances under which the position held or desired is customarily performed, that enable a qualified individual with a disability to perform the essential functions of that position (3)modifications or adjustments that enable a covered entity's employee with a disability to enjoy *equal benefits and privileges of employment* as are enjoyed by its other similarly situated employees without disabilities resource-based relative value scale (RBRVS) - CORRECT ANSWER scale of national uniform relative values for all physicians' services. The relative value of each service must be the sum of relative value units representing physicians' work, practice expenses net of malpractice expenses, and the cost of professional liability insurance resource utilization group (RUG) - CORRECT ANSWER measures of staffing intensity and are used to categorize residents for Medicare payment under the skilled nursing facility prospective payment system "Skilled Nursing cleans RUGs" respect for persons - CORRECT ANSWER fundamental principle in research with human subjects. Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as *autonomous agents*, and second, that persons with *diminished autonomy are entitled to protection*. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy. Taken from the Belmont Report restricted funds - CORRECT ANSWER donors to a nonprofit organization may designate or "restrict" the use of their donations to a particular purpose or project. An example is a gift to a particular scholarship fund at a university revenue cycle - CORRECT ANSWER time between the organization's delivery of services and its receipt of payments for those services. Effective management of the revenue cycle improves internal processes to reduce the length of this cycle and return cash to the organization more quickly risk adjustment - CORRECT ANSWER way payments to health plans are changed to take into account a person's health status risk sharing - CORRECT ANSWER limits the unanticipated losses or unexpected gains by spreading risk throughout a population root cause analysis - CORRECT ANSWER class of problem solving methods aimed at identifying the root causes of problems or events. The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimized. However, it is recognized that complete prevention of recurrence by a single intervention is not always possible. Thus, RCA is often considered to be an iterative process, and is frequently viewed as a tool of continuous improvement safe harbor requirement - CORRECT ANSWER European Commission's Directive on Data Protection went into effect in October, 1998, and would prohibit the transfer of personal data to non-European Union nations that do not meet the European "adequacy" standard for privacy protection. While the United States and the European Union share the goal of enhancing privacy protection for their citizens, the United States takes a different approach to privacy from that taken by the European Union. The United States uses a sectoral approach that relies on a mix of legislation, regulation, and self-regulation. The European Union, however, relies on comprehensive legislation that, for example, requires creation of government data protection agencies, registration of databases with those agencies, and in some instances prior approval before personal data processing may begin. As a result of these different privacy approaches, the Directive could have significantly hampered the ability of U.S. companies to engage in many trans-Atlantic transactions. In order to bridge these different privacy approaches and provide a streamlined means for U.S. organizations to comply with the Directive, the U.S. Department of Commerce in consultation with the European Commission developed a "safe harbor" framework. The safe harbor -- approved by the EU in 2000-- is an important way for U.S. companies to avoid experiencing interruptions in their business dealings with the EU or facing prosecution by European authorities under European privacy laws. Certifying to the safe harbor will assure that EU organizations know that your company provides "adequate" privacy protection, as defined by the Directive safety net provider - CORRECT ANSWER safety net providers are defined by the Institute of Medicine (IOM) as " providers that by mandate or mission organize and deliver a significant level of health care and other health-related services to the uninsured, Medicaid, and other vulnerable patients ." These providers have two distinguishing characteristics: 1) by legal mandate or explicitly adopted mission they maintain an "open door," offering access to services to patients regardless of their ability to pay; and 2) a substantial share of their patient mix is uninsured, covered by Medicaid, or are otherwise vulnerable patients. These core safety net providers typically include federal, state, and locally supported community health centers (CHCs) or clinics, many of which are deemed Federally Qualified Health Centers (FQHCs), public hospital systems, and local health departments. In some communities they also include mission-driven teaching hospitals, community hospitals and ambulatory care clinics (which are often located in central city areas or serve as the sole provider of health care in the community). Rural health clinics (RHCs), small rural hospitals, critical access hospitals (CAHs), clinics that receive Ryan White HIV/AIDS grant funding, and nurse managed clinics also are important examples of key components of the safety net sentinel event - CORRECT ANSWER defined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a person or persons, not related to the natural course of the patient's illness. Sentinel events specifically include loss of a limb or gross motor function, and any event for which a recurrence would carry a risk of a serious adverse outcome Six Sigma - CORRECT ANSWER measure of quality that strives for near perfection begun by the Motorola Corporation. Six Sigma is a disciplined, data-driven approach and methodology for eliminating defects (driving towards six standard deviations between the mean and the nearest specification limit) in any process -- from manufacturing to transactional and from product to service. The statistical representation of Six Sigma describes quantitatively how a process is performing. To achieve Six Sigma, a process must not produce more than 3.4 defects per million opportunities. A Six Sigma defect is defined as anything outside of customer specifications. A Six Sigma opportunity is then the total quantity of chances for a defect. Process sigma can easily be calculated using a Six Sigma calculator. The fundamental objective of the Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects skilled nursing facility (SNF) - CORRECT ANSWER facility (which meets specific regulatory certification requirements) which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital small area variation - CORRECT ANSWER research analysis tool used by health services researchers to describe how rates of health care use and events vary over well-defined geographic areas social health maintenance organization (SHMO) - CORRECT ANSWER special type of health plan that provides the full range of Medicare benefits offered by standard Medicare HMOs, plus other services that include the following: prescription drug and chronic care benefits, respite care, and short-term nursing home care; homemaker, personal care services, and medical transportation; eyeglasses, hearing aids, and dental benefits standard of care - CORRECT ANSWER medical or psychological treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition. A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance. Adjuvant chemotherapy for lung cancer is "a new standard of care, but not necessarily the only standard of care." ( New England Journal of Medicine, 2004) State Children's Health Insurance Program: Free or low-cost health insurance available in all states for uninsured children under age 19. State Children's Health Insurance Programs help reach uninsured children whose families earn too much to qualify for Medicaid, but not enough to get private coverage step-down unit - CORRECT ANSWER term based on Medicare cost center approach for measuring hospital cost where costs are progressively apportioned from auxiliary to intermediary and further down to final hospital or health center units strategic business units - CORRECT ANSWER organizational unit within the overall organization's hierarchy which is distinguishable from other business because it serves an outside market where management can conduct strategic planning in relation to products and markets strategic planning (management) - CORRECT ANSWER organization's process of defining its strategy, leadership and direction along with a framework for allocating its capital and human resources sub-acute care - CORRECT ANSWER sub-acute care is a level of care needed by a patient who does not require hospital acute care, but who requires more intensive skilled nursing care than is provided to the majority of patients in a skilled nursing facility substitute products - CORRECT ANSWER used as alternatives to the original, examples are generic drugs or blood or platelet substitute products strengths, weaknesses, opportunities, threats (SWOT) analysis - CORRECT ANSWER strategic planning tool used to evaluate the Strengths, Weaknesses, Opportunities, and Threats involved in a project or in a business venture. It involves specifying the objective of the business venture or project and identifying the internal and external factors that are favorable and unfavorable to achieving that objective. The technique is credited to Albert Humphrey, who led a research project at Stanford University in the 1960s and 1970s systems thinking - CORRECT ANSWER unique approach to problem solving, in that it views certain 'problems' as a part of the overall system so focusing on these outcomes will only further develop the undesired element or problem technical quality (of health care) - CORRECT ANSWER Clinical performance measures (also called "technical quality" measures) look at how well a health plan or hospital prevents and treats illnesses tertiary care - CORRECT ANSWER specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for specialized treatment and care Theory X/Theory Y (McGregor) - CORRECT ANSWER theories of human motivation created and developed by Douglas McGregor at the MIT Sloan School of Management in the 1960s that have been used in human resource management, organizational behavior, and organizational development. Theory X implies management assumes employees are inherently lazy and will avoid work if they can. Because of this, workers need to be closely supervised and comprehensive systems of controls developed. A hierarchical structure is needed with narrow span of control at each level. Theory Y management assumes employees may be ambitious, self-motivated, anxious to accept greater responsibility, and exercise self-control, self-direction, autonomy and empowerment. It is believed that employees enjoy their mental and physical work duties. It is also believed that if given the chance employees have the desire to be creative and forward thinking in the workplace 360-degree performance appraisal - CORRECT ANSWER 'multi-rater feedback', 'multisource feedback', or 'multisource assessment', is employee development feedback that comes from all around the employee. "360" refers to the 360 degrees in a circle. The feedback would come from subordinates, peers, and managers in the organizational hierarchy, as well as self-assessment, and in some cases external sources such as customers and suppliers or other interested stakeholders time value of money - CORRECT ANSWER based on the premise that an investor prefers to receive a payment of a fixed amount of money today, rather than an equal amount in the future, all else being equal. All of the standard calculations are based on the most basic formula, the present value of a future sum, "discounted" to the present. For example, a sum of FV to be received in one year is discounted (at the appropriate rate of r ) to give a sum of PV at present standard calculations based on the time value of money - CORRECT ANSWER Present Value, Present Value of an Annuity, Present Value of a Perpetuity, Future Value, Future Value of an Annuity Present Value (PV) - CORRECT ANSWER amount that will be received in the future Present value is the value today of an amount of money in the future. If the appropriate interest rate is 10 percent, then the present value of $100 spent or earned one year from now is $100 divided by 1.10, which is about $91. Present Value of an Annuity (PVA) - CORRECT ANSWER present value of a stream of (equally-sized) future payments, such as a mortgage Present Value of a Perpetuity - CORRECT ANSWER value of a regular stream of payments that lasts "forever", or at least indefinitely Future Value (FV) - CORRECT ANSWER amount invested (such as in a deposit account) now at a given rate of interest Future Value of an Annuity (FVA) - CORRECT ANSWER future value of a stream of payments (annuity), assuming the payments are invested at a given rate of interest Total Quality Management (TQM) - CORRECT ANSWER management strategy aimed at embedding awareness of quality in all organizational processes involving three domains: Total: Involving the entire organization, supply chain, and/or product life cycle; Quality: performance measures Management: The system of managing with steps like Plan, Organize, Control, Lead, Staff, and allocation. W. Edwards Deming, Joseph Juran, Philip B. Crosby, and Kaoru Ishikawa, known as the big four, contributed to the body of knowledge now known as Total Quality Management transactional leadership - CORRECT ANSWER uses conventional reward and punishment to gain compliance from constituents or employees. Two types of transactional leadership are: 1) Contingent reward 2) Management by exception (Management by exception is a style of business management that focuses on identifying and handling cases that deviate from the norm, recommended as best practice by PRINCE2. Management by exception has both a general business application and a business intelligence application) transformational leadership - CORRECT ANSWER leadership when one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality trustee (funds) - CORRECT ANSWER legal term that refers to a holder of property on behalf of a beneficiary two-factor theory - CORRECT ANSWER also known as Herzberg's Motivation-Hygiene Theory , was developed by Frederick Herzberg, a psychologist who found that job satisfaction and job dissatisfaction acted independently of each other. Two Factor Theory states that there are certain factors in the workplace that causes job satisfaction, while a separate set of factors cause dissatisfaction. This theory suggests that to improve job attitudes and productivity, administrators must recognize and attend to both sets of characteristics and not assume that an increase in satisfaction leads to a commensurate decrease in dissatisfaction union steward - CORRECT ANSWER title of an official position within the organizational hierarchy of a labor union. Its uniqueness lies in the fact that rank-and-file members of the union hold this position voluntarily (through democratic election by fellow workers or sometimes by appointment of a higher union body) while maintaining their role as an employee of the firm. As a result, the Union Steward becomes a significant link and conduit of information between the union leadership and rank-and-file workers universal coverage - CORRECT ANSWER health care coverage which is extended to all citizens, and sometimes permanent residents, of a governmental region. Universal health care programs vary widely in their structure and funding mechanisms, particularly the degree to which they are publicly funded up-coding - CORRECT ANSWER when false diagnosis codes were assigned to patient records in order to increase reimbursement to the hospitals by Medicare, Medicaid, TRICARE and the Federal Employees' Health Benefits Program. In 2000, HCA-The Healthcare Company (formerly known as Columbia-HCA), the largest for-profit hospital chain in the United States , has agreed to plead guilty to criminal conduct and pay more than $840 million in criminal fines, civil penalties and damages for alleged unlawful billing practices utilization review - CORRECT ANSWER also known as utilization management, UR is reviews of claims, services or procedures in a health care organization to ensure the service was necessary and appropriate. A UR can consist of a precertification review, admission review, continued stay review/concurrent review, discharge planning and case management. Throughout this continuum is the thread of quality management vertical integration - CORRECT ANSWER organizations that are united through a hierarchy and share a common owner. Usually each member of the hierarchy produces a different product or service, and the products combine to satisfy a common need virtual organization - CORRECT ANSWER corporate, not-for-profit, educational, or otherwise productive organizational entity that uses telecommunication tools to enable, maintain and sustain member relationships in distributed work environments waiver (Medicaid) - CORRECT ANSWER The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a distinct purpose, and distinct requirements Section 1115 Research & Demonstration Projects - CORRECT ANSWER this section provides the Secretary of Health and Human Services broad authority to approve projects that test policy innovations likely to further the objectives of the Medicaid program Section 1915(b) Managed Care/Freedom of Choice Waivers - CORRECT ANSWER this section provides the Secretary authority to grant waivers that allow states to implement managed care delivery systems, or otherwise limit individuals' choice of provider under Medicaid. "B..Free..waivers" Section 1915(c) Home and Community-Based Services Waivers - CORRECT ANSWER this section provides the Secretary authority to waive Medicaid provisions in order to allow long-term care services to be delivered in community settings. This program is the Medicaid alternative to providing comprehensive long-term services in institutional settings win-win strategies - CORRECT ANSWER conflict resolution process that aims to accommodate all disputants win-lose strategies - CORRECT ANSWER conflict resolution process where not all parties are accommodated lose-lose strategies - CORRECT ANSWER conflict resolution process where no parties are accommodated working capital management - CORRECT ANSWER decisions relating to working capital and short-term financing that involve managing the relationship between an organization's short-term assets and its short-term liabilities written agreement (labor/management contract) - CORRECT ANSWER Section Sec. 209. [42 U.S.C. 409] of the Social Security Act defines wages Executive Office of the President - CORRECT ANSWER The President, The Vice President, The White House Home Page, Offices within the Executive Office of the President, The President's Cabinet Offices within the Executive Office of the President - CORRECT ANSWER White House, The Cabinet, Council of Economic Advisers, Council on Environmental Quality, Domestic Policy Council, National Economic Council, National Security Council (NSC), Office of Administration, Office of Faith-Based and Community Initiatives, Office of Global Communications, Office of Management and Budget (OMB), Office of National AIDS Policy, Office of National Drug Control Policy, Office of Science and Technology Policy, Office of the United States Trade Representative, President's Foreign Intelligence Advisory Board, USA Freedom Corps Volunteer Network, White House Military Office Executive Departments - CORRECT ANSWER Department of Agriculture (USDA), Department of Commerce (DOC), Department of Defense (DOD), Department of Education (ED), Department of Energy (DOE), Department of Health and Human Services (HHS), Department of Homeland Security (DHS), Department of Housing and Urban Development (HUD), Department of Justice (DOJ), Department of Labor (DOL), Department of State (DOS), Department of the Interior (DOI), Department of the Treasury, Department of Transportation (DOT), Department of Veterans Affairs (VA) Lower Courts - CORRECT ANSWER Judicial Panel on Multidistrict Litigation; U.S. Bankruptcy Courts; U.S. Court of Appeals for the Federal Circuit; U.S. Court of International Trade; U.S. Courts of Appeals; U.S. District Courts; U.S. Federal Courts, by Geographic Location and Circuit Special Courts - CORRECT ANSWER U.S. Court of Appeals for the Armed Forces; U.S. Court of Appeals for Veterans Claims; U.S. Court of Federal Claims; U.S. Tax Court Court Support Organizations - CORRECT ANSWER Administrative Office of the United States Courts; Federal Judicial Center; U.S. Sentencing Commission Legislative Branch - CORRECT ANSWER Congress - US Senate and US House of Representatives; agencies that support congress U.S. Senate - CORRECT ANSWER Appropriations Committee; Finance Committee; Health, Education, Labor & Pensions Committees; Senator Leadership Offices; Senators U.S. House of Representatives - CORRECT ANSWER Appropriations Committee; Ways and Means Committee; House Leadership Offices; House Organizations, Commissions, and Task Forces; Office of Inspector General; Office of the Clerk; Representatives Agencies that Support Congress - CORRECT ANSWER Architect of the Capitol; Congressional Budget Office (CBO); Congressional Research Service; Copyright Office; Government Accountability Office (GAO); Government Printing Office (GPO); Library of Congress; Medicare Payment Advisory Commission; Open World Leadership Center; Stennis Center for Public Service; U.S. Botanic Garden Other Federal Commissions and Offices - CORRECT ANSWER Equal Employment Opportunity Commission (EEOC); Federal Mediation and Conciliation Service (FMCS); National Labor Relations Board (NLRB) Private Organizations - CORRECT ANSWER American College of Healthcare Executives (ACHE); American Hospital Association (AHA); American Medical Association (AMA); Blue Cross/Blue Shield; Institute of Medicine (IOM); Joint Commission on Accreditation of Healthcare Organizations (JCAHO); National Committee on Quality Assurance (NCQA); American Public Health Association (APHA) Americans with Disabilities Act (ADA), 1990 - CORRECT ANSWER gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications Purpose of ADA - CORRECT ANSWER (1) to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities; (2) to provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities; (3) to ensure that the Federal Government plays a central role in enforcing the standards established in this chapter on behalf of individuals with disabilities; and (4) to invoke the sweep of congressional authority, including the power to enforce the fourteenth amendment and to regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities Balanced Budget Act of 1997 - CORRECT ANSWER signed into law by President Clinton. created the State Children's Health Insurance Program (SCHIP); enacted limits on Medicaid payments to disproportionate share hospitals were revised; enacted new Medicaid managed care options and requirements for states were established. Medicare changes include - CORRECT ANSWER (1) Establishing an array of new Medicare managed care and other private health plan choices for beneficiaries, offered through a coordinated open enrollment process; (2) Expanding education and information to help beneficiaries make informed choices about their health care; (3) Requiring CMS to develop and implement five new prospective payment systems for Medicare services (for inpatient rehabilitation hospital or unit services, skilled nursing facility services, home health services, hospital outpatient department services, and outpatient rehabilitation services); (4) Slowing the rate of growth in Medicare spending and extending the life of the trust fund for 10 years; (5) Providing a broad range of beneficiary protections; (6) Expanding preventive benefits; and (7) Testing other innovative approaches to payment and service delivery through research and demonstrations Civilian Health and Medical Program for the Uniformed Services (CHAMPUS), 1996 - CORRECT ANSWER this final rule establishes requirements and procedures for implementation of the TRICARE Program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Principal components of the final rule include: establishment of a comprehensive enrollment system; creation of a triple option benefit, including a Uniform HMO Benefit required by law; a series of initiatives to coordinate care between military and civilian delivery systems, including Resource Sharing Agreements, Health Care Finders, PRIMUS and NAVCARE Clinics, and new prescription pharmacy services; and a consolidated schedule of charges, incorporating steps to reduce differences in charges between military and civilian services. This final rule also includes provisions establishing a special civilian provider program authority for active duty family members overseas. The TRICARE Program is a major reform of the MHSS that will improve services to beneficiaries while helping to contain costs Title VII of the Civil Rights Act of 1964 - CORRECT ANSWER amended, 42 U.S.C. §2000e, et seq ., prohibits discrimination in employment on the basis of race, sex, national origin and religion. It also is unlawful under the Act for an employer to take retaliatory action against any individual for opposing employment practices made unlawful by Title VII or for filing a discrimination charge or for testifying or assisting or participating in an investigation, proceeding, or hearing under Title VII Consolidated Omnibus Budget Reconciliation Act (COBRA), 1986 - CORRECT ANSWER gives workers who lose their health benefits the right to choose to continue group health benefits provided by the plan under certain circumstances. generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end Emergency Medical Treatment and Active Labor Act, 1986 - CORRECT ANSWER ensures public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented National Labor Relations Act ("NLRA") in 1935 - CORRECT ANSWER to protect the rights of employees and employers, to encourage collective bargaining, and to curtail certain private sector labor and management practices, which can harm the general welfare of workers, businesses and the U.S. economy Health Care Amendments to the National Labor Relations Act of 1974 - CORRECT ANSWER amended to cover any hospital, convalescent hospital, health maintenance organization, health clinic, nursing home, extended care facility or other institution devoted to the care of sick or aged persons Health Maintenance Organization Act of 1973 - CORRECT ANSWER also known as the HMO Act of 1973 , 42 U.S.C. § 300e, is a law passed by the Congress of the United States that resulted from discussions Paul Ellwood had with what is today the Department of Health and Human Services. It provided grants and loans to provide, start, or expand a Health Maintenance Organization (HMO); removed certain state restrictions for federally qualified HMOs; and required employers with 25 or more employees to offer federally certified HMO options alongside traditional indemnity insurance upon request (the "dual choice provision"). HMOs were required to meet three basic requirements. These were to offer a specified list of benefits to all members, charge all members the same monthly premium, and be structured as a nonprofit organization. The Act solidified the term HMO and gave HMOs greater access to the employer-based market, providing for the rapid expansion of HMOs in later years. No longer needed now that HMOs are widespread, the dual choice provision expired in 1995. Hill-Burton Act (Hospital Survey and Construction Act, 1946) - CORRECT ANSWER authorizes assistance to public and other nonprofit medical facilities such as acute care general hospitals, special hospitals, nursing homes, public health centers, and rehabilitation facilities. The Community Service Assurance under Title VI of the Public Health Service Act requires recipients of Hill-Burton funds to make services provided by the facility available to persons residing in the facility's service area without discrimination on the basis of race, color, national origin, creed, or any other ground unrelated to the individual's need for the service or the availability of the needed service in the facility. These requirements also apply to persons employed in the service area of the facility if it was funded under Title XVI of the Public Health Service Act. Please note that the community service obligation is different from the uncompensated care provision. The community service obligation does not require the facility to make non-emergency services available to persons unable to pay for them. It does, however, require the facility to make emergency services available without regard to the person's ability to pay several basic requirements every Hill-Burton hospital or other facility must comply with to fulfill the community service obligation - CORRECT ANSWER a person residing in the Hill-Burton facility's service area has the right to medical treatment at the facility without regard to race, color, national origin or creed; Hill-Burton facilities must participate in the Medicare and Medicaid programs unless they are ineligible to participate; Hill-Burton facilities must make arrangements for reimbursement for services with principal State and local third-party payors that provide reimbursement that is not less than the actual cost of the services; A Hill-Burton facility must post notices informing the public of its community service obligations in English and Spanish. If 10 percent or more of the households in the service area usually speak a language other than English or Spanish, the facility must translate the notice into that language and post it as well; A Hill-Burton facility may not deny emergency services to any person residing in the facility's service area on the grounds that the person is unable to pay for those services; A Hill-Burton facility may not adopt patient admissions policies that have the effect of excluding persons on grounds of race, color, national origin, creed or any other ground unrelated to the patient's need for the service or the availability of the needed service; The entire U. S. Department of Health and Human Services Hill-Burton regulation can be found at 42 CFR Part 124 Medicare and Medicaid (Social Security Act Amendments, 1965) - CORRECT ANSWER enacted as Title XVIII and Title XIX of the Social Security Act, extending health coverage to almost all Americans aged 65 or older (e.g., those receiving retirement benefits from Social Security or the Railroad Retirement Board), and providing health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities. Seniors were the population group most likely to be living in poverty; about half had insurance coverage Medicare Modernization Act, 2003 (Part D - CORRECT ANSWER Prescription Drugs):The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) made the most significant changes to Medicare since the program began. MMA creates a prescription drug discount card until 2006, allows for competition among health plans to foster innovation and flexibility in coverage, covers new preventive benefits, and makes numerous other changes. In 2006, the new voluntary Part D outpatient prescription drug benefit will be available to beneficiaries from private drug plans as well as Medicare Advantage plans. Employers who provide retiree drug coverage comparable to Medicare's will be eligible for a federal subsidy. Medicare will consider beneficiary income for the first time: beneficiaries with incomes less than 150% of the federal poverty limit will be eligible for subsidies for the new Part D prescription drug program; beneficiaries with higher incomes will pay a greater share of the Part B premium starting in 2007 Occupational Health and Safety Act (OSHA) - CORRECT ANSWER amended through January 1, 2004. An Act to assure safe and healthful working conditions for working men and women; by authorizing enforcement of the standards developed under the Act; by assisting and encouraging the States in their efforts to assure safe and healthful working conditions; by providing for research, information, education, and training in the field of occupational safety and health; and for other purposes Ryan White CARE Act, 1990 - CORRECT ANSWER Ryan White Comprehensive AIDS Resources Emergency (CARE) Act by wide, bipartisan margins in both houses. Enactment followed reports of severe distress in major U.S. metropolitan areas that were becoming overburdened by the cost of care for a growing number of Americans living with AIDS who had little or no health insurance. The AIDS epidemic, which began in 1981, had created a need for primary medical care that was exceeding the capacity of local health departments, hospital emergency rooms, and other health care institutions. Individuals and families affected by HIV/AIDS were struggling to obtain desperately needed medical care. The Ryan White CARE Act supports the development of systems of care that are responsive to local needs and resources. It is founded on strong partnerships between the federal government, states, and local communities in need, and emphasizes less-costly outpatient, primary care to prevent costly emergency room visits and hospitalizations. The CARE Act is named in honor of Ryan White, an Indiana teenager whose struggle with AIDS and against AIDS-related discrimination who helped to educate our nation about the needs of people with AIDS. Mr. White died on April 8, 1990, at the age of 19, just a few months before Congress passed the Act that bears his name Social Security Act of 1935 - CORRECT ANSWER signed into law by President Roosevelt. In addition to several provisions for general welfare, the new Act created a social insurance program designed to pay retired workers age 65 or older a continuing income after retirement. The Social Security Act did not quite achieve all the aspirations its supporters had hoped by way of providing a "comprehensive package of protection" against the "hazards and vicissitudes of life." Certain features of that package, notably disability coverage and medical benefits, would have to await future developments. But it did provide a wide range of programs to meet the nation's needs. In addition to the program we know think of as Social Security, it included unemployment insurance, old-age assistance, aid to dependent children and grants to the states to provide various forms of medical care. The two major provisions relating to the elderly were Title I- Grants to States for Old-Age Assistance, which supported state welfare programs for the aged, and Title II-Federal Old-Age Benefits. It was Title II that was the new social insurance program we now think of as Social Security. In the original Act benefits were to be paid only to the primary worker when he/she retired at age 65. Benefits were to be based on payroll tax contributions that the worker made during his/her working life. Taxes would first be collected in 1937 and monthly benefits would begin in 1942. (Under amendments passed in 1939, payments were advanced to 1940.) State Children's Health Insurance Program (SCHIP), Social Security Act - CORRECT ANSWER Title XXI of the Social Security Act and is jointly financed by the Federal and State governments and administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years (FY) 1998 through 2007. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997. State Children's Health Insurance Program (SCHIP) Directors - CORRECT ANSWER Each State, Territory, and the District of Columbia has a coordinator for the SCHIP program who is responsible for the administration of the approved SCHIP state plan State Children's Health Insurance Program (SCHIP) Waivers and Demonstrations - CORRECT ANSWER The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs and SCHIP programs. Each authority has a distinct purpose, and distinct requirements Temporary Assistance to Needy Families (1996) - CORRECT ANSWER under the welfare reform legislation of 1996, (the Personal Responsibility and Work Opportunity Reconciliation Act - PWRORA - Public Law 104-193), TANF replaced the welfare programs known as Aid to Families with Dependent Children (AFDC), the Job Opportunities and Basic Skills Training (JOBS) program and the Emergency Assistance (EA) program. The law ended federal entitlement to assistance and instead created TANF as a block grant that provides States, territories and tribes federal funds each year. These funds cover benefits, administrative expenses, and services targeted to needy families. TANF became effective July 1, 1997, and was reauthorized in February 2006 under the Deficit Reduction Act of 2005. TANF was designed to help needy families achieve self-sufficiency Women, Infants, and Children (WIC) Supplemental Nutrition Program population served - CORRECT ANSWER 45% of all infants born in the US, low-income, nutritionally at risk-pregnant women (through pregnancy and up to 6 weeks after birth or after pregnancy ends); breastfeeding women (up to infant's 1st birthday); nonbreastfeeding postpartum women (up to 6 months after the birth of an infant or after pregnancy ends; infants (up to 1st birthday); Children up to their 5th birthday WIC benefits - CORRECT ANSWER supplemental nutritious foods; nutrition education and counseling at WIC clinics; screening and referrals to other health, welfare and social services WIC program delivery - CORRECT ANSWER federal grant program (not entitlement) for which Congress authorizes a specific amount of funds each year for the program. administered at the Federal level by FNS; administered by 90 WIC state agencies, through approximately 46,000 authorized retailers; operates through 2,000 local agencies in 10,000 clinic sites, in 50 State health departments, 34 Indian Tribal Organizations, DC, and five territories entitlement program - CORRECT ANSWER congress sets aside funds to allow every eligible individual to participate in the program examples of where WIC services are provided - CORRECT ANSWER county health departments; hospitals; mobile clinics (vans); community centers; schools; public housing sites; migrant health centers and camps; Indian Health Service facilities CLAS Standards (*) - CORRECT ANSWER The Cultural and Linguistically Appropriate Services (CLAS) Standards are proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers. The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups; however, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans. The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The 14 standards are organized by themes: Culturally Competent Care (Standards 1:3), Language Access Services (Standards 4:7), and Organizational Supports for Cultural Competence (Standards 8:14). Within this framework, there are three types of standards of varying stringency: mandates, guidelines, and recommendations as follows: CLAS mandates are current Federal requirements for all recipients of Federal funds (Standards 4, 5, 6, and 7). CLAS guidelines are activities recommended by OMH for adoption as mandates by Federal, State, and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13). CLAS recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14) (*) Copied from "National Standards for Culturally and Linguistically Appropriate Services in Health Care" U.S. Department of Health and Human Services, OPHS Office of Minority Health, March 2001 (S04a) Cultural blindness - CORRECT ANSWER The express philosophy of being unbiased. Persons adopting this philosophy function with the belief that color or culture makes no difference and that all people are the same. Culturally-blind or myopic persons or agencies are characterized by the belief that helping approaches traditionally used by the dominant culture are universally applicable; if the system worked as it should, all people::regardless of race or culture::would be served with equal effectiveness. The consequences of such beliefs are to make services so ethnocentric as to render them virtually useless to all but the most assimilated people. While these agencies often view themselves as unbiased and responsive to needs of diverse populations, their ethnocentrism is reflected in their attitudes, policies, and practices Cultural Competence - CORRECT ANSWER A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. Competence, in context, implies "having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities" (DHHS, Office of Minority Health) Cultural Health - CORRECT ANSWER Cultural and linguistic competence of health professionals and organizations to address the health disparities Cultural inclusiveness - CORRECT ANSWER Cultural inclusiveness is characterized by acceptance and respect for difference, continuing cultural self-assessment regarding culture, careful attention to the dynamics of difference, continuous expansion of cultural knowledge and resources, and a variety of adaptations to service models in order to better meet the needs of diverse population Cultural and linguistic competence (medical field) - CORRECT ANSWER The ability of health care providers and health care organizations to understand and respond effectively to the cultural and linguistic needs brought by patients to the health care encounter. Discrimination - CORRECT ANSWER In general, discrimination, in a non-legal sense, is the discernment of qualities and recognition of the differences between things. We all have the power of discrimination, which is essential for us to be able to make decisions and judgments about things Diversity strategy - CORRECT ANSWER Achievement of cultural diversity can be viewed as a developmental process that occurs along a continuum and has a range of possibilities. It is recognized that many different paths lead to cultural diversity and there is no singular path. The strategy for persons and organizations for achieving cultural diversity and competency must involve a) developing a process for self-assessment at the organizational and individual levels; b) developing and implementing policy and guidelines; c) conducting and participating in training and professional development activities; and d) providing a forum for safe and honest dialogue with and among agency personnel and the diverse communities they serve. These activities must be an ongoing process and integral to the persons, organization's or program's personal efforts or core functions. Environmental justice - CORRECT ANSWER The pursuit of equal justice and equal protection under the law for all environmental statutes and regulations without discrimination based on race, ethnicity, and/or socio-economic status. Presidential Executive Order No. 12898 (issued February 11, 1994) requires Federal agencies to respond to the issue of environmental justice by "identify[ing] and address[ing] disproportionately high and adverse human health or environmental effects of its programs, policies, and activities on minority and low income populations." (http://www.srs.fs.usda.gov/sustain/data/authors/glossary) Health Disparities - CORRECT ANSWER Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. These population groups may be characterized by gender, age, ethnicity, education, income, social class, disability, geographic location, or sexual orientation (NIH Working Group on Health Disparities) Linguistic Competence - CORRECT ANSWER The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities (Tawara D. Goode and Wendy Jones, 8/00, Revised 8/03, 11/04) Cultural Competence: "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. Competence, in context, implies "having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities" (DHHS, Office of Minority Health) Social justice - CORRECT ANSWER Sometimes called civil justice refers to the concept of a society in which justice is achieved in every aspect of society, rather than merely the administration of law. It is generally thought of as a world which affords individuals and groups fair treatment and an impartial share of the benefits of society. Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity - CORRECT ANSWER This classification provides a minimum standard for maintaining, collecting, and presenting data on race and ethnicity for all Federal reporting purposes. The categories in this classification are social-political constructs and should not be interpreted as being scientific or anthropological in nature. They are not to be used as determinants of eligibility for participation in any Federal program. The standards have been developed to provide a common language for uniformity and comparability in the collection and use of data on race and ethnicity by Federal agencies. The standards have five categories for data on race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White. There are two categories for data on ethnicity: "Hispanic or Latino," and "Not Hispanic or Latino." (Office of Management and Budget, Standards for federal data on race and ethnicity, 1997 - Census 2000) accuracy - CORRECT ANSWER the degree to which a measurement or an estimate based on measurements represents the true value of the attribute that is being measured acute disease - CORRECT ANSWER 1. Referring to a health effect, with sudden onset, often brief; sometimes loosely used to mean severe 2. Referring to exposure, either brief, intense, or short-term; sometimes specifically referring to brief exposure to high intensity adjusted rate - CORRECT ANSWER a rate in which the effects of differences in composition of the populations being compared have been minimized by statistical age-specific rate - CORRECT ANSWER a rate for a specified age group. The numerator and denominator refer to the same age group association - CORRECT ANSWER (San: correlation, [statistical] dependence, relationship) Statistical dependence between two or more events, characteristics, or other variables. An association is present if the probability of occurrence of an event of characteristic, or the quantity if a variable, depends upon the occurrence of one or more other events, the presence of one or more other characteristics, or the quantity of one or more other variables. attack rate - CORRECT ANSWER the cumulative incidence of infection in a group observed over a period during an epidemic attributable risk - CORRECT ANSWER the rate (proportion) of disease or other outcome in exposed individuals that can be attributed to the exposure. This measure is derived by subtracting the rate of the outcome (usually incidence or mortality) among the unexposed from the rate among the exposed individuals; it is assumed that causes other than the one under investigation have had equal effects on the exposed and unexposed groups. case - CORRECT ANSWER A person in the population or study group identified as having the particular disease, health disorder, or condition under investigation. The epidemiological definition of a case is not necessarily the same as the ordinary clinic trial definition. case fatality rate - CORRECT ANSWER The proportion of cases of a specified condition which are fatal within a specified time cause-specific rate - CORRECT ANSWER a rate that specifies events, such as deaths, according to their cause chronic - CORRECT ANSWER 1. Referring to a health-related state, lasting a long time. 2. Referring to exposure, prolonged or long-term, often with specific reference to low intensity. 3. The US National Center for Health Statistics defines a "chronic" condition as one of 3 months' duration or longer clinical - CORRECT ANSWER concerned with or based on actual observation and treatment of disease in patients rather than experimentation or theory. Phase I trial - CORRECT ANSWER Safety and pharmacologic profiles. The first introduction of a candidate vaccine or a drug into a human population to determine its safety and mode of action. In drug trials, this phase may include studies of dose and route of administration. Phase I trials usually involve fewer than 100 healthy volunteers. Phase II trial - CORRECT ANSWER Pilot efficacy studies. Initial trial to examine efficacy usually in 200 to 500 volunteers; with vaccines, the focus is on immunogenicity, and with drugs, on demonstration of safety and efficacy in comparison to other existing regimens. Usually but not always, subjects are randomly allocated to study and control groups. Phase III trial - CORRECT ANSWER Extensive clinical trial. This phase is intended for complete assessment of safety and efficacy. It involves larger numbers, perhaps thousands, of volunteers, usually with random allocation to study and control groups, and may be a multicenter trial. Phase IV trial - CORRECT ANSWER With drugs, this phase is conducted after the national drug registration authority (e.g., the Food and Drug Administration in the United States) has approved the drug for distribution or marketing. Phase IV trials may include research designed to explore a specific pharmacologic effect, to establish the incident of adverse reactions, or to determine the effects of long-term use. Ethical review is required for phase IV clinical trials, but not for routine post marketing surveillance. community - CORRECT ANSWER A group of individuals organized into a unity, or manifesting some unifying trait or common interest; loosely, the locality or catchment area population for which a service is provided, or more broadly, the station, nation, or body politic. Confidence interval - CORRECT ANSWER The computed interval with a given probability, e.g., 95%, that the true value of a variable such as a mean, proportion, or rate is contained within the interval. confounder - CORRECT ANSWER (From the Latin confundere, to mix together) 1. A situation in which the effects of two processes are not separated. The distortion of the apparent effect of an exposure on risk brought about by the association with other factors that can influence the outcome. 2. A relationship between the effects of two or more causal factors as observed in a set of data such that it is not logically possible to separate the contribution that any single causal factor has made to an effect. 3. A situation in which a measure of the effect of an exposure on risk is distorted because of the association of exposure with other factor(s) that influence the outcome under study. control group - CORRECT ANSWER (or comparison group or controls) Subjects with whom comparison is made in a case control study, randomized controlled trial, or other variety of epidemiologic study. crude rate - CORRECT ANSWER a summary rate based on the actual number of events in a population over a given time period. cumulative incidence (cumulative incidence rate) - CORRECT ANSWER (Syn: incidence proportion) The number or proportion of a group of people who experience the onset of a health-related event during a specified time interval; this interval is generally the same for all members of the group, but, as in lifetime incidence, it may vary from person to person without reference to age. death rate - CORRECT ANSWER An estimate of the portion of a population that dies during a specified period. The numerator is the number of person dying during the period; the denominator is the number in the population, usually estimated as the midyear population. descriptive epidemiology - CORRECT ANSWER epidemiologic studies that are concerned with characterizing the amount and distribution of heath and disease within a population. dose-response - CORRECT ANSWER The relationship of observed outcomes (responses) in a population to varying levels of a protective or harmful agent such as a form of medication or an environmental contaminant. double-blind (masked) trial - CORRECT ANSWER A procedure of blind assignment to study and control groups and blind assessment of outcome, designed to ensure that ascertainment of outcome is not biased by knowledge of the group to which an individual was assigned. Double refers to both parties, i.e., the observer(s) in contact with the subjects and the subjects in the study and control groups. ecological fallacy - CORRECT ANSWER (Syn: aggregation bias, ecological bias) The bias that may occur because an association observed between variables on an aggregate level does not necessarily represent the association that exists at an individual level. ecological study - CORRECT ANSWER A study in which the units of analysis are populations or groups of people, rather than individuals. An example is the study of association between median income and cancer mortality rates in administrative jurisdictions such as states and counties. effect modification - CORRECT ANSWER (Syn: conditional variable, moderator variable) A factor that modifies the effect of a putative causal factor under study. Effect modification is detected by varying the selected effect measure for the factor under study across levels of another factor. environment - CORRECT ANSWER All that which is external to the individual human host. Can be divided into physical, biological, social, cultural, etc., any or all of which can influence health status of populations. epidemiology - CORRECT ANSWER The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems. etiologic fraction (attributable fraction, attributable risk percent) - CORRECT ANSWER The proportion of all cases that can be attributed to a particular exposure. It is the attributable difference (attributable risk) divided by the incidence rate in the group. If the association is causal, this is also the proportion by which the incidence rate would be reduced if the exposure were eliminated. The attributable fraction may apply to exposed individuals (attributable risk percent) or to the whole population (population attributable risk percent). etiology - CORRECT ANSWER Literally, the science of causes, causality; in common usage, cause. experimental study - CORRECT ANSWER A study in which conditions are under the direct control of the investigator. In epidemiology, a study in which a population is selected for a planned trial of a regimen whose effects are measured by comparing the outcome of the regimen in the experimental group with the outcome of another regimen in a control group. exposure - CORRECT ANSWER 1. Proximity and/or contact with a source of a disease agent in such a manner that effective transmission of the agent or harmful effects of the agent may occur. 2. The amount of a factor to which a group or individual was exposed; sometimes contrasted with dose, the amount that enters or interacts with the organism. 3. Exposures may of course be beneficial rather than harmful, e.g., exposure to immunizing agents. 4. The process by which an agent comes into contact with a person or animal in such a way that the person or animal may develop the relevant outcome, such as a disease. external validity - CORRECT ANSWER a study is externally valid, or generalizable, if it can produce unbiased inferences regarding a target population (beyond the subjects in the study). false negative - CORRECT ANSWER Negative test result in a person who possesses the attribute for which the test is conducted. false positive - CORRECT ANSWER Positive test result in a person who does not possess the attribute for which the test is conducted. follow-up period - CORRECT ANSWER Observation over a period of time of an individual, group, or initially defined population whose characteristics have been assessed in order to observe changes in health status or health-related variables. genetics - CORRECT ANSWER The branch of biology dealing with heredity and variation of individual members of a species. Hawthorne effect - CORRECT ANSWER The effect (usually positive or beneficial) of being under study upon the persons being studied; their knowledge of the study often influences their behavior. healthy worker effect - CORRECT ANSWER A phenomenon observed initially in studies of occupational diseases. Workers usually exhibit lower overall death rates than the general population, because the severely ill and chronically disabled are ordinarily excluded from employment. Death rates in the general population may be inappropriate for comparison if this effect is not taken into account. host - CORRECT ANSWER In an epidemiologic context, the host may be the population or group; biological, social, and behavioral characteristics of this group that are relevant to heath are called "host factors." human subjects - CORRECT ANSWER individuals who consent to participate in a scientific investigation. hypothesis - CORRECT ANSWER 1. A supposition, arrived at from observation or reflection, that leads to refutable predictions. 2. Any conjecture cast in a form that will allow it to be tested and refuted. incidence density (incidence rate) - CORRECT ANSWER The rate at which new events occur in a population. The numerator is the number of new events that occur in a defined period; the denominator is the population at risk of experiencing the event during this period, sometimes expressed as person-time. index case - CORRECT ANSWER The first case in a family or other defined group to come to the attention of the investigator. induction period - CORRECT ANSWER The period required for a specific cause to produce disease. More precisely, the interval from the causal action of a factor to the initiation of the disease. information bias - CORRECT ANSWER (Syn: observational bias) A flaw in measuring exposure or outcome data that results in a different quality (accuracy) of information between comparison groups. informed consent (research-based) - CORRECT ANSWER Voluntary consent given by a subject-i.e., person or a responsible proxy (e.g., a parent)- for participation in a study, immunization program, treatment regimen, etc., after being informed of the purpose, methods, procedures, benefits and risks, and, when relevant, the degree of uncertainty about outcome. internal validity - CORRECT ANSWER The index and comparison groups are selected and compared in such a manner that the observed differences between them on the dependent variables under study may, apart from sampling error, be attributed only to the hypothesized effect under investigation. interviewee bias (or response bias) - CORRECT ANSWER Systematic error due to differences in characteristics between those who choose or volunteer to take part in a study and those who do not. latent period (latency) - CORRECT ANSWER Delay between exposure to a disease-causing agent and the appearance of manifestations of the disease. lead time bias - CORRECT ANSWER (Syn: zero time shift) Overestimation of survival time, due to the backward shift in the starting point for measuring survival that arises when diseases such as cancer are detected early, as by screening procedures length bias - CORRECT ANSWER A systematic error due to selection of disproportionate numbers of long-duration cases (cases who survive longest) in one group but not in another. This can occur when prevalent rather that incident cases are included in a case control study. matching - CORRECT ANSWER The process of making a study group and a comparison group comparable with respect to extraneous factors. measurement error - CORRECT ANSWER A mismatch between an estimated value and its true value. Can be observed when using multiple measures of the same entity or concept. misclassification - CORRECT ANSWER The erroneous classification of an individual, a value, or an attribute into a category other than that to which it should be assigned. The probability of misclassification may be the same in all study groups (nondifferential misclassification) or may vary between groups (differential misclassification). morbidity - CORRECT ANSWER Any departure, subjective or objective, from a state of physiological or psychological well-being. Natality - CORRECT ANSWER The occurrence of births in a population. natural history of disease - CORRECT ANSWER The course of a disease from onset (inception) to resolution. Many diseases have certain well-defined stages that, taken all together, are referred to as the "natural history of the disease" in question. observer bias - CORRECT ANSWER Systematic difference between a true value and that actually observed, due to failure of the observer to measure or identify the phenomenon accurately. odds ratio - CORRECT ANSWER (Syn: cross-product ratio, relative odds) The ratio of two odds. period prevalence - CORRECT ANSWER The total number of persons known to have had the disease or attribute at any time during a specified period. person-time (person-years) - CORRECT ANSWER A measurement combining persons and time as the denominator in incidence and mortality rates when, for varying periods, individual subjects are at risk of developing disease or dying. personal identifiers - CORRECT ANSWER information, including demographic data, that relates to the individual's past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present or future payment for the provision of health care to the individual. point prevalence - CORRECT ANSWER The number of persons with a disease or an attribute at a specified point in time. population attributable risk - CORRECT ANSWER (Syn: population risk difference) The incidence of a disease in a population that is associated with (attributable to) exposure to the risk factor. It is often expressed as a percentage (i.e., population attributable risk percent, population etiologic fraction). population survey - CORRECT ANSWER An investigation in which information is systematically collected but in which the experimental method is not used. Precision - CORRECT ANSWER 1. The quality of being sharply defined or stated. 2. In statistics, precision is defined as the inverse of the variance of a measurement or estimate. prevalence - CORRECT ANSWER The number of events, e.g., instances of a given disease or other condition, in a given population at a designated time. primary prevention - CORRECT ANSWER Activities, designed to reduce the occurrence of disease, that occur during the period of prepathogenesis, i.e., before an agent interacts with a host. probability sample - CORRECT ANSWER (Syn: random sample) All individuals have a known chance of selection. They may all have an equal chance of being selected, or, if a stratified sampling method is used, the rate at which individuals from several subsets are sampled can be varied so as to produce greater representation of some classes than of others. proportional mortality ratio - CORRECT ANSWER The proportion of observed deaths from a specified condition in a defined population, divided by the proportion of deaths expected from this condition in a standard population, expressed either on an age-specific basis or after age adjustment. P value (probability) - CORRECT ANSWER The probability that a test statistic would be as extreme as or more extreme than observed if the null hypothesis were true. quasi-experimental study - CORRECT ANSWER A situation in which the investigator lacks full control over the allocation and/or timing of intervention but nonetheless conducts the study as if it were an experiment, allocating subjects to groups. Inability to allocate subjects randomly is a common situation that may be best described as a quasi-experiment. random error - CORRECT ANSWER Fluctuations around a true value of a parameter because of sampling variability. Can occur as a result of poor precision, sampling error, or variability in measurement. rate - CORRECT ANSWER A measure of frequency of occurrence of a phenomenon. In epidemiology, demography, and vital statistics, a rate is an expression of the frequency with which an event occurs in a defined population in a specified period of time. rate ratio - CORRECT ANSWER The ratio of two rates. The term is used in epidemiologic research with a precise meaning, i.e., the ratio of the rate in the exposed population to the rate in the unexposed population. registry - CORRECT ANSWER In epidemiology the term register is applied to the file of data concerning all cases of a particular disease or other health-relevant condition in a defined population such that the cases can be related to a population base. relative risk - CORRECT ANSWER 1. The ratio of the risk of disease or death among the exposed to the risk among the unexposed. 2. Alternatively, the ratio of cumulative incidence rate in the exposed to the cumulative incidence rate to the unexposed, i.e., the rate ratio. resistance - CORRECT ANSWER The ability of an agent to survive adverse environmental conditions. risk - CORRECT ANSWER The probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or by a certain age. risk difference - CORRECT ANSWER (Syn: excess risk) The absolute difference between two risks. sampling error - CORRECT ANSWER That part of the total estimation error of a parameter caused by the random nature of the sample. screening - CORRECT ANSWER Screening was defined in 1951 by the US Commission on Chronic Illness as, "the presumptive identification of unrecognized disease or defect by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic. Persons with positive or suspicious findings must be referred to their physicians for diagnosis and necessary treatment." secular trends - CORRECT ANSWER (Syn: temporal trend) Changes over a long period of time, generally years or decades. Examples include the decline of tuberculosis mortality and the rise, followed by a decline, in coronary heart disease mortality in many industrial countries in the past 50 years. sensitivity - CORRECT ANSWER (of a screening test) The proportion of truly diseased persons in the screened population who are identified as diseased by the screening test. specificity - CORRECT ANSWER The proportion of truly nondiseased persons who are so identified by the screening test. standardized mortality ratio - CORRECT ANSWER The ratio of the number of deaths observed in the study group or population to the number that would be expected if the study population had the same specific rates as the standard population, multiplied by 100. Usually expressed as a percentage. stratification - CORRECT ANSWER The process of or result of separating a sample into several subsamples according to specified criteria, such as age groups, socioeconomic status, etc. study population (sample) - CORRECT ANSWER a selected subset of a population. surveillance - CORRECT ANSWER Systematic ongoing collection, collation, and analysis of data and the timely dissemination of information to those who need to know so that action can be taken. target population - CORRECT ANSWER 1. The collection of individuals, items, measurements, etc., about which inferences are desired. The term is sometimes used to indicate the population from which a sample is drawn and sometimes to denote any "reference" population about which inferences are required. 2. The group of persons for whom an intervention is planned. temporality - CORRECT ANSWER the timing of information about cause and effect. validity - CORRECT ANSWER Measurement - an expression of the degree to which a measurement measures what it purports to measure. Study - the degree to which the inference drawn from a study, especially generalizations extending beyond the study population, are warranted when account is taken of the study methods, the representativeness of the study sample, and the nature of the population from which it is drawn. vital statistics - CORRECT ANSWER Systematically tabulated information concerning births, marriages, divorces, separations, and deaths based on registrations of these vital events. adjusted rate (adjustment) - CORRECT ANSWER A summarizing procedure for a statistical measure in which the effects of differences in composition of the populations being compared have been minimized by statistical methods. Examples are adjustment by regression analysis and by standardization. Adjustment is often performed on rates or relative risks, commonly because of differing age distributions in populations that are being compared. The mathematical procedure commonly used to adjust rates for age differences is direct or indirect standardization. alpha (α) - CORRECT ANSWER The probability of a type I error, the error of rejecting a true null hypothesis, i.e. declaring a difference exists when it does not. alternative hypothesis - CORRECT ANSWER 1. A supposition, arrived at from observation or reflection, that leads to refutable predictions. 2. Any conjecture cast in a form that will allow it to be tested and refuted. analysis of covariance (ANCOVA) - CORRECT ANSWER Originally used for an extension of the analysis of variance that allows for the possible effects of continuous concomitant variables (covariates) on the response variable, in addition to the effects of the factor or treatment variables. Usually assumed that covariates are unaffected by treatments and that their relationship to the response is linear. If such a relationship exists then inclusion of covariates in this way decreases the error mean square and hence term now appears to also be more generally used for almost any analysis seeking to assess the relationship between a response variable and a number of explanatory variables. analysis of variance (ANOVA) - CORRECT ANSWER The separation of variance attributable to one cause from the variance attributable to others. By partitioning the total variance of a set of observations into parts due to particular factors, for example, sex, treatment group, etc, and comparing variances (mean squares) by way of F-tests, differences between means can be assessed. The simplest analysis of this type involves a one-way design, in which N subjects are allocated, usually at random, to the k different levels of a single factor. The total variation in the observations is then divided into a part due to differences between level means (the between groups sum of squares) and a part due to the differences between subjects in the same group (the within groups sum of squares, also known as the residual sum of squares). These terms are usually arranged as an analysis of variance table. [see diagram in study guide] If the means of the populations represented by the factor levels are the same, then within the limits of random variations, the between groups mean square and within groups mean square, should be the same. Whether this is so can, if certain assumptions are met, be assessed by a suitable F-test are that the response variable is normally distributed in each population and that the populations have the same variance. Essentially an example of a generalized linear model with an identity link function and normally distributed errors. beta (β) - CORRECT ANSWER The probability of a type II error, the error of failing to reject a false null hypothesis, i.e. declaring that a difference does not exist when in fact it does bias - CORRECT ANSWER In general terms, deviations of results or inferences from the truth, or processes leading to such deviation. More specifically, the extent to which the statistical method used in a study does not estimate the quantity thought to be estimated, or does not test the hypothesis to be tested. In estimated usually measured by the difference between a parameter estimate and its expected value. An estimator for which is said to be unbiased . binary variable (binary observation) - CORRECT ANSWER Observations which occur in one of two possible states, these often being labeled 0 and I. Such data is frequently encountered in medical investigations; commonly occurring examples include 'dead/alive', 'improved/not improved' and 'depressed/not depressed.' Data involving this type of variable often require specialized techniques for their analysis such as logical regression. binomial distribution - CORRECT ANSWER [ see online definition list ] Biostatistics - CORRECT ANSWER A branch of science which applies statistical methods to biological problems. The science of biostatistics encompasses the design of biological experiments, especially in medicine and health sciences bivariate - CORRECT ANSWER outcomes belong to two categories, e.g. yes/no, acceptable/defective "bivariate binomial distribution" blinded study (blinding) - CORRECT ANSWER A procedure used in clinical trials to avoid the possible bias that might be introduced if the patient and/or doctor knew which treatment the patient is receiving. If neither the patient nor doctor are aware of which treatment has been given the trial is termed double-________. If only one of the patient or doctor is unaware, the trial is called single-_____. Clinical trials should use the maximum degree possible, although in some areas, for example, surgery, it is often impossible for an investigation to be double-______. Bonferroni correction - CORRECT ANSWER A procedure for guarding against an increase in the probability of a type I error when performing multiple significance tests. To maintain the probability of a type I error at some selected value (α), each of the m tests to be performed is judged against a significance level (α/m ). For a small number of simultaneous tests (up to five) this method provides a simple and acceptable answer to the problem of multiple testing. It is however highly conservative and not recommended if large numbers of tests are to be applied, when one of the many other multiple comparison procedures available is generally preferable case-control study - CORRECT ANSWER (Syn: case comparison study, case compeer study, case history study, case referent study, retrospective study) The observational epidemiologic study of persons with the disease (or other outcome variable) of interest and a suitable control (comparison, reference) group of persons without the disease. categorical data - CORRECT ANSWER Categorical data represent types of data which may be divided into groups. Examples of categorical variables are race, sex, age group, and educational level. While the latter two variables may also be considered in a numerical manner by using exact values for age and highest grade completed, it is often more informative to categorize such variables into a relatively small number of groups. censored observation - CORRECT ANSWER An observation (Xi) on some variable of interest is said to be censored if it is known only that Xi =Li ( left-censored) or Xi =Ui ( right-censored) where Li and Ui are fixed values. Such observations arise most frequently in studies where the main purpose variable is time until a particular event occurs (for example, time to death) when at the completion of the study, the event of interest has not happened to a number of subjects. Chi-Square Distribution - CORRECT ANSWER This is based on a normally distributed population with variance σ², with randomly selected independent samples of size n and computed sample variance s² for each sample. The sample statistic X²= ( n - 1) s²/σ². This distribution is skewed, the values can be zero or positive but not negative, and it is different for each number of degrees of freedom. Generally, as the number of degrees of freedom increases, this distribution approaches a normal distribution. Chi-square test for trend - CORRECT ANSWER A test applied to a two-dimensional contingency table in which one variable has two categories and the other has k ordered categories, to assess whether there is a difference in the trend of the proportions in the two groups. The result of using the ordering in this way is a test that is more powerful than using the chi-squared statistic to test for independence. clinical trial - CORRECT ANSWER (Syn: therapeutic trial) A research activity that involves the administration of a test regimen to humans to evaluate its efficacy and safety. The term is subject to wide variation in usage, from the first use in humans without any control treatment to a rigorously designed and executed experiment involving test and control treatments and randomization. Several phases of clinical trials are distinguished. coefficient of variation (CV) - CORRECT ANSWER The measure of spread for a set of data defined as 100 x standard deviation / mean CV = s/x bar(100) = sample CV = σ/µ(100) = population Originally proposed as a way of comparing the variability in different distributions, but found to be sensitive to errors in the mean. Simpler definition: The ratio of the standard deviation to the mean. This is meaningful only if the variable is measured on a ratio scale. cohort study - CORRECT ANSWER (Syn: concurrent, follow-up, incidence, longitudinal, prospective study) The analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. complementary event - CORRECT ANSWER Mutually exclusive events A and B for which Pr(A) + Pr(B) = 1 where Pr denotes probability. conditional probability - CORRECT ANSWER The probability that an event occurs given the outcome of some other event. Usually written, Pr(A l B). For example, the probability of a person being colour blind given that the person is male is about 0.1, and the corresponding probability given that the person is female is approximately 0.0001. It is not, of course, necessary that Pr(A l B) = Pr(A l B); the probability of having spots given that a patient has measles, for example, is very high, the probability of measles given that a patient has spots is, however, much less. If Pr(A l B) = Pr(A l B) then the events A and B are said to be independent. confidence interval (CI) - CORRECT ANSWER A range of values, calculated from the sample observations, that is believed, with a particular probability, to contain the true value of a population parameter. A 95% confidence interval, for example, implies that were the estimation process repeated again and again, then 95% of the calculated intervals would be expected to contain the true parameter value. Note that the stated probability level refers to properties of the interval and not to the parameter itself which is not considered a random variable. confounding variable - CORRECT ANSWER (also confounding factor , lurking variable , a confound , or confounder ) is an extraneous variable in a statistical model that correlates (positively or negatively) with both the dependent variable and the independent variable . The methodologies of scientific studies therefore need to control for these factors to avoid what is known as a type 1 error : A 'false positive' conclusion that the dependent variables are in a causal relationship with the independent variable . Such a relation between two observed variables is termed a spurious relationship . Thus, confounding is a major threat to the validity of inferences made about cause and effect, i.e. internal validity , as the observed effects should be attributed to the confounder rather than the independent variable. By definition, a confounding variable is associated with both the probable cause and the outcome. The confounder is not allowed to lie in the causal pathway between the cause and the outcome: If A is thought to be the cause of disease C, the confounding variable B may not be solely caused by behaviour A; and behaviour B shall not always lead to behaviour C. An example: Being female does not always lead to smoking tobacco, and smoking tobacco does not always lead to cancer. Therefore, in any study that tries to elucidate the relation between being female and cancer should take smoking into account as a possible confounder. In addition, a confounder is always a risk factor that has a different prevalence in two risk groups (e.g. females/males). (Hennekens, Buring & Mayrent, 1987) continuous data - CORRECT ANSWER result from infinitely many possible values that correspond to some continuous scale that covers a range of values without gaps, interruptions or jumps, e.g. blood pressure. controlled trial - CORRECT ANSWER A Phase III clinical trial in which an experimental treatment is compared with a control treatment, the latter being either the current standard treatment or a placebo. covariate - CORRECT ANSWER Often used simply as an alternative name for explanatory variables, but perhaps more specifically to refer to variables that are not of primary interest in an investigation, but are measured because it is believed that they are likely to affect the response variable and consequently need to be included in analyses and model building. cox regression model (Proportional Hazards Model) - CORRECT ANSWER A statistical model used in survival analysis developed by D.R. Cox in 1972 asserting that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time. critical value - CORRECT ANSWER The value with which a statistic calculated from sample data is compared in order to decide whether a null hypothesis should be rejected. The value is related to the particular significance level chosen. crossover rate - CORRECT ANSWER The proportion of patients in a clinical trial transferring from the treatment decided by an initial random allocation to an alternative one. cross-sectional study - CORRECT ANSWER (Syn: disease frequency survey, prevalence study) A study that examines the relationship between diseases (or other health-related characteristics) and other variables of interest as they exist in defined population at one particular time. cumulative frequency distribution - CORRECT ANSWER The tabulation of a sample of observations in terms of numbers falling below particular values. The empirical equivalent of the cumulative probability distribution. An example of such a tabulation is shown [ see online definition list ] degrees of freedom - CORRECT ANSWER An elusive concept that occurs throughout statistics. Essentially the term means the number of independent units of information in a sample relevant to the estimation of a parameter or calculation of a statistic. For example, in a two-by-two contingency table with a given set of marginal totals, only one of the four cell frequencies is free and the table has therefore a single degree of freedom. In many cases the term corresponds to the number of parameters in a model. Also used to refer to a parameter of various families of distributions, for example, Student's t-distribution and the F-distribution. dependent variable (response or outcome variable) - CORRECT ANSWER The variable of primary importance in investigations since the major objective is usually to study the effects of treatment and/or other explanatory variables on this variable and to provide suitable models for the relationship between it and the explanatory variables. descriptive statistics - CORRECT ANSWER A general term for methods of summarizing and tabulating data that make their main features more transparent. For example, calculating means and variances and plotting histograms. dichotomous observation - CORRECT ANSWER A nominal measure with two outcomes (examples are gender male or female; survival yes or no); also called binary. See dichotomous data. dichotomous scale - CORRECT ANSWER one that arranges items into either of two mutually exclusive categories, e.g. yes/no, alive/dea discrete data - CORRECT ANSWER result when the number of possible values is either a finite number or a "countable" number. discrete variable - CORRECT ANSWER a countable and finite variable, for example grade: 1, 2, 3, 4...- 12. distribution (population) - CORRECT ANSWER In statistics this term is used for any finite or infinite collection of 'units', which are often people but may be, for example, institutions, events, etc. double-blinded trial - CORRECT ANSWER A procedure used in clinical trials to avoid the possible bias that might be introduced if the patient and/or doctor knew which treatment the patient is receiving. If neither the patient nor doctor are aware of which treatment has been given the trial dummy coding - CORRECT ANSWER Dummy coding provides one way of using categorical predictor variables in various kinds of estimation models (see also effect coding), such as, linear regression. Dummy coding uses only ones and zeros to convey all of the necessary information on group membership. dummy variable (indicator variable) - CORRECT ANSWER in statistics, a variable taking only one of two possible values, one (usually 1) indicating the presence of a condition, and the other (usually 0) indicating the absence of the condition, used mainly in regression analysis. effect or effect size - CORRECT ANSWER a measure of the strength of the relationship between two variables. In scientific experiments, it is often useful to know not only whether an experiment has a statistically significant effect, but also the size of any observed effects. In practical situations, effect sizes are helpful for making decisions. Effect size measures are the common currency of meta-analysis studies that summarize the findings from a specific area of research. Effective sample size - CORRECT ANSWER The sample size after dropouts, deaths and other specified exclusions from the original sample. expected frequencies - CORRECT ANSWER A term usually encountered in the analysis of contingency tables. Such frequencies are estimates of the values to be expected under the hypothesis of interest. In a two-dimensional table, for example, the values under independence are calculated from the product of the appropriate row and column totals divided by the total number of observations. experiment (in probability) - CORRECT ANSWER A probability experiment involves performing a number of trials to measure the chance of the occurrence of an event our outcome. ***experimental study - CORRECT ANSWER A study in which conditions are under the direct control of the investigator. In epidemiology, a study in which a population is selected for a planned trial of a regimen whose effects are measured by comparing the outcome of the regimen in the experimental group with the outcome of another regimen in a control group. explanatory variable - CORRECT ANSWER The variables appearing on the right-hand size of the equations defining, for example, multiple regression or logistic regression, and which seek to predict or 'explain' the response variable. Also commonly known as the independent variables, although this is not to be recommended since they are rarely independent of one another. factor analysis - CORRECT ANSWER A set of statistical methods for analyzing the correlations among several variables in order to estimate the number of fundamental dimensions that underlie the observed data and to describe and measure those dimensions. Used frequently in the development of scoring systems for rating scales and questionnaires. factorial designs - CORRECT ANSWER Designs which allow two or more questions to be addressed in an investigation. The simplest factorial design is one in which each of two treatments or interventions are either present or absent, so that subjects are divided into four groups; those receiving neither treatment, those having only the first treatment, those having only the second treatment and those receiving both treatments. Such designs enable possible interactions between factors to be investigated. A very important special case of a factorial design is that where each of k factors of interest has only two levels; these are usually known as 2kfactorial designs. A single replicate of a 2kdesign is sometimes called an unreplicated factorial. false-negative - CORRECT ANSWER The proportion of cases in which a diagnostic test indicates disease is absent in patients who HAVE the disease. false-positive - CORRECT ANSWER The proportion of cases in which a diagnostic test indicates disease is present in disease-free patients F distribution (variance ratio distribution) - CORRECT ANSWER The distribution of the ratio of two independent quantities each of which is distributed like a variance in normally distributed samples. So named in honor of R.A. Fisher who first described the distribution. Fisher's exact test - CORRECT ANSWER An alternative procedure to use of the chi-squared statistic for assessing the independence of two variables forming a two-by-two contingency table particularly when the expected frequencies are small. The method consists of evaluating the sum of the probabilities associated with the observed table and all possible two-by-two tables that have the same row and column totals as the observed data but exhibit more extreme departure from independence. The probability of each table is calculated from the hypergeometric distribution. frequency (occurrence) - CORRECT ANSWER a general term describing the frequency or occurrence of a disease or other attribute or event in a population without distinguishing between incidence and prevalence. frequency distribution - CORRECT ANSWER lists data values (either individually or by groups of intervals), along with their corresponding frequencies (or counts). frequency table - CORRECT ANSWER a way of summarizing data; used as a record of how often each value (or set of values) of a variable occurs. A frequency table is used to summarize categorical, nominal, and ordinal data. It may also be used to summarize continuous data once the data is divided into categories. F-test - CORRECT ANSWER A test for the equality of the variances of two populations having normal distributions, based on the ratio of the variances of a sample of observations taken from each. Most often encountered in the analysis of variance , where testing whether particular variances are the same also test for the equality of a set of means gold standard trials - CORRECT ANSWER A term usually retained for those clinical trials in which there is random allocation to treatments, a control group and double-blinding. goodness of fit - CORRECT ANSWER Degree of agreement between an empirically observed distribution and a mathematical or theoretical distribution. goodness-of-fit test - CORRECT ANSWER A statistical test of the hypothesis that data have been randomly sampled or generated from a population that follows a particular theoretical distribution or model. The most common such tests are chi-square tests. hazard rate (force of morbidity, instantaneous incidence rate) - CORRECT ANSWER A theoretical measure of the risk of an occurrence of an event, e.g. death or new disease, at a point in time, t , defined mathematically as the limit, as Δ t approaches zero, of the probability that an individual well at time t will experience the event by t + Δ t , divided by Δ t . histogram - CORRECT ANSWER A graphical representation of a set of observations in which class frequencies are represented by the areas of rectangles centred on the class interval. If the latter are all equal, the heights of the rectangles are also proportional to the observed frequencies. A histogram of heights of elderly women is shown [ see online definition list ] historical controls - CORRECT ANSWER A group of patients treated in the past with a standard therapy, used as the control group for evaluating a new treatment on current patients. Although used fairly frequently in medical investigations, the approach is not to be recommended since possible biases, due to other factors that may have changed over the time, can never be satisfactory eliminated. homogeneity (homogeneous) - CORRECT ANSWER A term that is used in statistics to indicate the equality of some quantity of interest (most often a variance), in a number of different groups, populations, etc. homoscedasticity - CORRECT ANSWER homo means "same" and -scedastic means "scattered" therefore homoscedasticity means the constancy of the variance of a measure over the levels of the factors under study. hypothesis testing - CORRECT ANSWER A general term for the procedure of assessing whether sample data is consistent or otherwise with statements made about the population. incidence - CORRECT ANSWER A measure of the rate at which people without a disease develop the disease during a specific period of time. Calculated as incidence = [number of new cases of a disease over a period of time / population at risk of the disease in the time period] it measures the appearance of disease. More generally, the number of new events, e.g. new cases of a disease in a specified population, within a specified period of time. The term incidence is sometimes wrongly used to denote incidence rate. Independence - CORRECT ANSWER Two events are said to be independent if the occurrence of one is in no way predictable from the occurrence of the other. Two variables are said to be independent if the distribution of values of one is the same for all values of the other. independent variable (explanatory variables) - CORRECT ANSWER The variables appearing on the right-hand side of the equations defining, for example, multiple regression or logistic regression, and which seek to predict or 'explain' the response variable. Using the term independent variable is not recommended since they are rarely independent of one another. inference (statistical) - CORRECT ANSWER The process of drawing conclusions about a population on the basis of measurements or observations made on a sample of individuals for the population. intercept - CORRECT ANSWER The parameter in an equation derived from a regression analysis corresponding to the expected value of the response variable when all the explanatory variables are zero. interquartile range - CORRECT ANSWER A measure of spread given by the difference between the first and third quartiles of a sample Inter-rater reliability (observer variation, inter-rater agreement, Concordance) - CORRECT ANSWER the degree of agreement among raters. It gives a score of how much homogeneity or consensus there is in the ratings given by judges. It is useful in refining the tools given to human judges, for example by determining if a particular scale is appropriate for measuring a particular variable. If various raters do not agree, either the scale is defective or the raters need to be re-trained. There are a number of statistics which can be used to determine inter-rater reliability. Different statistics are appropriate for different types of measurement. Some options are: joint-probability of agreement, Cohen's kappa and the related Fleiss' kappa, inter-rater correlation, concordance correlation coefficient and intra-class correlation. intervention study - CORRECT ANSWER A study in which conditions are under the direct control of the investigator. In epidemiology, a study in which a population is selected for a planned trial of a regimen whose effects are measured by comparing the outcome of the regimen in the experimental group with the outcome of another regimen in a control group. Kaplan-Meier estimate (product limit method) - CORRECT ANSWER A nonparametric method of compiling life or survival tables. This combines calculated probabilities of survival and estimates to allow for censored observations, which are assumed to occur randomly. The intervals are defined as ending each time an event (death, withdrawal) occurs and are therefore unequal. Kappa - CORRECT ANSWER A measure of the degree of nonrandom agreement between observers or measurements of the same categorical variable K=Po-Pe/1-Pe where Po is the proportion of times the measurements agree, and Pe is the proportion of times they can be expected to agree by chance alone. If the measurements agree more often than expected by chance, kappa is positive; if concordance is complete, kappa = 1; if there is no more nor less than chance concordance, kappa = 0; if the measurements disagree more than expected by chance, kappa is negative. kurtosis - CORRECT ANSWER the extent to which a unimodal distribution is peaked. least squares - CORRECT ANSWER A principle of estimation, attributable to Gauss, in which the estimates of a set of parameters in a statistical model are those quantities that minimize the sum of squared differences between the observed values of the dependent variable and the values predicted by the mode level of significance - CORRECT ANSWER The level of probability at which it is agreed that the null hypothesis will be rejected. Conventionally set at 0.05. life table analysis - CORRECT ANSWER A procedure often applied in prospective studies to examine the distribution of mortality and/or morbidity in one or more diseases in a cohort study of patients over a fixed period of time. For each specific increment in the follow-up period, the number entering the period, the number leaving during the period, and the number either dying from the disease (mortality) or developing the disease (morbidity), are all calculated. It is assumed that an individual not completed the follow-up period is exposed for half this period, thus enabling the data for those 'leaving' and those 'staying' to be combined into an appropriate denominator for the estimation of the percentage dying from or developing the disease. The advantage of this approach is that all patients, not only those who have been involved for an extended period, can be included in the estimation process. likelihood function - CORRECT ANSWER A function constructed from a statistical model and a set of observed data that gives the probability of the observed data for various values of the unknown model parameters. The parameter values that maximize the probability are the maximum likelihood estimates of the parameters. likelihood ratio - CORRECT ANSWER The ratio of the likelihood of observing data under actual conditions, to observing these data under the other, e.g., "ideal" conditions; or comparison of various model conditions to assess which model provides the best fit. Likelihood ratios are used to appraise screening and diagnostic tests in clinical epidemiology. likelihood ratio test - CORRECT ANSWER A statistical test based on the ratio of the maximum value of the likelihood function under one statistical model to the maximum value under another statistical model; the models differ in that one includes and the other excludes one or more parameters. linear regression (of Y on X) - CORRECT ANSWER a form of regression analysis in which observational data are modeled by a function which is a linear combination of the model parameters and depends on one or more independent variables. In simple linear regression the model function represents a straight line. The results of data fitting are subject to statistical analysis. The data consist of m values taken from observations of the dependent variable (response variable) y . The independent variables are also called regressors, exogenous variables, input variables and predictor variables. In simple linear regression the data model is written as yi = ß₀ + xiß₁+ εi where εi is an observational error. ß₀ (intercept) and ß₁ (slope) are the parameters of the model. logit (log-odds) - CORRECT ANSWER the logarithm of the ratio of frequencies of two different categorical outcomes such as healthy versus sick. logit model - CORRECT ANSWER A linear model for the logit (natural log of the odds) of disease as a function of a quantitative factor X: Logit (disease given X = x ) = α + β x This model is mathematically equivalent to the logistic model. log-linear model - CORRECT ANSWER A statistical model that uses an analysis of variance type of approach for the modeling of frequency counts in contingency tables. longitudinal study (cohort study) - CORRECT ANSWER Studies that give rise to longitudinal data. The defining characteristic of such a study is that subjects are measured repeatedly through time. Mantel-Haenszel estimate - CORRECT ANSWER Mantel and Haenszel provided an adjusted odds ratio as an estimate of relative risk that may be derived from grouped and matched sets of data. It is now known as the Mantel-Haenszel estimate. The statistic may be regarded as a type of weighted average of the individual odds ratios, derived from stratifying a sample into a series of strata that are internally homogeneous with respect to confounding factors. The Mantel-Haenszel summarization method can also be extended to the summarization of rate ratios and rate differences from follow-up studies. An estimator of the assumed common odds ratio in a series of two-by-two contingency tables arising from different populations, for example, occupation, country of origin, etc. Mantel-Haenszel test - CORRECT ANSWER A summary chi-square test developed by Mantel and Haenszel for stratified data and used when controlling for confounding. Marginals - CORRECT ANSWER the row and column totals of a contingency table. matching (or matched groups) - CORRECT ANSWER The process of making a study group and a comparison group comparable with respect to extraneous factors. Often used in retrospective studies when selecting cases and controls to control variation in a response variable due to sources other than those immediately under investigation. Several kinds of matching can be identified, the most common of which is when each case is individually matched with a control subject on the matching variables, such as age, sex, occupation, etc. When the variable on which the matching takes place is continuous it is usually transformed into a series of categories (e.g. age), but a second method is to say that two values of the variable match if their difference lies between defined limits. This method is known as caliper matching. Also important is group or category matching in which the distributions of the extraneous factors are made similar in the groups to be compared. maximum likelihood estimate - CORRECT ANSWER the value for an unknown parameter that maximizes the probability of obtaining exactly the data that were observed. Used to solve logistic regression. mean-squared error - CORRECT ANSWER the expected value of the square of the difference between an estimator and the true value of a parameter. If the estimator is unbiased then the mean squared error (MSE) is simply the variance of the estimator. For a biased estimator the MSE is equal to the sum of the variance and the square of the bias. Measurement error - CORRECT ANSWER A mismatch between an estimated value and its true value. Can be observed when using multiple measures of the same entity or concept. measurement scale - CORRECT ANSWER the range of possible values for a measurement (e.g. the set of possible responses to a question, the physically possible range for a set of body weights). Measurement scales can be classified according to the quantitative character of the scale: dichotomous scale - one that arranges items into either of two mutually exclusive categories, e.g. yes/no, alive/dead. nominal scale - classification into unordered qualitative categories, e.g. race, religion, country of birth. Measurements of individual attributes are purely nominal scales, as there is no inherent order to their categories. ordinal scale - classification into ordered qualitative categories, e.g. grade, where the values have a distinct order but their categories are qualitative in that there is no natural (numerical) distance between their possible values. interval scale -an equal interval involves assignment of values with a natural distance between them, so that a particular distance (interval) between two values in another region of the scale. Examples include Celsius and Fahrenheit temperature, date of birth. ratio scale - a ratio is an interval scale with a true zero point, so that ratios between values are meaningfully defined. Examples are absolute temperature, weight, height, blood count, and income, as in each case it is meaningful to speak of one value as being so many times greater or less than another value. measures of central tendency - CORRECT ANSWER A general term for several values of the distribution of a set of values or measurements located at or near the middle of the set. The principal measures of central tendency are the mean, median, and mode. median - CORRECT ANSWER The value in a set of ranked observations that divides the data into two parts of equal size. When there is an odd number of observations the median is the middle value. When there is an even number of observations the measure is calculated as the average of the two central values. Provides a measure of location of a sample that is suitable for asymmetric distributions and is also relatively insensitive to the presence of outliers. meta-analysis - CORRECT ANSWER A collection of techniques whereby the results of two or more independent studies are statistically combined to yield an overall answer to a question of interest. The rationale behind this approach is to provide a test with more power than is provided by the separate studies themselves. The procedure has become increasingly popular in the last decade or so but it is not without its critics particularly because of the difficulties of knowing which studies should be included and to which population final results actually apply. multicollinearity - CORRECT ANSWER in multiple regression analysis, a situation in which at least some of the independent variables are highly correlated with each other. Such a situation can result in inaccurate estimates of the parameters in the regression model. multinomial distribution - CORRECT ANSWER the probability distribution associated with the classification of each of a sample of individuals into one of several mutually exclusive and exhaustive categories. When the number of categories is two, the distribution is called binomial. multiple comparison test - CORRECT ANSWER Procedures for detailed examination of the differences between a set of means, usually after a general hypothesis that they are all equal has been rejected. No single technique is best in all situations and a major distinction between techniques is how they control the possible inflation of the type I error. multivariate analysis - CORRECT ANSWER a set of techniques used when the variation in several variables has to be studied simultaneously. In statistics any analytic method that allows the simultaneous study of two or more dependent variables. mutually exclusive events - CORRECT ANSWER Events that cannot occur jointly. nominal scale - CORRECT ANSWER classification into unordered qualitative categories, e.g. race, religion, country of birth. Measurements of individual attributes are purely nominal scales, as there is no inherent order to their categories. nonparametric method (distribution fee methods) - CORRECT ANSWER Statistical techniques of estimation and inference that are based on a function of the sample observations, the probability distribution of which does not depend on a complete specification of the probability distribution of the population from which the sample was drawn. Consequently the techniques are valid under relatively general assumptions about the underlying population. Often such methods involve only the ranks of the observations rather than the observations themselves. Examples are Wilcoxon's signed rank test and Friedman's two way analysis of variance. In many cases these tests are only marginally less powerful than their analogues which assume a particular population distribution (usually a normal distribution), even when that assumption is true. Also commonly known as nonparametric methods although the terms are not completely synonymous. nonrandomized clinical trial - CORRECT ANSWER A clinical trial in which a series of consecutive patients receive a new treatment and those that respond (according to some pre-defined criterion) continue to receive it. Those patients that fail to respond receive an alternative, usually the conventional, treatment. The two groups are then compared on one or more outcome variables. One of the problems with such a procedure is that patients who respond may be healthier than those who do not respond, possibly resulting in an apparent but not real benefit of treatment. null hypothesis - CORRECT ANSWER The 'no difference' or 'no association' hypothesis to be tested (usually by means of a significance test) against an alternative hypothesis that postulates non-zero difference or association. observational study - CORRECT ANSWER A study in which the objective is to uncover cause-and-effect relationships but in which it is not feasible to use controlled experimentation, in the sense of being able to impose the procedure or treatments whose effects it is desired to discover, or to assign subjects at random to different procedures. Surveys and most epidemiologic studies fall into this class. Since the investigator does not control the assignment of treatments there is no way to ensure that similar subjects receive different treatments. The classical example of such a study that successfully uncovered evidence of an important causal relationship is the smoking and lung cancer investigation of Doll and Hill. observer variation (error) - CORRECT ANSWER variation (or error) due to failure of the observer to measure or identify a phenomenon accurately. Observer variation erodes scientific credibility whenever it appears. There are two varieties of observer variation: interobserver variation, i.e. the amount observers vary from one another when reporting on the same material, and intraobserver variation, i.e. the amount one observer varies between observations when reporting more than once on the same material. odds - CORRECT ANSWER the ratio of the probability of occurrence of an event to that of nonoccurrence (a binary variable), or the ratio of the probability that something is so to the probability that it is not so. one-tailed test (one-sided test) - CORRECT ANSWER A significance test for which the alternative hypothesis is directional; for example, that one population mean is greater than another. The choice between a one-sided and two-sided test must be made before any test statistic is calculated. ordinal scale - CORRECT ANSWER classification into ordered qualitative categories, e.g. grade, where the values have a distinct order but their categories are qualitative in that there is no natural (numerical) distance between their possible values. outliers - CORRECT ANSWER observations differing so widely from the rest of the data as to lead one to suspect that a gross error may have been committed, or suggesting that these values come from a different population. Statistical handling of outliers varies and is difficult. parameter - CORRECT ANSWER A numerical characteristic of a population or a model. The probability of a 'success' in a binomial distribution, for example. parametric test - CORRECT ANSWER a statistical test that depends upon assumptions about the distribution of the data, e.g. that the data are normally distributed. Percentile - CORRECT ANSWER The set of divisions that produce exactly 100 equal parts in a series of continuous values, such as blood pressure, weight, height, etc. Thus a person with blood pressure above the 80th percentile has a greater blood pressure value than over 80% of the other recorded values. point estimate (estimation) - CORRECT ANSWER The process of providing a numerical value for a population parameter on the basis of information collected from a sample. If a single figure is calculated for the unknown parameter the process is called point estimation. If an interval is calculated which is likely to contain the parameter, then the procedure is called interval estimation. post hoc comparisons - CORRECT ANSWER Analyses not explicitly planned at the start of a study but suggested by an examination of the data. Such comparisons are generally performed only after obtaining a significant overall F value. power - CORRECT ANSWER The probability of rejecting the null hypothesis when it is false. Power gives a method of discriminating between competing test of the same hypothesis, the test with the higher power being preferred. It is also the basis of procedures for estimating the sample size needed to detect an effect of a particular magnitude. Mathematically, power is 1-β (type II error). predictive value of a negative test - CORRECT ANSWER the probability that a person with a negative test does not have the disease. predictive value of a positive test - CORRECT ANSWER the probability that a person with a positive test is a true positive (i.e. does have the disease). principal component analysis - CORRECT ANSWER a statistical method to simplify the description of a set of interrelated variables. Its general objectives are data reduction and interpretation; there is no separation into dependent and independent variables; the original set of correlated variables is transformed into a smaller set of uncorrelated variables called the principal components. Often used as the first step in a factor analysis. probability - CORRECT ANSWER A measure associated with an event A and denoted by Pr(A) which takes a value such that 0 ≤ Pr(A) ≤ 1. Essentially the quantitative expression of the chance than an event will occur. In general the higher the value of Pr(A) the more likely It is that the event will occur. If the event cannot happen Pr(A) = 0; if an event is certain to happen Pr(A) = 1. Numerical values can be assigned in simple cases by one of the following two methods: If the sample space can be divided into subsets of n (n ≥ 2) equally likely outcomes and the event A is associated with r (0 ≤ r ≤ n) of these, then Pr(A) = r / n. If an experiment can be repeated a large number of times, n, and in r cases the event A occurs, then r / n is called the relative frequency of A. If this leads to a limit as n ? 8, this limit is Pr(A). probability distribution - CORRECT ANSWER For a discrete random variable, a mathematical formula that gives the probability of each value of the variable. See, for example, binomial distribution and Poisson distribution. For a continuous random variable, a curve described by a mathematical formula which specifies, by ways of areas under the curve, the probability that the variable falls within a particular interval. Examples include the normal distribution and the exponential distribution. In both cases the term probability density may also be used. (A distinction is sometimes made between 'density' and 'distribution', when the latter is reserved for the probability that the random variable falls below some value. In this dictionary, however, the latter will be termed the cumulative probability distribution and probability distribution and probability density used synonymously. proportion - CORRECT ANSWER A type of ratio in which the numerator is included in the denominator. prospective study (cohort study) - CORRECT ANSWER Studies in which individuals are followed-up over a period of time. A common example of this type of investigation is where samples of individuals exposed and not exposed to a possible risk factor for a particular disease, are followed forward in time to determine what happens to them with respect to the illness under investigation. At the end of a suitable time period a comparison of the incidence of the disease amongst the exposed and non-exposed is made. A classical example of such a study is that undertaken among British doctors in the 1950s, to investigate the relationship between smoking and death from lung cancer. All clinical trials are prospective. P-value - CORRECT ANSWER the probability that a test statistic would be as extreme as or more extreme than observed if the null hypothesis were true. qualitative data - CORRECT ANSWER 1. observations or information characterized by measurement on a categorical scale, i.e. a dichotomous (non-numeric) or nominal scale, or if the categories are ordered, an ordinal scale. Examples are sex, hair color, death or survival. 2. systematic non-numerical observations by sociologists, anthropologists, etc. using approved methods such as participant observation or key informants. quantiles - CORRECT ANSWER Divisions of a probability distribution or frequency distribution into equal, ordered subgroups, for example, quartiles or percentiles. quartile - CORRECT ANSWER The values that divide a frequency distribution or probability distribution into four equal parts. random error or variation - CORRECT ANSWER The variation in a data set unexplained by identifiable sources. randomization (randomized experiment) - CORRECT ANSWER Allocation of individuals to groups, e.g., for experimental and control regimens, by chance. randomized controlled trial (RCT) - CORRECT ANSWER an epidemiologic experiment in which subjects in a population are randomly allocated into groups, usually called study and control groups, to receive or not receive an experimental preventive or therapeutic procedure, maneuver, or intervention. The results are assessed by rigorous comparison of rates of disease, death, recovery, or other appropriate outcome in the study and control groups. RCTs are generally regarded as the most scientifically rigorous method of hypothesis testing available in epidemiology. random sample - CORRECT ANSWER Either a set of n independent and identically distributed random variables, or a sample of n individuals selected from a population in such a way that each sample of the same size is equally likely. random variable - CORRECT ANSWER A variable, the values of which occur according to some specified probability distribution. range - CORRECT ANSWER The difference between the largest and smallest observations in a data set. Often used as an easy-to-calculate measure of the dispersion in a set of observations but not recommended for this task because of its sensitivity to outliers and the fact that its value increases with sample size. ranks - CORRECT ANSWER The relative positions of the members of a sample with respect to some characteristic. ratio - CORRECT ANSWER The value obtained by dividing one quantity by another: a general term of which rate, proportion, percentage, etc., are subsets. The important difference between a proportion and a ratio is that the numerator of a proportion is included in the population defined by the denominator, whereas this is not necessarily so for a ratio. receiver operating characteristic (ROC or relative operating characteristic) curve - CORRECT ANSWER a graphic means for assessing the ability of a screening test to discriminate between healthy and diseased persons. The term receiver operating characteristic comes from psychometry, where the characteristic operating response of a receiver-individual to faint stimuli or nonstimuli was recorded. regression - CORRECT ANSWER As used by Francis Galton (1822-1911) one of the founders of modern biology and biometry, in his book Hereditary Genius (1869), this meant the tendency of offspring of exceptional parents to possess characteristics closer to the average for the general population. Hence "regression to the mean," i.e. the tendency of individuals at the extremes to have values nearer to the mean on repeated measurement. Can also be a synonym for regression analysis in statistics. regression analysis - CORRECT ANSWER given data on a dependent variable y and one or more independent or predictor variables x1, x2, etc., regression analysis involves finding the "best" mathematical model (within some restricted class of models) to describe y as a function of the x's, or to predict y from the x's. The most common form is a linear model; in epidemiology, the logistic and proportional hazards models are also common relative risk (RR or risk ratio) - CORRECT ANSWER A measure of the association between exposure to a particular factor and risk of a certain outcome, calculated as relative risk = [incidence rate among exposed]/[incidence rate among non-exposed] Thus a relative risk of 5, for example, means that an exposed person is 5 times as likely to have the disease than one who is not exposed. Relative risk does not measure the probability that someone with the factor will develop the disease. The disease may be rare among both the nonexposed and the exposed. reliability - CORRECT ANSWER The extent to which the same measurements of individuals obtained under different conditions yield similar results. Reliability refers to the degree to which the results obtained by a measurement, procedure can be replicated. Lack of reliability may arise from divergences between observers or instruments of measurement or instability of the attribute being measured. repeated-measures design - CORRECT ANSWER Repeated measures is a type of analysis of variance that generalizes Student's t test for paired samples. It is used when two or more measurements of the same type are made on the same subject. Analysis of variance is characterized by the use of factors, which are composed of levels. Repeated measures analysis of variance involves two types of factors--between subjects factors and within subjects factors. The repeated measures make up the levels of the within subjects factor. For example, suppose each subject has his/her reaction time measured under three different conditions. The conditions make up the levels of the within subjects factor. Depending on the study, subjects may divided into groups according to levels of other factors called between subjects factors. Each subject is observed at only a single level of a between-subjects factor. For example, if subjects were randomized to aeorbic or stretching exercise, form of exercise would be a between-subjects factor. The levels of a within-subject factor change as we move within a subject, while levels of a between-subject factor change only as we move between subjects. response variable - CORRECT ANSWER The variable of primary importance in investigations since the major objective is usually to study the effects of treatment and/or other explanatory variables on this variable and to provide suitable models for the relationship between the explanatory variables. retrospective study - CORRECT ANSWER A general term for studies in which all the events of interest occur prior to the onset of the study and findings are based on looking backward in time. Most common is the case-control study, in which comparisons are made between individuals who have a particular disease or condition (the cases) and individuals who do not have the disease (the controls). A sample of cases is selected from the population of individuals who have the disease of interest and a sample of controls is taken from among those individuals known not to have the disease. Information about possible risk factors for the disease is then obtained retrospectively for each person in the study by examining past records, by interviewing each person and/or interviewing their relatives, or in some other way. In order to make the cases and controls otherwise comparable, they are frequently matched on characteristics known to be strongly related to both disease and exposure leading to a matched case-control study. Age, sex and socioeconomic status are examples of commonly used matching variables. Also commonly encountered is the retrospective cohort study, in which a past cohort of individuals are identified from previous information, for example, employment records, and their subsequent mortality or morbidity determined and compared with the corresponding experience of some suitable control group. risk factor - CORRECT ANSWER An aspect of persona behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic which is thought to be associated with a particular disease or condition. risk ratio - CORRECT ANSWER The ratio of two risks, usually exposed/not exposed. sample (1 of 3) - CORRECT ANSWER a selected subset of a population. A sample may be random or nonrandom and may be representative or nonrepresentative. Several types of samples exist: 1. area sample - a method of sampling that can be used when the numbers in the population are unknown. The total area to be sampled is divided into subareas, e.g. by means of a grid that produces squares on a map; these subareas are then numbered and sampled, using a table of random numbers. 2. cluster sample - each unit selected is a group of persons (all persons in a city block, a family, a school, etc.) rather than an individual. 3. grab sample (sample of convenience) - samples selected by easily employed but basically nonprobabilistic methods. It is improper to generalize from the results of a survey based upon such a sample, for there is no way of knowing what types of bias may have been present. sample (2 of 3) - CORRECT ANSWER 4. probability (random) sample -all individuals have a known chance of selection. They may all have an equal chance of being selected, or, if a stratified sampling method is used, the rate at which individuals from several subsets are sampled can be varied so as to produce greater representation of some classes than others. 5. simple random sample - a form of sampling design in which n distinct units are selected from the N units in the population in such a way that every possible combination of n units is equally likely to be the sample selected. With this type of sampling design the probability that the ith population unit is included in the same, so that the inclusion probability is the same for each unit. Designs other than this one may also give each unit equal probability of being included, both other here does each possible sample of n units have the same probability. sample (3 of 3) - CORRECT ANSWER 6. stratified random sample - this involves dividing the population into distinct subgroups according to some important characteristic, such as age or socioeconomic status, and selecting a random sample out of each subgroup. If the proportion of the sample drawn from each of the subgroups or strata, is the same as the proportion of the total population contained in each stratum, then all strata will be fairly represented with regard to numbers of persons in the sample. 7. systematic sample - the procedure of selecting according to some simple, systematic rule, such as all persons whose names begin with specified alphabetic letters, born on certain dates, or located at specified points on a list. A systematic sample may lead to errors that invalidate generalizations. sampling distribution - CORRECT ANSWER The probability distribution of a statistic calculated from a random sample of a particular size. For example, the sampling distribution of the arithmetic mean of samples of size n taken from a normal distribution with mean μ with standard deviation s, is a normal distribution also with mean μ but with standard deviation δ/√n. Specificity - CORRECT ANSWER An index of the performance of a diagnostic test, calculated as the percentage of individuals without the disease who are classified as not having the disease, i.e. the conditional probability of a negative test result given that the disease is absent. A test is specific if it is positive for only a small percentage of those without the disease. Slope - CORRECT ANSWER used to describe the measurement of the steepness, incline, gradient, or grade of a straight line. A higher slope value indicates a steeper incline. The slope is defined as the ratio of the "rise" divided by the "run" between two points on a line, or in other words, the ratio of the altitude change to the horizontal distance between any two points on the line. The slope of a line in the plane containing the x and y axes is generally represented by the letter m, and is defined as the change in the y coordinate divided by the corresponding change in the x coordinate, between two distinct points on the line. This is described by the following equation: m = Δy / Δx If y is a linear function of x, then the coefficient of x is the slope of the line created by plotting the function. Therefore, if the equation of the line is given in the form y = mx + b then m is the slope. This form of a line's equation is called the slope-intercept form, because b can be interpreted as the y-intercept of the line, the y-coordinate where the line intersects the y-axis. standard deviation - CORRECT ANSWER A measure of dispersion or variation. The most commonly used measure of the spread of a set of observations. Equal to the positive square root of the variance. standard error (SE) - CORRECT ANSWER The standard deviation of the sampling distribution of a statistic. For example, the standard error of the sample mean of n observations is δ/√n where s2 is the variance of the original observations. standardization - CORRECT ANSWER A set of techniques used to remove as much as possible the effects of age or other confounding variables when comparing two or more populations. The common method uses weighted averaging of rates of age, sex or some other confounding variable(s) according of some specified distribution of these variables. statistical significance - CORRECT ANSWER Statistical methods allow an estimate to be made of the probability of the observed or greater degree of association between independent and dependent variables under the null hypothesis. From this estimate, in a sample of given size, the statistical "significance" of a result can be stated. Usually the level of statistical significance is stated by the p value. stem and leaf plot - CORRECT ANSWER A method of displaying data in which each observation is split into two parts labeled the 'stem' and the 'leaf'. A tally of the leaves corresponding to each stem ahs the shape of a histogram but also retains the actual observation values. subjective probability (personal probability) - CORRECT ANSWER A radically different approach to allocating probabilities to events than, for example, the commonly used long-term relative frequency approach. In this approach, probability represents a degree of belief in a proposition, based on all the information. Two people with different information and different subjective ignorance may therefore assign different probabilities to the same proposition. They only constraint is that a single person's probabilities should not be consistent survival analysis - CORRECT ANSWER a class of statistical procedures for estimating the survival function and for making inferences about the effects on it of treatments, prognostic factors, exposures, and other covariates. symmetric distribution - CORRECT ANSWER A probability distribution or frequency distribution that is symmetrical about some central value test statistic - CORRECT ANSWER A statistic used to assess a particular hypothesis in relation to some population. The essential requirement of such a statistic is known a distribution when the null hypothesis is true t-test (T-distribution) - CORRECT ANSWER the t-distribution is the distribution of a quotient of independent random variables, the numerator of which is a standard normal variate and the denominator of which is the positive square root of the quotient of a chi-square distributed variate and its number of degrees of freedom. The t-test uses a statistic that, under the null hypothesis, has the t-distribution to test whether two means differ significantly, or to test linear regression or correlation coefficients. two-sample t-test - CORRECT ANSWER a hypothesis test for answering questions about the mean where the data are collected from two random samples of independent observations, each from an underlying normal distribution two-tailed test - CORRECT ANSWER a statistical significance test based on the assumption that the data are distributed in both directions from the central value(s). two-way analysis of variance (factorial AOV) - CORRECT ANSWER The two-way analysis of variance is an extension to the one-way analysis of variance. There are two independent variables (hence the name two-way). The two independent variables in a two-way ANOVA are called factors. The idea is that there are two variables, or factors, which affect the dependent variable. Each factor will have two or more levels within it, and the degrees of freedom for each factor is one less than the number of levels. The same assumptions apply for one-way analysis of variance. Type I error - CORRECT ANSWER The error of rejecting a true null hypothesis; i.e. declaring a difference exists when it does not. Type II error - CORRECT ANSWER the error of failing to reject a false null hypothesis; i.e. declaring a difference does not exist when it in fact does. Variable - CORRECT ANSWER Some characteristic that differs from subject to subject or from time to time. Any attribute, phenomenon, or event that can have different values. weighted sample - CORRECT ANSWER a sample that is not strictly proportional to the distribution of classes in the universe population. A weighted sample has been adjusted to include larger proportions of some than other parts of the population because those parts accorded greater "weight" would otherwise not have sufficient numbers in the sample to lead to generalizable conclusions, or because they are considered to be more important, more interesting, more worthy of detailed study or other reasons. z-score (standard scores) - CORRECT ANSWER Variable values transformed to zero mean and unit variance. Absorption (in biology) - CORRECT ANSWER Penetration of a substance into an organism and its cells by various processes, some specialized, some involving expenditure of energy (active transport), some involving a carrier system, and others involving passive movement down an electrochemical gradient. Note: In mammals, usually through the respiratory tract, gastrointestinal tract, or skin into the circulatory system and from the circulation into organs, tissues and cells. Acceptable Risk - CORRECT ANSWER The risk that has minimal detrimental effects or for which benefits outweigh the potential hazards. Note: Calculated risk of an increase of one case in a million people per year for cancer is usually considered to be negligible. Acid Deposition (Acid Rain) - CORRECT ANSWER This occurs after the release of nitrogen oxide and sulfur dioxide from point or nonpoint sources into the atmosphere. Chemical processes may transform these chemicals into sulfuric and nitirc acids. These are returned to the earth in snowfall, rain, fog, and dust and may deposit at distances far from the original sources. Acute Exposure - CORRECT ANSWER A single exposure to a toxic substance which may result in severe biological harm or death. Usually characterized as lasting no longer than a day, as compared to longer, continuing exposure over a period of time. Additive effect - CORRECT ANSWER A biologic response to exposure to multiple substances that equals the sum of responses of all the individual substances added together Adverse health effect - CORRECT ANSWER A change in body function or cell structure that might lead to disease or health problems Aerobic - CORRECT ANSWER Life or processes that require, or are not destroyed by, the presence of oxygen. (See: anaerobic.) Aerosol - CORRECT ANSWER Mixture of small droplets or particles (solid, liquid, or a mixed variety) and a carrier gas (usually air). Agency for Toxic Substances and Disease Registry (ATSDR) - CORRECT ANSWER Based in Atlanta, Georgia, this is a federal public health agency of the U.S. Department of Health and Human Services. The agency serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. Air Toxics - CORRECT ANSWER Any air pollutant for which a national ambient air quality standard (NAAQS) does not exist (i.e. excluding ozone, carbon monoxide, PM-10, sulfur dioxide, nitrogen oxide) that may reasonably be anticipated to cause cancer; respiratory, cardiovascular, or developmental effects; reproductive dysfunctions, neurological disorders, heritable gene mutations, or other serious or irreversible chronic or acute health effects in humans Alpha particle - CORRECT ANSWER A positively charged particle ejected spontaneously from the nuclei of some radioactive elements. It is identical to a helium nucleus that has a mass number of 4 and an electrostatic charge of +2. It has low penetrating power and a short range (a few centimeters in air). The most energetic alpha particle will generally fail to penetrate the dead layers of cells covering the skin and can be easily stopped by a sheet of paper. Alpha particles are hazardous when an alpha-emitting isotope is inside the body. Ambient Air - CORRECT ANSWER Any unconfined portion of the atmosphere: open air, surrounding air. American Conference of Governmental Industrial Hygienists (ACGIH) - CORRECT ANSWER A member-based organization that advances occupational and environmental health. Anaerobic - CORRECT ANSWER life or process that occurs in, or is not destroyed by, the absence of oxygen. Analyte - CORRECT ANSWER A substance that is undergoing analysis or is being measured. For example, if the analyte is mercury, the laboratory test will determine the amount of mercury in the sample. Antagonism (in toxicology) - CORRECT ANSWER Combined effect of two or more factors that is smaller than the solitary effect of any one of those factors. Anthropogenic - CORRECT ANSWER Caused by or influenced by human activities Apoptosis - CORRECT ANSWER Programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells. Aqueous - CORRECT ANSWER a. of, relating to, or resembling water b. made from, with, or by water Aqueous Solubility - CORRECT ANSWER The maximum concentration of a chemical that will dissolve in pure water at a reference temperature. Aquifer - CORRECT ANSWER An underground geological formation, or group of formations, containing water. Are sources of groundwater for wells and springs. ALARA - CORRECT ANSWER Acronym for "as low as (is) reasonably achievable." Means making every reasonable effort to maintain exposures to ionizing radiation as far below the dose limits as practical, consistent with the purpose for which the licensed activity is undertaken, taking into account the state of technology, the economics of improvements in relation to state of technology, the economics of improvements in relation to benefits to the public health and safety, and other societal and socioeconomic considerations, and in relation to utilization of nuclear energy and licensed materials in the public interest Assessment endpoint - CORRECT ANSWER An explicit expression of the environmental value that is to be protected, operationally defined by an ecological entity and its attributes. For example, salmon are valued ecological entities; reproduction and age class structure are some of their important attributes. Together "salmon reproduction and age class structure" form an assessment endpoint. Asthma - CORRECT ANSWER Chronic respiratory disease characterized by bronchoconstriction, excessive mucus secretion and oedema of the pulmonary alveoli, resulting in difficulty in breathing out, wheezing, and cough. B lymphocyte (B cell) - CORRECT ANSWER A type of lymphocyte (white blood cells), produced in the bone marrow, which synthesizes and secretes antibodies in response to the presence of a foreign substance or one identified by it as being foreign. Also called B-cell. Background Level - CORRECT ANSWER 1. The concentration of a substance in an environmental media (air, water, or soil) that occurs naturally or is not the result of human activities. 2. In exposure assessment the concentration of a substance in a defined control area, during a fixed period of time before, during, or after a data-gathering operation. Bacteria - CORRECT ANSWER (Singular: bacterium) Microscopic living organisms. Bacteria in soil, water or air may be pathogenic and cause illnesses in humans, animals and plants. They can also be non-pathogenic and be beneficial in pollution control by metabolizing organic matter in sewage, oil spills or other pollutants. Basal metabolic rate - CORRECT ANSWER The rate at which heat is given off by an organism at complete rest. Bedrock - CORRECT ANSWER The solid rock underneath surface soils. Bench-scale Tests - CORRECT ANSWER Laboratory testing of potential cleanup technologies (See: treatability studies .) Beta particle - CORRECT ANSWER A charged particle emitted from a nucleus during radioactive decay, with a mass equal to 1/1837 that of a proton. A negatively charged beta particle is identical to an electron. A positively charged beta particle is called a positron. Large amounts of beta radiation may cause skin burns, and beta emitters are harmful if they enter the body. Beta particles may be stopped by thin sheets of metal or plastic. Bioaccumulants - CORRECT ANSWER Substances that increase in concentration in various tissues of living organisms as they take in contaminated air, water, or food because the substances are very slowly metabolized or excreted. (See: biological magnification .) Biochemical Oxygen Demand (BOD) - CORRECT ANSWER A measure of the amount of oxygen consumed in the biological processes that break down organic matter in water. The greater the BOD, the greater the degree of pollution. Biocid/e n., -al adj. - CORRECT ANSWER Substance intended to kill living organisms. Biohazard - CORRECT ANSWER An agent of biological origin that has the capacity to produce deleterious effects on humans, i.e. microorganisms, toxins, and allergens derived from those organisms; and allergens and toxins derived from higher plants and animals. Biological Exposure Indices (BEI) - CORRECT ANSWER A guidance value recommended by ACGIH for assessing biological monitoring result Biologic monitoring - CORRECT ANSWER The measuring of hazardous substances in biologic materials (such as blood, hair, urine, or breath) to determine whether exposure has occurred. A blood test for lead is an example of biologic monitoring. Biologic uptake - CORRECT ANSWER The transfer of substances from the environment to plants, animals, and humans. Biomarker - CORRECT ANSWER A cellular or molecular indicator of exposure, health effects, or susceptibility. Biomarkers can be used to measure internal dose, biologically effective dose, early biological response, altered structure or function, suceptability. Biomedical testing - CORRECT ANSWER Testing of persons to find out whether a change in a body function might have occurred because of exposure to a hazardous substance. Bioremediation - CORRECT ANSWER Use of living organisms to clean up oil spills or remove other pollutants from soil, water, or wastewater; use of organisms such as non-harmful insects to remove agricultural pests or counteract diseases of trees, plants, and garden soil. Biota - CORRECT ANSWER The animal and plant life of a given region BOD5 - CORRECT ANSWER The amount of dissolved oxygen consumed in five days by biological processes breaking down organic matter. Body burden - CORRECT ANSWER Total amount of a substance, organism, or noxious agent present in an organism at a given time Built Environment - CORRECT ANSWER It encompasses all buildings, spaces and products that are created, or modified, by people. It includes homes, schools, workplaces, parks/recreation areas, greenways, business areas and transportation systems. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains, and across the country in the form of highways. It includes land-use planning and policies that impact our communities in urban, rural and suburban areas. Cancer risk - CORRECT ANSWER A theoretical risk for getting cancer if exposed to a substance every day for 70 years (a lifetime exposure). The true risk might be lower. Centers for Disease Control and Prevention (CDC) - CORRECT ANSWER Collaborates to create the expertise, information, and tools that people and communities need to protect their health - through health promotion, prevention of disease, injury and disability, and preparedness for new threats. Seeks to accomplish its mission by working with partners throughout the nation and the world to - monitor health - detect and investigate health problems - conduct research to enhance prevention - develop and advocate sound public health policies - implement prevention strategies - promote healthy behaviors - foster safe and healthful environments - provide leadership and training Certified Output Protection Protocol - CORRECT ANSWER A device driver technology used to enable high-bandwidth Digital Content Protection ( HDCP ) during the transmission of digital video between applications and high-definition displays. A Microsoft security technology for video systems that require a logo certification. For security drivers are authenticated and protected from tampering to prevent unauthorized high-quality recording from the video outputs. COPP control signals are also encrypted. Chemical, Biological, Radioactive Nuclear, Explosive (CBRNE) Incidents - CORRECT ANSWER Deliberate, malicious acts with the intention to kill or sicken and disrupt society; may be used in warfare or terrorism Chemical Oxygen Demand (COD) - CORRECT ANSWER A measure of the oxygen required to oxidize all compounds, both organic and inorganic, in water. Chronic Effect - CORRECT ANSWER 1. An adverse effect on a human or animal resulting from long term exposure to a substance. 2. A persistent (month, years or permanent) adverse health effect resulting from a short term (acute) exposure Chronic Exposure - CORRECT ANSWER Multiple exposures occurring over an extended period of time or over a significant fraction of an animal's or human's lifetime (Usually seven years to a lifetime.) Chronic Obstructive Pulmonary Disease - CORRECT ANSWER A lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the diagnosis. Not simply a "smoker's cough" but an under-diagnosed, life-threatening lung disease. Cluster investigation - CORRECT ANSWER A review of an unusual number, real or perceived, of health events (for example, reports of cancer) grouped together in time and location. Designed to confirm case reports; determine whether they represent an unusual disease occurrence; and, if possible, explore possible causes and contributing environmental factors. Cohort study - CORRECT ANSWER An epidemiological method of identifying two groups (cohorts) of individuals, one which has received the exposure of interest and one which has not, and following both groups forward for the outcome of interest. Command and control - CORRECT ANSWER Standards are usually tailor-made to regulate how a specific activity or class of activities need to be carried out. Compliance monitoring and eventual sanctioning of trespasses are usually indispensable features of effective C&C. The primary disadvantages of the approach are that it is overly constraining, leaves little room for flexibility, is not adaptable on a case-by-case basis and tends to retard technological change. Moreover, regulations underlying the approach offer no incentive for producers to attain standards higher than those imposed by the law. While this approach is often criticized for these reasons, it is widely used by government agencies and even sometimes requested by the industry. Producing regulations is done within the logic of public administration, often regardless of their enforceability. In terms of political relations, "something has been done", and since the same norm or standard applies to everybody, it provides a sense of fairness. The frequent weakness of results monitoring and accountability, in the political arena, however, often leaves implementation in the shadow. Community Assistance Panel (CAP) - CORRECT ANSWER A group of people from a community and from health and environmental agencies who work with ATSDR to resolve issues and problems related to hazardous substances in the community. Members work with ATSDR to gather and review community health concerns, provide information on how people might have been or might now be exposed to hazardous substances, and inform ATSDR on ways to involve the community in its activities. Comparison value (CV) - CORRECT ANSWER Calculated concentration of a substance in air, water, food, or soil that is unlikely to cause harmful (adverse) health effects in exposed people. The value is used as a screening level during the public health assessment process. Substances found in amounts greater than their CVs might be selected for further evaluation in the public health assessment process. Composite Sample - CORRECT ANSWER 1. Composite sampling is a technique whereby multiple temporally or spatially discrete, media or tissue samples are combined, thoroughly homogenized, and treated as a single sample. An example would be a series of water samples taken over a given period of time and weighted by flow rate. Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) - CORRECT ANSWER Also known as Superfund, is the federal law that concerns the removal or cleanup of hazardous substances in the environment and at hazardous waste sites. ATSDR, which was created by the law, is responsible for assessing health issues and supporting public health activities related to hazardous waste sites or other environmental releases of hazardous substances. Concentration - CORRECT ANSWER The relative amount of a substance within another substance. An example is five ppm of carbon monoxide in air or 1 mg/l of iron in water. Consumer Product Safety Commission (CPSC) - CORRECT ANSWER Charged with protecting the public from unreasonable risks of serious injury or death from more than 15,000 types of consumer products. Deaths, injuries and property damage from consumer product incidents cost the nation more than $800 billion annually. The CPSC is committed to protecting consumers and families from products that pose a fire, electrical, chemical, or mechanical hazard or can injure children. The CPSC's work to ensure the safety of consumer products - such as toys, cribs, power tools, cigarette lighters, and household chemicals - contributed significantly to the 30 percent decline in the rate of deaths and injuries associated with consumer products over the past 30 years. Criteria Pollutants - CORRECT ANSWER The 1970 amendments to the Clean Air Act required EPA to set National Ambient Air Quality Standards for certain pollutants known to be hazardous to human health. EPA has identified and set standards to protect human health and welfare for six pollutants: ozone, carbon monoxide, total suspended particulates, sulfur dioxide, lead, and nitrogen oxide. The term derives from the requirement that EPA must describe the characteristics and potential health and welfare effects of these pollutants. It is on the basis of these criteria that standards are set or revised. Cryptosporidium - CORRECT ANSWER A protozoan microbe associated with the disease cryptosporidiosis in man. The disease can be transmitted through ingestion of drinking water, person-to-person contact, or other pathways, and can cause acute diarrhea, abdominal pain, vomiting, fever, and can be fatal as it was in the 1993 Milwaukee episode. Curie (Ci) - CORRECT ANSWER The basic unit used to describe the intensity of radioactivity in a sample of material. The curie is equal to 37 billion (3.7 x 10 10 ) disintegrations per second, which is approximately the activity of 1 gram of radium. A curie is also a quantity of any radionuclide that decays at a rate of 37 billion disintegrations per second. It is named for Marie and Pierre Curie, who discovered radium in 1898. 37 billion (3.7 x 10 10 ) becquerels = 1 curie (Ci). Cytokine - CORRECT ANSWER Any of a group of soluble proteins that are released by a cell causing a change in function or development of the same cell (autocrine), an adjacent cell (paracrine), or a distant cell (endocrine); cytokines are involved in reproduction, growth and development, normal homeostatic regulation, response to injury and repair, blood clotting, and host resistance (immunity and tolerance). Delayed health effect - CORRECT ANSWER A disease or an injury that happens as a result of exposures that might have occurred in the past. Dermal Absorption/Penetration - CORRECT ANSWER Process by which a chemical penetrates the skin and enters the body as an internal dose. Dermal Toxicity - CORRECT ANSWER The ability of a pesticide or toxic chemical to poison people or animals by contact with the skin. (See: contact pesticide.) Descriptive epidemiology - CORRECT ANSWER Study of the occurrence of disease or other health -related characteristics in populations, including general observations concerning the relationship of disease to basic characteristics such as age, sex, race, occupation, and social class; it may also be concerned with geographic location. The major characteristics in descriptive epidemiology can be classified under the headings: individuals, time and place Detection Limit - CORRECT ANSWER The lowest concentration of a chemical that can reliably be distinguished from a zero concentration. Disease registry - CORRECT ANSWER A system of ongoing registration of all cases of a particular disease or health condition in a defined population. Disease Vector - CORRECT ANSWER A phrase used in parasitology and entomology to describe a special type of intermediate host for parasites. A vector is not only required as part of the parasite's development, but it also delivers the parasite directly to subsequent hosts, avoiding free living stages such as those observed in Schistosoma which infects snails before having a brief free living stage that actively infects their next host. Disinfectant - CORRECT ANSWER A chemical or physical process that kills or prevent the growth of bacteria and other micro- organisms in water, air, or on surfaces. Chlorine is often used to disinfect sewage treatment effluent, water supplies, wells, and swimming pools. Disinfectant By-Product - CORRECT ANSWER A compound formed by the reaction of a disinfenctant such as chlorine with organic material in the water supply; a chemical byproduct of the disinfection process DNA Repair - CORRECT ANSWER As a major defense against environmental damage to cells DNA repair is present in all organisms examined including bacteria, yeast, drosophila, fish, amphibians, rodents and humans. DNA repair is involved in processes that minimize cell killling, mutations, replication errors, persistence of DNA damage and genomic instability. Abnormalities in these processes have been implicated in cancer and aging. Dosage/Dose - CORRECT ANSWER 1. The actual quantity of a chemical administered to an organism or to which it is exposed. 2. The amount of a substance that reaches a specific tissue (e.g. the liver). 3. The amount of a substance available for interaction with metabolic processes after crossing the outer boundary of an organism. (See: absorbed dose, administered dose, applied dose, potential dose.) Dose-Response Relationship - CORRECT ANSWER The quantitative relationship between the amount of exposure to a substance and the extent of toxic injury or disease produced. Ecological Risk Assessment - CORRECT ANSWER The application of a formal framework, analytical process, or model to estimate the effects of human actions(s) on a natural resource and to interpret the significance of those effects in light of the uncertainties identified in each component of the assessment process. Such analysis includes initial hazard identification, exposure and dose-response assessments, and risk characterization. Economic Incentives - CORRECT ANSWER Incentives are a different approach. The idea of incentives is not to strictly forbid/allow, but rather to provide signals on public objectives while leaving some room for individual and collective decision-making to respond to them. Incentives play indirectly through the determinants of individual/collective choices, such as the profit motive or normative values. Market or social forces can be very efficient vectors to force the global outcome of individual actions towards collectively set objectives. Different kinds of incentives can be developed in isolation or in combination: - improving the institutional framework (definition of rights and participatory processes) - developing collective values (education, information, training) - creating nonmarket economic incentives (taxes and subsidies) - establishing market incentives (tradable property/access rights; eco-labelling) ED50 - CORRECT ANSWER The dose of a drug that is pharmacologically effective for 50% of the population exposed to the drug or a 50% response in a biological system that is exposed to the drug. Emergency Planning and Community Right-to-Know Act (EPCRA) - CORRECT ANSWER This act establishes requirements for Federal, state and local governments, Indian Tribes, and industry regarding emergency planning and "Community Right-to-Know" reporting on hazardous and toxic chemicals. The provisions help increase the public's knowledge and access to information on chemicals at individual facilities, their uses, and releases into the environment. States and communities, working with facilities, can use the information to improve chemical safety and protect public health and the environment. EPCRA was passed in response to concerns regarding the environmental and safety hazards posed by the storage and handling of toxic chemicals. These concerns were triggered by the disaster in Bhopal, India, in which more than 2,000 people suffered death or serious injury from the accidental release of methyl isocyanate. To reduce the likelihood of such a disaster in the United States, Congress imposed requirements on both states and regulated facilities. Endocrine disruptor - CORRECT ANSWER Exogenous chemical that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, its progeny or (sub) populations. Environmental Equity/Justice - CORRECT ANSWER Equal protection from environmental hazards for individuals, groups, or communities regardless of race, ethnicity, or economic status. This applies to the development, implementation, and enforcement of environmental laws, regulations, and policies, and implies that no population of people should be forced to shoulder a disproportionate share of negative environmental impacts of pollution or environmental hazard due to a lack of political or economic strength levels. Environmental media - CORRECT ANSWER Soil, water, air, biota (plants and animals), or any other parts of the environment that can contain contaminants. Environmental media and transport mechanism - CORRECT ANSWER Environmental media include water, air, soil, and biota (plants and animals). Transport mechanisms move contaminants from the source to points where human exposure can occur. The environmental media and transport mechanism is the second part of an exposure pathway Ergonomics - CORRECT ANSWER Ergonomics is the study of human characteristics for the appropriate design of the living and working environment. Ergonomic researchers strive to learn about human characteristics (capabilities, limitations, motivations, and desires) so that this knowledge can be used to adapt a human-made environment to the people involved. There are three levels of ergonomic knowledge utilization: tolerable, acceptable, and optimal. Estrogen - CORRECT ANSWER Any of various natural steroids (as estradiol) that are formed from androgen precursors, that are secreted chiefly by the ovaries, placenta, adipose tissue, and testes, and that stimulate the development of female secondary sex characteristics and promote the growth and maintenance of the female reproductive system. Eutrophication - CORRECT ANSWER The slow aging process during which a lake, estuary, or bay evolves into a bog or marsh and eventually disappears. During the later stages of eutrophication the water body is choked by abundant plant life due to higher levels of nutritive compounds such as nitrogen and phosphorus. Human activities can accelerate the process. Exposure Assessment - CORRECT ANSWER Identifying the pathways by which toxicants may reach individuals, estimating how much of a chemical an individual is likely to be exposed to, and estimating the number likely to be exposed. Exposure-dose reconstruction - CORRECT ANSWER A method of estimating the amount of people's past exposure to hazardous substances. Computer and approximation methods are used when past information is limited, not available, or missing. Exposure investigation - CORRECT ANSWER The collection and analysis of site-specific information and biologic tests (when appropriate) to determine whether people have been exposed to hazardous substances. Exposure pathway - CORRECT ANSWER The route a substance takes from its source (where it began) to its end point, and how people get exposed to it. An exposure pathway has five parts: a source of contamination (such as an abandoned business); an environmental media and transport mechanism (such as movement through groundwater); a point of exposure (such as a private well); a route of exposure (eating, drinking, breathing, or touching), and a receptor population (people potentially or actually exposed). When all five parts are present, the exposure pathway is termed a completed exposure pathway. Feasibility Study - CORRECT ANSWER 1. Analysis of the practicability of a proposal; e.g., a description and analysis of potential cleanup alternatives for a site such as one on the National Priorities List. The feasibility study usually recommends selection of a cost-effective alternative. It usually starts as soon as the remedial investigation is underway; together, they are commonly referred to as the "RI/FS". 2. A small-scale investigation of a problem to ascertain whether a proposed research approach is likely to provide useful data. Exposure-Response relationship - CORRECT ANSWER the connection between the amount of a chemical administered and a specific toxic effect in the organism, also called the dose-response relationship Gamma radiation - CORRECT ANSWER High-energy, short wavelength, electromagnetic radiation emitted from the nucleus. Gamma radiation frequently accompanies alpha and beta emissions and always accompanies fission. Gamma rays are very penetrating and are best stopped or shielded by dense materials, such as lead or depleted uranium. Gamma rays are similar to x-rays. Gas phase - CORRECT ANSWER The simplest chemical reactions are those that occur in the gas phase in a single step, such as the transfer of a chlorine atom from ClNO 2 to NO to form NO₂ and ClNO. ClNO₂ ( g ) + NO( g ) ↔ NO₂ ( g ) + ClNO( g ) This reaction can be understood by writing the Lewis structures for all four components of the reaction. Both NO and NO₂ contain an odd number of electrons. Both NO and NO₂ can therefore combine with a neutral chlorine atom to form a molecule in which all of the electrons are paired. This reaction therefore involves the transfer of a chlorine atom from one molecule to another, as shown in the figure below. Geographic Information System (GIS) - CORRECT ANSWER A computer system designed for storing, manipulating, analyzing, and displaying data in a geographic context. Gene - CORRECT ANSWER Structurally a basic unit of hereditary material; an ordered sequence of nucleotide bases that encodes one polypeptide chain (following transcription to mRNA). SN cistron. Global Warming - CORRECT ANSWER An increase in the near surface temperature of the Earth. Global warming has occurred in the distant past as the result of natural influences, but the term is most often used to refer to the warming predicted to occur as a result of increased emissions of greenhouse gases. Scientists generally agree that the Earth's surface has warmed by about 1 degree Fahrenheit in the past 140 years. The Intergovernmental Panel on Climate Change (IPCC) recently concluded that increased concentrations of greenhouse gases are causing an increase in the Earth's surface temperature and that increased concentrations of sulfate aerosols have led to relative cooling in some regions, generally over and downwind of heavily industrialized areas. Gradient - CORRECT ANSWER Change in the value of a quantity (as temperature, pressure, or concentration) with change in a given variable and especially per unit on a linear scale. Gray (Gy) - CORRECT ANSWER The international system (SI) unit of absorbed dose. One gray is equal to an absorbed dose of 1 Joule/kilogram (one gray equals 100 rads). Hazard Analysis and Critical Control Points - CORRECT ANSWER HACCP is a production control system for the food industry. It is a process that identifies where potential contamination can occur (the critical control points or CCPs) and strictly manages and monitors these points as a way of ensuring the process is in control and th Half-Life - CORRECT ANSWER 1. The time required for half the atoms in a sample to decay, or a pollutant to lose one-half of its original concentration, for example, the biochemical half-life of DDT in the environment is 15 years. 2. The time required for half of the atoms of a radioactive element to undergo self-transmutation or decay (half-life of radium is 1620 years). 3. The time required for the elimination of half a total dose from the body. Hazard - CORRECT ANSWER 1. Potential for radiation, a chemical or other pollutant to cause human illness or injury. 2. In the pesticide program, the inherent toxicity of a compound. Hazard identification of a given substances is an informed judgment based on verifiable toxicity data from animal models or human studies. Hazardous Substance - CORRECT ANSWER 1. Any material that poses a threat to human health and/or the environment. Typical hazardous substances are toxic, corrosive, ignitable, explosive, or chemically reactive. 2. Any substance designated by EPA to be reported if a designated quantity of the substance is spilled in the waters of the United States or is otherwise released into the environment. Hazardous Substance Release and Health Effects Database (HazDat) - CORRECT ANSWER The scientific and administrative database system developed by ATSDR to manage data collection, retrieval, and analysis of site-specific information on hazardous substances, community health concerns, and public health activities. Hazardous Waste - CORRECT ANSWER By-products of society that can pose a substantial or potential hazard to human health or the environment when improperly managed. Possesses at least one of four characteristics (ignitability, corrosivity, reactivity, or toxicity), or appears on special EPA lists. Health Assessment - CORRECT ANSWER Public health assessments challenge ATSDR to integrate environmental sampling data, health outcome data, and community concerns successfully in the evaluation of the health implications of hazardous substances released to the environment. Doing so enables ATSDR staff members to make the difficult decisions as to why, where, and for whom public health actions should be undertaken. Health Consultation - CORRECT ANSWER A review of available information or collection of new data to respond to a specific health question or request for information about a potential environmental hazard. Health consultations are focused on a specific exposure issue. Health consultations are therefore more limited than a public health assessment, which reviews the exposure potential of each pathway and chemical [compare with public health assessment ]. Health effects studies related to contaminants - CORRECT ANSWER a combination of procedures, methods and tools bywhich a policy, program or project may be judged as to its potential effects on thehealth of a population, and the distribution of those effects within the population. Health investigation - CORRECT ANSWER The collection and evaluation of information about the health of community residents. This information is used to describe or count the occurrence of a disease, symptom, or clinical measure and to evaluate the possible association between the occurrence and exposure to hazardous substances. Health Registry - CORRECT ANSWER The Agency for Toxic Substances and Disease Registry (ATSDR) , based in Atlanta, Georgia, is a federal public health agency of the U.S. Department of Health and Human Services . ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. Health Statistics Review - CORRECT ANSWER The analysis of existing health information (i.e., from death certificates, birth defects registries, and cancer registries) to determine if there is excess disease in a specific population, geographic area, and time period. A health statistics review is a descriptive epidemiologic study.) Heavy Metals - CORRECT ANSWER Metallic elements with high atomic weights; (e.g. mercury, chromium, cadmium, arsenic, and lead); can damage living things at low concentrations and tend to accumulate in the food chain. Helminths - CORRECT ANSWER A group of parasites commonly referred to as worms. The group includes trematodes, cestodes, and nematodes. Schistosomes are trematodes; the species that most commonly infect humans are: Schistosoma haematobium, S. intercalatum, S. japonicum, S. mansoni, and S.mekongi. Cestodes include the beef and pork tapeworms, the largest of the helminths, and nematodes include the roundworm Ascaris lumbri-coides, the whipworm Trichuris trichiura, and the hookworms Necator americanus and Ancylostoma duodenale; these nematodes are collectively referred to as soil-transmitted helminths (STH). Herbicide - CORRECT ANSWER Substance intended to kill plants. HGPRT - CORRECT ANSWER Hypoxanthine-guanine phosphoribosyltransferase ( HGPRT ) is an enzyme in purine metabolism . The enzyme primarily functions to salvage purines from degraded DNA to renewed purine synthesis. In this role, it acts as a catalyst in the reaction between guanine and phosphoribosyl pyrophosphate (PRPP) to form GMP Indeterminate public health hazard - CORRECT ANSWER The category used in ATSDR's public health assessment documents when a professional judgment about the level of health hazard cannot be made because information critical to such a decision is lacking. Industrial Hygiene - CORRECT ANSWER Industrial hygiene is the science of anticipating, recognizing, evaluating, and controlling workplace conditions that may cause workers' injury or illness. Industrial hygienists use environmental monitoring and analytical methods to detect the extent of worker exposure and employ engineering, work practice controls, and other methods to control potential health hazards. Infection control - CORRECT ANSWER All policies, procedures and activities, which aim to prevent or minimize the risk of transmission of infectious diseases. This refers to health care acquired infections (HAI) as well as to infections of public health concern, making it a crosscutting, multidisciplinary activity Infectious Diseases - CORRECT ANSWER Diseases caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans Inorganic Chemicals - CORRECT ANSWER Chemical substances of mineral origin, not of basically carbon structure. Institute of Medicine (IOM) - CORRECT ANSWER The IOM was established in 1970 and chartered under the National Academy of Sciences. IOM provides independent, objective, evidence-based advice to policy makers, health professionals, the private sector and the public. The mission of the IOM is to embrace the health of people everywhere. Intermediate duration exposure - CORRECT ANSWER Contact with a substance that occurs for more than 14 days and less than a year [compare with acute exposure and chronic exposure ] International Agency for Research on Cancer - CORRECT ANSWER IARC's mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships. In vitro - CORRECT ANSWER In glass, referring to a study in the laboratory usually involving isolated organ, tissue, cell, or biochemical systems In vivo - CORRECT ANSWER In the living body, referring to a study performed on a living organism Inversion - CORRECT ANSWER A layer of warm air that prevents the rise of cooling air and traps pollutants beneath it; can cause an air pollution episode. Ionizing Radiation - CORRECT ANSWER Radiation that can strip electrons from atoms; e.g. alpha, beta, and gamma radiation IRIS - CORRECT ANSWER EPA's Integrated Risk Information System, an electronic data base containing the Agency's latest descriptive and quantitative regulatory information on chemical constituents. The information in IRIS is intended for those without extensive training in toxicology, but with some knowledge of health sciences. Landfills - CORRECT ANSWER 1. Sanitary landfills are disposal sites for non-hazardous solid wastes spread in layers, compacted to the smallest practical volume, and covered by material applied at the end of each operating day 2. Secure chemical landfills are disposal sites for hazardous waste, selected and designed to minimize the chance of release of hazardous substances into the environment Latency - CORRECT ANSWER Time from the first exposure of a chemical until the appearance of a toxic effect. LD 50/Lethal Dose - CORRECT ANSWER The dose of a toxicant or microbe that will kill 50 percent of the test organisms within a designated period. The lower the LD 50, the more toxic the compound Leaching - CORRECT ANSWER The process by which soluble constituents are dissolved and filtered through the soil by a percolating fluid. (See: leachate.) Leachate - CORRECT ANSWER Water that collects contaminants as it trickles through wastes, pesticides or fertilizers. Leaching may occur in farming areas, feedlots, and landfills, and may result in hazardous substances entering surface water, ground water, or soil. Life Cycle management - CORRECT ANSWER Every activity that a business performs has an impact - on a social, economic and environmental level. Often these impacts are not obvious or immediate, there are many that are hidden or indirect, that only appear when you take a more holistic view - essentially, when you take a step back and examine the complete life cycle of your products and services . A life cycle is made up of all the activities that go into making, selling, using, transporting and disposing of a product or service - from initial design, right through the supply chain Lipophilic - CORRECT ANSWER Having an affinity for fat and high lipid solubility: a physicochemical property which describes a partitioning equilibrium of solute molecules between water and an immiscible organic solvent, favoring the latter, and which correlates with bioaccumulation. Related bioaccumulation , bioaccumulation factor, bioconcentration , octanol-water partition coefficient . Synonyms; hydrophobicity . Antonyms; hydrophilicity , lipophobicity . Local Emergency Planning Committee (LEPC) - CORRECT ANSWER A committee appointed by the state emergency response commission, as required by SARA Title III, to formulate a comprehensive emergency plan for its jurisdiction. Lowest-observed-adverse-effect level (LOAEL) - CORRECT ANSWER Lowest concentration or amount of a substance ( dose ), found by experiment or observation, which causes an adverse effect on morphology, functional capacity, growth, development, or life span of a target organism distinguishable from normal (control) organisms of the same species and strain under defined conditions of exposure Lymphocyte - CORRECT ANSWER Animal white blood cell (as opposed to red blood cell) that interacts with a foreign substance or organism, or one which it identifies as foreign, and initiates an immune response against the substance or organism. There are two groups of lymphocytes, B lymphocytes and T lymphocytes NT B lymphocyte , immune response , T lymphocyte Macrophage - CORRECT ANSWER Large (10-20 mm diameter) amoeboid and phagocytic cell found in many tissues, especially in areas of inflammation; macrophages are derived from blood monocytes and play an important role in host defense mechanisms. Malaria - CORRECT ANSWER A mosquito-borne disease caused by a parasite. Infected patients often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. Each year 350-500 million cases occur worldwide, and over one million people die, most of them young children in sub-Saharan Africa. This sometimes fatal disease can be prevented and cured. Bednets, insecticides, and antimalarial drugs are effective tools to fight this disease in areas where it is transmitted. Travelers to a high-risk area should avoid mosquito bites and take a preventive antimalarial drug. Material Safety Data Sheet (MSDS) - CORRECT ANSWER A compilation of information required under the OSHA Communication Standard on the identity of hazardous chemicals, health, and physical hazards, exposure limits, and precautions. Section 311 of SARA requires facilities to submit MSDSs under certain circumstances. Maximum Contaminant Level - CORRECT ANSWER The maximum permissible level of a contaminant in water delivered to any user of a public system. MCLs are enforceable standards. Measure of effect (measurement endpoint) - CORRECT ANSWER A change in an attribute of an assessment endpoint or its surrogate in response to a stressor to which it is exposed. Medical Monitoring - CORRECT ANSWER an automated medical device that senses a patient's vital signs and displays the results. In critical care units of hospitals it allows continuous supervision of a patient without continuous attendance thus improving patient care Medical Waste - CORRECT ANSWER Any solid waste generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals, excluding hazardous waste identified or listed under 40 CFR Part 261 or any household waste as defined in 40 CFR Sub-section 261.4 (b)(1) Mesothelioma - CORRECT ANSWER Malignant tumor of the mesothelium of the pleura, pericardium or peritoneum, that may be caused by exposure to asbestos fibers and some other fibers BT tumour RT malignant Metabolism - CORRECT ANSWER The conversion or breakdown of a substance from one form to another by a living organism Metabolites - CORRECT ANSWER Any substances produced by biological processes, such as those from pesticides Metabolomics - CORRECT ANSWER The use of genomic information to facilitate studies of metabolic processes. Minimal Risk Level (MRL) - CORRECT ANSWER An MRL is an estimate of the daily human exposure to a hazardous substance that is likely to be without appreciable risk of adverse noncancer health effects over a specified duration of exposure. These substance specific estimates, which are intended to serve as screening levels, are used by ATSDR health assessors and other responders to identify contaminants and potential health effects that may be of concern at hazardous waste sites. Missense mutations - CORRECT ANSWER A single base pair substitution that results in the translation of a different amino acid at that position Mold - CORRECT ANSWER include all species of microscopic fungi that grow in the form of multicellular filaments, called hyphae . [1] In contrast, microscopic fungi that grow as single cells are called yeasts . A connected network of these tubular branching hyphae has multiple, genetically identical nuclei and is considered a single organism, referred to as a colony or in more technical terms a mycelium MRSA - CORRECT ANSWER Methicillin- resistant Staphylococcus aureus : any of several bacterial strains of the genus Staphylococcus (S. aureus) that are resistant to beta-lactam antibiotics (as methicillin and nafcillin, amoxicillin, and penicillin.) and that are typically benign colonizers of the skin and mucous membranes (as of the nostrils) but may cause severe infections (as by entrance through a surgical wound) especially in immunocompromised individuals. Mutagen/Mutagenicity - CORRECT ANSWER An agent that causes a permanent genetic change in a cell other than that which occurs during normal growth. Mutagenicity is the capacity of a chemical or physical agent to cause such permanent changes. Nanoscale - CORRECT ANSWER Materials and structures range from 1-100 nanometers. They can have different properties at the nanoscale. Nanotechnology - CORRECT ANSWER Research and technology development at the atomic, molecular or macromolecular levels, in the length scale of approximately 1 - 100 nanometer range, to provide a fundamental understanding of phenomena and materials at the nanoscale and to create and use structures, devices and systems that have novel properties and functions because of their small and/or intermediate size. The novel and differentiating properties and functions are developed at a critical length scale of matter typically under 100 nm. National Academy of Science - CORRECT ANSWER An honorific society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. National Ambient Air Quality Standards (NAAQS) - CORRECT ANSWER Standards established by EPA that apply for outdoor air throughout the country. National Institutes of Health - CORRECT ANSWER A part of the U.S. Department of Health and Human Services that is the primary Federal agency for conducting and supporting medical research. National Institute for Occupational Safety and Health (NIOSH) - CORRECT ANSWER The federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. The institute is a part of the CDC in the Department of Health and Human Services . National Priorities List (NPL) - CORRECT ANSWER EPA's list of the most serious uncontrolled or abandoned hazardous waste sites identified for possible long-term remedial action under Superfund. The list is based primarily on the score a site receives from the Hazard Ranking System. EPA is required to update the NPL at least once a year. A site must be on the NPL to receive money from the Trust Fund for remedial action. National Research Council - CORRECT ANSWER The mission of the NRC is to improve government decision making and public policy, increase public education and understanding, and promote the acquisition and dissemination of knowledge in matters involving science, engineering, technology, and health. National Toxicology Program (NTP) - CORRECT ANSWER The NTP is an interagency program, within the Department of Health and Human Services, whose mission is to evaluate agents of public health concern by developing and applying tools of modern toxicology and molecular biology. The program maintains an objective, science-based approach in dealing with critical issues in toxicology and is committed to using the best science available to prioritize, design, conduct, and interpret its studies. To that end, the NTP is continually evolving to remain at the cutting edge of scientific research and to develop and apply new technologies. Natural attenuation - CORRECT ANSWER Reliance on natural attenuation processes (within the context of a carefully controlled and monitored site cleanup approach) to achieve site-specific remediation objectives within a time frame that is reasonable compared to that offered by other more active methods. The 'natural attenuation processes' that are at work in such a remediation approach include a variety of physical, chemical, or biological processes that, under favorable conditions, act without human intervention to reduce the mass, toxicity, mobility, volume, or concentration of contaminants in soil or groundwater. These in-situ processes include biodegradation; dispersion; dilution; sorption; volatilization; radioactive decay; and chemical or biological stabilization, transformation, or destruction of contaminants." ( EPA, OSWER Directive 9200.4-17P ) No apparent public health hazard - CORRECT ANSWER A category used in ATSDR's public health assessments for sites where human exposure to contaminated media might be occurring, might have occurred in the past, or might occur in the future, but where the exposure is not expected to cause any harmful health effects. Noise-induced hearing loss - CORRECT ANSWER Irreversible hearing loss caused by exposure to very loud impulse sounds, such as an explosion, or to less-intense sounds for an extended period of time. Loud noise levels damage hair cells of the inner ear. Non-ionizing Electromagnetic Radiation - CORRECT ANSWER 1. Radiation that does not change the structure of atoms but does heat tissue and may cause harmful biological effects. 2. Microwaves, radio waves, and low-frequency electromagnetic fields from high-voltage transmission lines. No Observable Adverse Effect Level (NOAEL) - CORRECT ANSWER An exposure level at which there are no statistically or biologically significant increases in the frequency or severity of adverse effects between the exposed population and its appropriate control; some effects may be produced at this level, but they are not considered as adverse, or as precursors to adverse effects. In an experiment with several NOAELs, the regulatory focus is primarily on the highest one, leading to the common usage of the term NOAEL as the highest exposure without adverse effects. No public health hazard - CORRECT ANSWER A category used in ATSDR's public health assessment documents for sites where people have never and will never come into contact with harmful amounts of site-related substances. Not in my Back Yard (NIMBY) - CORRECT ANSWER Thoroughly analyzes the issues and documents the problems that make enforcement of environmental justice almost nonexistent. Executive Order 12,898, which created a right to environmental justice, has yet to be fully realized or enforced. As a result of judicial decisions limiting the ability of individuals to file disparate impact cases under § 602 of Title VI and § 1983 of the Civil Rights Act, communities have been forced to rely even more on what should be but often is not—vigorous agency enforcement to remedy environmental justice complaints. Odor Threshold - CORRECT ANSWER The minimum odor of a water or air sample that can just be detected after successive dilutions with odorless water. Also called threshold odor. Organophosphates - CORRECT ANSWER Pesticides that contain phosphorus, some of which are used in fertilizers and pesticides, are short-lived, but some can be toxic when first applied. Occupational Safety and Health Administration (OSHA) - CORRECT ANSWER Mission is to assure the safety and health of America's workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health. Particulates - CORRECT ANSWER 1. Fine liquid or solid particles such as dust, smoke, mist, fumes, or smog, found in air or emissions 2. Very small solids suspended in water; they can vary in size, shape, density and electrical charge and can be gathered together by coagulation and flocculation. Parts Per Billion (ppb)/Parts Per Million (ppm) - CORRECT ANSWER Units commonly used to express contamination ratios, as in establishing the maximum permissible amount of a contaminant in water, land, or air. Permeability - CORRECT ANSWER The rate at which liquids pass through soil or other materials in a specified direction. Permissible Exposure Limit - CORRECT ANSWER Also referred to as PEL, federal limits for workplace exposure to contaminants as established by OSHA. Persistent Organic Pollutants (POPs) - CORRECT ANSWER POPs are a set of chemicals that are toxic, persist in the environment for long periods of time, and biomagnify as they move up through the food chain. POPs have been linked to adverse effects on human health and animals, such as cancer, damage to the nervous system, reproductive disorders, and disruption of the immune system. Because they circulate globally via the atmosphere, oceans, and other pathways, POPs released in one part of the world can travel to regions far from their source of origin. Pesticide - CORRECT ANSWER Substances or mixture intended for preventing, destroying, repelling, or mitigating any pest. Also, any substance or mixture intended for use as a plant regulator, defoliant, or desiccant. Physiologically based pharmacokinetic model (PBPK model) - CORRECT ANSWER A computer model that describes what happens to a chemical in the body. This model describes how the chemical gets into the body, where it goes in the body, how it is changed by the body, and how it leaves the body. Plume - CORRECT ANSWER 1. A visible or measurable discharge of a contaminant from a given point of origin. Can be visible or thermal in water, or visible in the air as, for example, a plume of smoke. 2 The area of radiation leaking from a damaged reactor. 3. Area downwind within which a release could be dangerous for those exposed to leaking fumes. PM-10/PM-2.5 - CORRECT ANSWER PM-10 is a measure of particles in the atmosphere that are less than 10 micrometers in diameter that include both fine and coarse dust particles. These particles pose the greatest health concern because they can pass through the nose and throat and get into the lungs. PM-2.5 is a measure of smaller particles in the air. The particle mix in most U.S. cities is dominated by fine particles (less than 2.5 micrometers in diameter) generated by combustion sources, with smaller amounts of coarse dust (between 2.5 and 10 micrometers in diameter).PM-10 has been the pollutant particulate level standard against which EPA has been measuring Clean Air Act compliance. On the basis of newer scientific findings, the Agency is considering regulations that will make PM-2.5 the new "standard". Polarity - CORRECT ANSWER In electricity, the quality of having two oppositely charged poles, one positive and one negative. Polluter-pays principle - CORRECT ANSWER Office of Site Remediation Enforcement manages the enforcement of EPA's national hazardous waste cleanup programs: Superfund (officially known as the Comprehensive Environmental Response, Compensation and Liability Act), the Resource Conservation and Recovery Act (RCRA), the Oil Pollution Act (OPA), and underground storage tanks (UST). OSRE support and provide the means for the regions and states to vigorously and effectively enforce these statutes. OSRE goals are to achieve prompt site cleanup and maximum liable party participation in performing and paying for cleanup in ways which promote environmental justice and fairness. Population - CORRECT ANSWER A group of interbreeding organisms occupying a particular space; the number of humans or other living creatures in a designated area. Potentially Responsible Party (PRP) - CORRECT ANSWER Any individual or company--including owners, operators, transporters or generators--potentially responsible for, or contributing to a spill or other contamination at a Superfund site. Whenever possible, through administrative and legal actions, EPA requires PRPs to clean up hazardous sites they have contaminated. Precautionary Principle - CORRECT ANSWER When information about potential risks is incomplete, basing decisions about the best ways to manage or reduce risks on a preference for avoiding unnecessary health risks instead of on unnecessary economic expenditures. Preliminary Assessment - CORRECT ANSWER An assessment of information about a site and its surrounding area. A Preliminary Assessment is designed to determine whether a sites poses little or no threat to human health and the environment or if it does pose a threat, whether the threat requires further investigation. PA investigations collect readily available information about a site and its surrounding area. The PA is designed to distinguish, based on limited data, between sites that pose little or no threat to human health and the environment and sites that may pose a threat and require further investigation. The PA also identifies sites requiring assessment for possible emergency response actions. If the PA results in a recommendation for further investigation, a Site Inspection is performed. Prevalence - CORRECT ANSWER The number of existing disease cases in a defined population during a specific time period [contrast with incidence ]. When used without qualification, the term usually refers to the situation at a specified point in time (point prevalence). Note that this is a number not a rate. Prevalence survey - CORRECT ANSWER The measure of the current level of disease(s) or symptoms and exposures through a questionnaire that collects self-reported information from a defined population Probability - CORRECT ANSWER Chance (a measure of how likely it is that some event will occur; a number expressing the ratio of favorable cases to the whole number of cases possible) "the probability that an unbiased coin will fall with the head up is 0.5" Promoter - CORRECT ANSWER A chemical believed to promote carcinogenicity or mutagenicity Proteomics - CORRECT ANSWER The term 'proteome' was first used in 1994 to refer to all the proteins in a cell, tissue, or organism. Proteomics refers to the study of the proteome. Because proteins are involved in almost all biological activities, including disease, the proteome is a critical target for understanding how disease arises and how to prevent it. Protein scientists pursue many avenues of inquiry about proteins, working to determine their function and amino acid sequence; their three-dimensional structure; how the addition of sugars, phosphates, or fats affects protein function; and how proteins interact with other molecules, including other proteins. Some researchers focus on the proteins present in particular parts of the cell such as the outer cell membrane, the nucleus, the cytoplasm (the region of the cell outside the nucleus), or the nuclear membrane; others analyze protein-protein interactions in a particular cell or organism; some study the differences between the proteins present in diseased vs. healthy cells. Protozoa - CORRECT ANSWER One-celled animals that are larger and more complex than bacteria. May cause disease. Public availability session - CORRECT ANSWER An informal, drop-by meeting at which community members can meet one-on-one with ATSDR staff members to discuss health and site-related concerns. Public Comment Period - CORRECT ANSWER The time allowed for the public to express its views and concerns regarding an action by EPA (e.g. a Federal Register Notice of proposed rule-making, a public notice of a draft permit, or a Notice of Intent to Deny). Public health advisory - CORRECT ANSWER A statement made by ATSDR to EPA or a state regulatory agency that a release of hazardous substances poses an immediate threat to human health. The advisory includes recommended measures to reduce exposure and reduce the threat to human health. Public health assessment (PHA) - CORRECT ANSWER An ATSDR document that examines hazardous substances, health outcomes, and community concerns at a hazardous waste site to determine whether people could be harmed from coming into contact with those substances. The PHA also lists actions that need to be taken to protect public health [compare with health consultation]. Public health hazard - CORRECT ANSWER A category used in ATSDR's public health assessments for sites that pose a public health hazard because of long-term exposures (greater than 1 year) to sufficiently high levels of hazardous substances or radionuclides that could result in harmful health effects. Public health hazard categories - CORRECT ANSWER Public health hazard categories are statements about whether people could be harmed by conditions present at the site in the past, present, or future. One or more hazard categories might be appropriate for each site. The five public health hazard categories are no public health hazard , no apparent public health hazard , indeterminate public health hazard , public health hazard , and urgent public health hazard . Public health statement - CORRECT ANSWER The first chapter of an ATSDR toxicological profile. The public health statement is a summary written in words that are easy to understand. The public health statement explains how people might be exposed to a specific substance and describes the known health effects of that substance. Public health surveillance (epidemiologic surveillance) - CORRECT ANSWER The ongoing, systematic collection, analysis, and interpretation of health data. This activity also involves timely dissemination of the data and use for public health programs. Public meeting - CORRECT ANSWER A public forum with community members for communication about a site. ( http://www.atsdr.cdc.gov/glossary.html ) Pulmonary airways: The lung is the essential respiration organ in air-breathing vertebrates , the most primitive being the lungfish . The two lungs are located in the chest on either side of the heart . Their principal function is to transport oxygen from the atmosphere into the bloodstream , and to release carbon dioxide from the bloodstream into the atmosphere. This exchange of gases is accomplished in the mosaic of specialized cells that form millions of tiny, exceptionally thin-walled air sacs called alveoli . The lungs also have non respiratory functions. Quality Assurance/Quality Control - CORRECT ANSWER A system of procedures, checks, audits, and corrective actions to ensure that all EPA research design and performance, environmental monitoring and sampling, and other technical and reporting activities are of the highest achievable quality. Radiation Measurement Units - CORRECT ANSWER Most scientists in the international community measure radiation using the System Internationale (SI), a uniform system of weights and measures that evolved from the metric system. In the United States, however, the conventional system of measurement is still widely used. Different units of measure are used depending on what aspect of radiation is being measured. For example, the amount of radiation being given off, or emitted, by a radioactive material is measured using the conventional unit curie (Ci), named for the famed scientist Marie Curie, or the SI unit becquerel (Bq). The radiation dose absorbed by a person (that is, the amount of energy deposited in human tissue by radiation) is measured using the conventional unit rad or the SI unit gray (Gy). The biological risk of exposure to radiation is measured using the conventional unit rem or the SI unit sievert (Sv). Radioisotope - CORRECT ANSWER An unstable isotope of an element that decays or disintegrates spontaneously, emitting radiation. Approximately 5,000 natural and artificial radioisotopes have been identified. Radionuclide - CORRECT ANSWER Radioactive particle, man-made (anthropogenic) or natural, with a distinct atomic weight number. Receptor - CORRECT ANSWER Ecological entity exposed to a stressor. Reference Dose (RfD) - CORRECT ANSWER The RfD is a numerical estimate of a daily oral exposure to the human population, including sensitive subgroups such as children, that is not likely to cause harmful effects during a lifetime. RfDs are generally used for health effects that are thought to have a threshold or low dose limit for producing effects. Registry - CORRECT ANSWER A systematic collection of information on persons exposed to a specific substance or having specific diseases [see exposure registry and disease registry ]. Relative Risk Assessment - CORRECT ANSWER Estimating the risks associated with different stressors or management actions. Remedial Investigation - CORRECT ANSWER After a site is listed on the NPL, a remedial investigation/feasibility study (RI/FS) is performed at the Superfund site to establish site cleanup criteria; identify preliminary alternatives for remedial action; and support technical and cost analyses of alternatives. The remedial investigation is usually done with the feasibility study. Together they are usually referred to as the "RI/FS". Remediation - CORRECT ANSWER 1. Cleanup or other methods used to remove or contain a toxic spill or hazardous materials from a Superfund site; 2. for the Asbestos Hazard Emergency Response program, abatement methods including evaluation, repair, enclosure, encapsulation, or removal of greater than 3 linear feet or square feet of asbestos-containing materials from a building. Renewable Energy Production Incentive (REPI) - CORRECT ANSWER Incentive established by the Energy Policy Act available to renewable energy power projects owned by a state or local government or nonprofit electric cooperative. Resource Conservation and Recovery Act (1976, 1984) (RCRA) - CORRECT ANSWER This Act regulates management and disposal of hazardous wastes currently generated, treated, stored, disposed of, or distributed. Risk Assessment - CORRECT ANSWER Qualitative and quantitative evaluation of the risk posed to human health and/or the environment by the actual or potential presence and/or use of specific pollutants. Risk Management - CORRECT ANSWER The process of evaluating and selecting alternative regulatory and non-regulatory responses to risk. The selection process necessarily requires the consideration of legal, economic, and behavioral factors. Risk Reduction - CORRECT ANSWER The goal of risk reduction is to reduce the risk to life and property, which includes existing structures and future construction, in the pre and post-disaster environments. This is achieved through regulations, local ordinances, land use and building practices, and Mitigation projects that reduce or eliminate long-term risk from hazards and their effects Rodenticide - CORRECT ANSWER A chemical or agent used to destroy rats or other rodent pests, or to prevent them from damaging food, crops, etc. Sample - CORRECT ANSWER A portion or piece of a whole. A selected subset of a population or subset of whatever is being studied. For example, in a study of people the sample is a number of people chosen from a larger population [see population ]. An environmental sample (for example, a small amount of soil or water) might be collected to measure contamination in the environment at a specific location. Sample size - CORRECT ANSWER The number of units chosen from a population or an environment. Sampling Strategy - CORRECT ANSWER A detailed outline of which measurements will be taken at what times, on which material, in what manner, and by whom. Sampling plans should be designed in such a way that the resulting data will contain a representative sample of the parameters of interest and allow for all questions, as stated in the goals, to be answered. Secondary infection - CORRECT ANSWER Secondary infection occurs during or after treatment of a primary infection because the normal bacterial flora is destroyed, allowing yeast to flourish. Select Agent Program - CORRECT ANSWER The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 ( Public Law 107-188; June 12, 2002 ) requires that the United States improve its ability to prevent, prepare for, and respond to acts of bioterrorism and other public health emergencies that could threaten either public health and safety or American Agriculture. It necessitates that individuals possessing, using, or transferring agents or toxins deemed a severe threat to public, animal or plant health, or to animal or plant products notify either the Secretary of the Department of Health and Human Services (HHS) or the Secretary of the Department of Agriculture (USDA). In accordance with the Act, implementing regulations detailing the requirements for possession, use, and transfer for select agents and toxins were published by HHS ( 42 CFR part 73 ) and by USDA ( 9 CFR part 121 and 7 CFR part 331 ) . Registration of an entity requires that an "Application for Laboratory Registration for Possession, Use, and Transfer of Select Agents and Toxins" ( APHIS/CDC Form 1 ) should be completed and submitted to either HHS Centers for Disease Control ( CDC ) or to USDA Animal Plant Health Inspection Service (APHIS) within seven days. Registration also requires that the U.S. Department of Justice ( DOJ ) complete a security risk assessment ( SRA ) for the facility, its owners, and the designated responsible official. Sievert (SV) - CORRECT ANSWER The international system (SI) unit for dose equivalent equal to 1 Joule/kilogram. 1 sievert = 100 rem. Named for physicist Rolf Sievert. Signaling Pathways - CORRECT ANSWER A series of specific actions in a cell in which a signal is passed from one molecule to the next in the series. Signaling pathways are used to control many cell functions, such as cell division and programmed cell death. Silicosis - CORRECT ANSWER Silicosis is a disabling, nonreversible and sometimes fatal lung disease caused by overexposure to respirable crystalline silica. Silica is the second most common mineral in the earth's crust and is a major component of sand, rock, and mineral ores. Overexposure to dust that contains microscopic particles of crystalline silica can cause scar tissue to form in the lungs (fibrosis), which reduces the lungs' ability to extract oxygen from the air we breathe. Single nucleotide polymorphism (SNP) - CORRECT ANSWER DNA sequence variations that occur when a single nucleotide (A, T, C, or G) in the genome sequence is altered. Each individual has many single nucleotide polymorphisms that together create a unique DNA pattern for that person. SNPs promise to significantly advance our ability to understand and treat human disease. Site Inspection - CORRECT ANSWER The collection of information from a Superfund site to determine the extent and severity of hazards posed by the site. It follows and is more extensive than a preliminary assessment. The purpose is to gather information necessary to score the site, using the Hazard Ranking System, and to determine if it presents an immediate threat requiring prompt removal. Slope factor - CORRECT ANSWER Value, in inverse concentration or dose units, derived from the slope of a dose-response curve; in practice, limited to carcinogenic effects with the curve assumed to be linear at low concentrations or doses. The product of the slope factor and the exposure is taken to reflect the probability of producing the related effect. RT concentration-effect curve , concentration-response curve , dose , dose-effect curve , dose-response curve . Social Capital - CORRECT ANSWER The fabric of a community and the community pool of human resources available to it is often called its "social capital." This term refers to the individual and communal time and energy that is available for such things as community improvement, social networking, civic engagement, personal recreation, and other activities that create social bonds between individuals and groups. Solubility - CORRECT ANSWER The amount of mass of a compound that will dissolve in a unit volume of solution. Aqueous Solubility is the maximum concentration of a chemical that will dissolve in pure water at a reference temperature. Solvent - CORRECT ANSWER A liquid capable of dissolving or dispersing another substance (for example, acetone or mineral spirits) Somatic - CORRECT ANSWER 1. Pertaining to the body as opposed to the mind. 2. Pertaining to nonreproductive cells or tissues. 3. Pertaining to the framework of the body as opposed to the viscera. Special populations - CORRECT ANSWER People who might be more sensitive or susceptible to exposure to hazardous substances because of factors such as age, occupation, sex, or behaviors (for example, cigarette smoking). Children, pregnant women, and older people are often considered special populations. Statistics - CORRECT ANSWER A branch of mathematics that deals with collecting, reviewing, summarizing, and interpreting data or information. Statistics are used to determine whether differences between study groups are meaningful. Substance A chemical. Substance-specific applied research - CORRECT ANSWER A program of research designed to fill important data needs for specific hazardous substances identified in ATSDR's toxicological profiles . Filling these data needs would allow more accurate assessment of human risks from specific substances contaminating the environment. This research might include human studies or laboratory experiments to determine health effects resulting from exposure to a given hazardous substance. Substrate (in biology) - CORRECT ANSWER Substance material on which an enzyme acts. Surface on which an organism grows or to which is attached. Susceptible populations - CORRECT ANSWER A susceptible population is a group who may experience more severe adverse effects atcomparable levels or adverse effects at lower exposure levels than the general population. The greater response of these sensitive subpopulations may be a result of a variety of intrinsic or extrinsic factors. Sustainable Development - CORRECT ANSWER "Development that meets the needs of the present without compromising the ability of future generations to meet their own needs." — from the World Commission on Environment and Development's Sustainable Management - CORRECT ANSWER Defined under the RMA as managing the use, development, and protection of natural and physical resources in a way, or at a rate, which enables people and communities to provide for their social, economic, and cultural well being and for their health and safety while (a) sustaining the potential of natural and physical resources (excluding minerals) to meet the reasonably foreseeable needs of future generations; (b) safeguarding the life-supporting capacity of air, water, soil, and ecosystems; and (c) avoiding, remedying, or mitigating any adverse effects of activities on the environment. State Emergency Response Commission (SERC) - CORRECT ANSWER Commission appointed by each state governor according to the requirements of SARA Title III. The SERCs designate emergency planning districts, appoint local emergency planning committees, and supervise and coordinate their activities. State Implementation Plans (SIP) - CORRECT ANSWER EPA approved state plans for the establishment, regulation, and enforcement of air pollution standards. Superfund - CORRECT ANSWER The program operated under the legislative authority of CERCLA and SARA that funds and carries out EPA solid waste emergency and long-term removal and remedial activities. These activities include establishing the National Priorities List, investigating sites for inclusion on the list, determining their priority, and conducting and/or supervising cleanup and other remedial actions Superfund Amendments and Reauthorization Act (SARA) - CORRECT ANSWER In 1986, SARA amended the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) and expanded the health-related responsibilities of ATSDR. CERCLA and SARA direct ATSDR to look into the health effects from substance exposures at hazardous waste sites and to perform activities including health education, health studies, surveillance, health consultations, and toxicological profiles. Survey - CORRECT ANSWER A systematic collection of information or data. A survey can be conducted to collect information from a group of people or from the environment. Surveys of a group of people can be conducted by telephone, by mail, or in person. Some surveys are done by interviewing a group of people [see prevalence survey]. Synergistic effect - CORRECT ANSWER A biologic response to multiple substances where one substance worsens the effect of another substance. The combined effect of the substances acting together is greater than the sum of the effects of the substances acting by themselves [see additive effect and antagonistic effect ]. Target organ(s) - CORRECT ANSWER Organ(s) in which the toxic injury manifests itself in terms of dysfunction or overt disease WHO, 1979 RT receptor T-lymphocyte (T-cell) - CORRECT ANSWER One type of white blood cell that attacks virus-infected cells, foreign cells, and cancer cells. T lymphocytes also produce a number of substances that regulate the immune response. TD50 - CORRECT ANSWER May be defined as follows: for a given target site(s), if there are no tumors in control animals, then TD50 is that chronic dose-rate in mg/kg body wt/day which would induce tumors in half the test animals at the end of a standard lifespan for the species. Since the tumor(s) of interest often does occur in control animals, TD50 is more precisely defined as: that dose-rate in mg/kg body wt/day which, if administered chronically for the standard lifespan of the species, will halve the probability of remaining tumorless throughout that period. A TD50 can be computed for any particular type of neoplasm, for any particular tissue, or for any combination of these. The range of statistically significant TD50 values for chemicals in the CPDB that are carcinogenic in rodents is more than 10 million-fold. Technical safety services (TSS) - CORRECT ANSWER Technical Safety Services, Inc. has built its foundation by providing superior testing and certification services to the most demanding Fortune 100 biotechnology, pharmaceutical and medical device companies in the nation. Our ability to listen to clients' needs, in addition to our flexibility, innovation, and precision, are the qualities that distinguish TSS from all other service companies Temperature Danger Zone - CORRECT ANSWER The range of temperatures at which bacteria can grow - usually between 40° and 140° F (4° and 60° C). For food safety, it's important to keep food below or above the "danger zone." Threshold - CORRECT ANSWER The lowest dose of a chemical at which a specified measurable effect is observed and below which it is not observed. // Dose or exposure concentration below which a defined effect will not occur. Total maximum daily load - CORRECT ANSWER A regulatory term in the U.S. Clean Water Act (CWA), describing a value of the maximum amount of a pollutant that a body of water can receive while still meeting water quality standards . [1] Alternatively, TMDL is an allocation of that pollutant deemed acceptable to the subject receiving waters . TMDLs have been used extensively by the United States Environmental Protection Agency (EPA) and state environmental agencies in implementing the CWA by establishing maximum pollution limits for industrial wastewater dischargers. EPA published regulations in 1992 establishing TMDL procedures. [2] Application of TMDL has broadened significantly in the last decade to include many watershed-scale efforts. This process incorporates both point source and nonpoint source pollutants within a watershed . Toxic agent - CORRECT ANSWER Chemical or physical (for example, radiation, heat, cold, microwaves) agents that, under certain circumstances of exposure, can cause harmful effects to living organisms Toxicant - CORRECT ANSWER A harmful substance or agent that may injure an exposed organism. Toxicological Profile - CORRECT ANSWER An examination, summary, and interpretation of a hazardous substance to determine levels of exposure and associated health effects. Toxicology - CORRECT ANSWER Scientific discipline involving the study of the actual or potential danger presented by the harmful effects of substances (poisons) on living organisms and ecosystems, of the relationship of such harmful effects to exposure, and of the mechanisms of action, diagnosis, prevention and treatment of intoxications NT chemical toxicology Toxic substances Control Act (TSCA) - CORRECT ANSWER regulates the introduction of new or already existing chemicals. It grandfathered most existing chemicals, in contrast to the Registration, Evaluation and Authorization of Chemicals (REACH) legislation of the European Union . However, as explained below, the TSCA specifically regulates polychlorinated biphenyl (PCB) products. The TSCA is found in United States law at 15 USC (C. 53) 2601-2692 . It is administered by the U.S. Environmental Protection Agency (EPA). Subchapter I of the TSCA, "Control of Toxic Substances," is the original substance of the 1976 act, PL 94-469, including regulation of polychlorinated biphenyl (PCB) products. Toxin - CORRECT ANSWER Poisonous substance produced by a biological organism such as a microbe, animal or plant PS venom Tumor - CORRECT ANSWER 1. Any abnormal swelling or growth of tissue, whether benign or malignant. 2. An abnormal growth, in rate and structure, that arises from normal tissue, but serves no physiological function SN neoplasm Tumor initiation - CORRECT ANSWER A process in which normal cells are changed so that they are able to form tumors. Substances that cause cancer can be tumor initiators. Tumor progression - CORRECT ANSWER Increase in the size of a tumor or spread of cancer in the body. Tumor promotion - CORRECT ANSWER A process in which existing tumors are stimulated to grow. Tumor promoters are not able to cause tumors to form. Uncertainty Factor - CORRECT ANSWER One of several factors used in calculating the reference dose from experimental data. UFs are intended to account for (1) the variation in sensitivity among humans (2) the uncertainty in extrapolating animal data to humans (3) the uncertainty in extrapolating data obtained in a study that covers less than the full life of the exposed animal or human (4) the uncertainty in using LOAEL data rather than NOAEL data. Unit risk (as used by the USEPA) - CORRECT ANSWER Incremental upper-boundary lifetime risk estimated to result from lifetime exposure to an agent if it is in air at a concentration of 1 mg/m3 or in the water at a concentration of 1 mg/L Urgent public health hazard - CORRECT ANSWER A category used in ATSDR's public health assessments for sites where short-term exposures (less than 1 year) to hazardous substances or conditions could result in harmful health effects that require rapid intervention. U.S. Department of Defense (DoD) - CORRECT ANSWER Manages an inventory of installations and facilities to keep Americans safe. The Department's physical plant is huge by any standard, consisting of more than several hundred thousand individual buildings and structures located at more than 5,000 different locations or sites. When all sites are added together, the Department of Defense utilizes over 30 million acres of land. U.S. Department of Energy (DOE) - CORRECT ANSWER Overarching mission is to advance the national, economic, and energy security of the United States; to promote scientific and technological innovation in support of that mission; and to ensure the environmental cleanup of the national nuclear weapons complex. U.S Department of Health and Human Services (DHHS) - CORRECT ANSWER The U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. U.S Department of Homeland Security - CORRECT ANSWER In 2002, the Homeland Security Act was created as a vehicle to mobilize and organize the nation to secure the US from terrorist attacks. In order for this mission to be successful, it requires focused effort from our entire society. Established, primarily, to unify, guide and coordinate this vast national effort. The DHS has developed its own high level strategic plan, a vision, mission statements, strategic goals and objectives to guide the approximately 180,000 DHS employees that daily perform this very important task. U.S. Environmental Protection Agency (EPA) - CORRECT ANSWER The mission is to protect human health and the environment. Since 1970, this agency has been working for a cleaner, healthier environment for the American people. U.S. Food and Drug Administration - CORRECT ANSWER The agency responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation. Also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health. Vector - CORRECT ANSWER 1. An organism, often an insect or rodent which carries disease. 2. Plasmids, viruses, or bacteria used to transport genes into a host cell. A gene is placed in the vector; the vector then "infects" the bacterium. Ventilation/Suction - CORRECT ANSWER The act of admitting fresh air into a space in order to replace stale or contaminated air; achieved by blowing air into the space. Similarly, suction represents the admission of fresh air int Virus - CORRECT ANSWER A virus is an extremely tiny infectious agent that is only able to live inside a cell. To reproduce, a virus invades a cell within the body of a human or other creature. Once replicated, the new viruses leave the host cell and are ready to invade others. Volatile - CORRECT ANSWER Any substance that evaporates readily. Volatile Organic Compound (VOC) - CORRECT ANSWER Any organic compound that participates in atmospheric photochemical reactions except those designated by EPA as having negligible photochemical reactivity. Wastewater Treatment Plant - CORRECT ANSWER A facility containing a series of tanks, screens, filters, and other processes by which pollutants are removed from water. Most treatments include chlorination to attain safe drinking water standards. Waterborne Disease Outbreak - CORRECT ANSWER The significant occurrence of acute illness associated with drinking water from a public water system that is deficient in treatment, as determined by appropriate local or state agencies. Watershed - CORRECT ANSWER The land area that drains into a stream; the watershed for a major river may encompass a number of smaller watersheds that ultimately combine at a common point. Water Quality Management - CORRECT ANSWER Planning for the protection of a water's quality for various Beneficial Uses , for theprovision of adequate wastewater collection, treatment, and disposal for municipalities and industries, and for activities that might create water quality problems, and regulating and enforcing programs to accomplish the planning goals and laws and regulations dealing with water pollution control. Weapons of Mass Destruction - CORRECT ANSWER - Any explosive or incendiary device, as defined in Title 18 USC, Section 921: bomb, grenade, rocket, missile, mine, or other device with a charge of more than four ounces; - Any weapon designed or intended to cause death or serious bodily injury through the release, dissemination, or impact of toxic or poisonous chemicals or their precursors; - Any weapon involving a disease organism; or - Any weapon designed to release radiation or radioactivity at a level dangerous to human life. X-rays - CORRECT ANSWER Penetrating electromagnetic radiation (photon) having a wavelength that is much shorter than that of visible light. These rays are usually produced by excitation of the electron field around certain nuclei. In nuclear reactions, it is customary to refer to photons originating in the nucleus as x-rays Zoonotic diseases - CORRECT ANSWER Any disease and/or infection which is naturally "transmissible from vertebrate animals to man" is classified as a zoonosis according to the PAHO publication "Zoonoses and communicable diseases common to man and animals". Over 200 zoonoses have been described and they are known since many centuries. They involve all types of agents: bacteria, parasites, viruses and unconventional agents Bioterrorism - CORRECT ANSWER Terrorism by intentional release or dissemination of biological agents ( bacteria , viruses or toxins ); these may be in a naturally-occurring or in a human-modified form. Lumen - CORRECT ANSWER the cavity of a tubular organ Morbidity - CORRECT ANSWER Rate of disease incidence. Mortality - CORRECT ANSWER Death rate. Molecule - CORRECT ANSWER The smallest division of a compound that still retains or exhibits all the properties of the substance. Exposure-effect relationship - CORRECT ANSWER See NT concentration-effect relationship , dose-effect relationship Hydrophilic - CORRECT ANSWER Having a strong affinity for water. Hydrophobic - CORRECT ANSWER Having a strong aversion for water. Incidence - CORRECT ANSWER The number of new cases of disease in a defined population over a specific time period. Often confused with incidence rate. Ionizing radiation - CORRECT ANSWER Any radiation capable of displacing electrons from atoms or molecules, thereby producing ions. Some examples are alpha, beta, gamma, x-rays, neutrons, and ultraviolet light. High doses of ionizing radiation may produce severe skin or tissue damage. Radiation that can strip electrons from atoms; e.g. alpha, beta, and gamma radiation. Mutation - CORRECT ANSWER A change (damage) to the DNA, genes, or chromosomes of living organisms.