Site Selection: Area Offices should generate a list of previously inspected establishments where COVID-19 citations or HALs were issued, including remote-only inspections where COVID-19-related citations were issued. They should also create a list of establishments with closed COVID-19 UPA, including COVID-19 complaints and RRIs. The establishments on these lists shall be limited to the NAICS codes listed in Attachment 1, the criteria for focused healthcare inspections listed above, and generated using the OSHA Information System (OIS) beginning with March 1, 2020. Area Offices will use either list or a combination of the lists to meet their inspection goals.
Assessment of COVID-19 Mitigation Strategies: All COVID-19 focused healthcare inspections should follow inspection procedures in the Field Operations Manual (FOM) (including the presence of employee representatives, e.g., union officials, during all aspects of the inspection), and coding instructions in the COVID-19 NEP, but shall be limited to the following assessments:
Walkaround: The walkaround portion of the inspection shall be less extensive than a usual inspection, limited in scope, and focused on the areas of potential non-compliance listed below. In accordance with the FOM, the scope of an inspection may be expanded where plain-view hazards are identified during the walkaround, or where information obtained from workers or worker representative(s) indicate deficiencies in compliance;
Since 2004, FHWA's Pedestrian and Bicyclist Focused Approach to Safety has been working with agencies around the country to aggressively reduce pedestrian and bicyclist deaths. These efforts include focusing extra resources on the planning organizations and States with a higher proportion of pedestrian and bicyclist fatalities. The program originally focused on pedestrians but was expanded in 2015 to include bicyclists. In 2021, FHWA decided pedestrians and bicyclists should be treated separately and selected Focus Approach States and planning organizations based on current crash data analysis.
This new Network will support at least three Centers whose collective efforts will lead to a greatly enhanced understanding of mechanisms underlying the impact of chronic psychosocial stress on cardiovascular health. Each center application will include three (3) research projects from at least two (2) science disciplines. Due to the critical need for fundamental understanding of mechanisms that drive cardiovascular effects of chronic psychosocial stress, two of the proposed projects must be basic science focused.
The focused practice designation, approved by ABMS in March 2017, recognizes the value that physicians and specialists (also known as diplomates) who focus some or all their practice within a specific area of a specialty and/or subspecialty can provide to improving health care. It reflects an evolution of practice that occurs following initial certification and is relevant to continuing certification. For example, a diplomate may focus his or her practice on work in the hospital setting or concentrate on specific patient populations, conditions, and/or specialized procedures that emerge as medicine evolves.
ABMS Member Boards can propose areas for focused practice designation to ABMS that align with the standards for certification and continuing certification. Proposals outline the eligibility criteria, clinical practice experience (patients treated/procedures performed), formal training, if required, and assessment process for continuing certification that eligible diplomates complete for focused practice designation. The proposal goes through a review and approval process similar to the one used for a new specialty or subspecialty.
Diplomates already certified in an established, approved specialty or subspecialty may apply to those boards with an approved focused practice designation. Among other requirements, diplomates must meet specific criteria including the length of time they have focused in the particular area and the number of patients they have treated or procedures they have performed. Requirements also may include formal training.
Diplomates can maintain their designation by meeting the clinical practice requirements for the specified area of focused practice and the requirements for maintaining their certification. Requirements related to the focused practice designation also may count toward the requirements to maintain primary specialty or subspecialty certification.
By implementing a focused-acceleration approach, cities could achieve 90 to 100 percent of their 2030 emissions targets and build the knowledge and foundational capabilities needed to reach net zero carbon by 2050 (exhibit). At the same time, the incremental investment required to achieve 2030 emissions targets is significant: roughly $50 to $200 per metric ton of CO2 equivalent. However, all opportunities provide a positive return on investment in the mid to long term, whether through direct cash flow for investors (for example, in the case of renewables and efficiency improvements) or broader boosts to economic activity in the city (for example, transit-oriented development). For many opportunities, up-front investments are paid back within five to ten years.
During a focused ultrasound treatment, the patient remains awake and lies inside an MRI scanner with his/her head in the focused ultrasound helmet-like device. The treating neurosurgeon identifies the target area based off of high-resolution MRI scans, and a total of 1,024 individual ultrasound transducers are then precisely focused on the targeted area. At first, low-energy ultrasound is applied to the targeted area, allowing the patient to provide feedback of tremor improvement as well as any potential side effects. This feedback allows the treating neurosurgeon to adjust the treatment before high-energy ultrasound is applied.
Following the procedure, the patient will move to the recovery room, where the focused ultrasound helmet device is removed. The physician will let the patient know when they can go home and when they will need to return for a follow-up visit.
With focused deterrence, the police and representatives from the community engage with those at high risk of being a party to violence and convey clear incentives for avoiding violence and deterrents for engaging in violence. On the incentive side, targeted offenders receive information about and access to various services, such as job training and drug treatment (Center for Evidence-Based Crime Policy, undated). On the deterrence side, these individuals receive information on the enhanced penalties that they and their peers will face if there are subsequent violent incidents. These penalties will range from focused and enhanced prosecution for the violent crimes to arrests and other penalties for any low-level offense (drug trafficking, illegal gambling, etc.) subsequently committed by the parties involved. Beyond the use of carrots and sticks, focused deterrence initiatives attempt to decrease the opportunities that individuals have to commit violence, make the local community a partner in deflecting individuals away from crime, and improve police-community relations (Braga and Weisburd, 2012a, p. 26).
There are several variants of focused deterrence. Recent evidence (Braga, Weisburd, and Turchan, 2018) suggests that variants that seek to dissuade criminal groups (e.g., gangs) from engaging in violence are most effective, so this essay is focused on those variants. Variants that strictly seek to deter individuals (as opposed to gangs) are less effective. Variants that seek to dissuade drug selling are even less effective, although Braga, Weisburd, and Turchan found that almost half the drug-focused initiatives had severe implementation problems and that the drug-focused initiatives that did not report such severe problems had better results.
The National Network for Safe Communities (2016) provides a detailed guidebook on the core model for conducting focused deterrence for groups, the Group Violence Intervention (PDF), which is an updated version of Boston's Operation Ceasefire model for focused deterrence. The Network also provides an implementation guide on the core model for deterring open-air drug dealing, the Drug Market Intervention (2015) (PDF).
This hierarchy of teams for a focused deterrence strategy is illustrated in Figure 1. Another source for guidance on group violence is the extensive guide prepared by the National Network for Safe Communities (2016).
This is not the only way to run focused deterrence interventions, but more-successful interventions reviewed by RAND frequently included these steps (see Analyzing the Evidence for Focused Deterrence).
For focused deterrence to work, the targeted criminal population must be aware of the deterrence strategy. Boston's Operation Ceasefire (Braga and Weisburd, 2015) provides a commonly used template for focused deterrence meetings. The specific format was designed for interventions with the members of multiple gangs, or of a specified gang collectively, but can also be tailored to individuals. The general elements include the following:
All studies reviewed by Braga and Weisburd offered their respective populations various services, such as job training, drug abuse treatment, and assistance in housing, as incentives for turning away from violence (Braga and Weisburd, 2012b, p. 350). The services component of focused deterrence tends to be the least covered in practice, which is unfortunate because incentives for desisting from violence are as important as sanctions for disobedience. A suite of services could include the following (which is not intended to be a complete list):
A key aspect of focused deterrence is ongoing support and monitoring of at-risk individuals from the community, beyond the influence of law enforcement and social services. Unfortunately, these activities are not commonly documented, so it is difficult to provide an overall assessment of them. That said, community support plays the key role of helping continue the intervention when law enforcement is not present. From our review of focused deterrence studies, examples of community members who provide this support include