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The recommended action of the protected-mode general-protection exception handler is to hiv infection rates by group symmetrel 100 mg low price then call the virtual8086 monitor and let it handle the pending interrupt hiv infection rates houston cheap symmetrel 100mg otc. The next time the processor receives a maskable hardware interrupt antiviral resistance discount 100mg symmetrel visa, it will then handle it as described in steps 1 through 5 earlier in this section hiv infection on tongue order cheap symmetrel line. The table also summarizes the various actions the processor takes for each method. When this flag is clear, the processor responds to interrupts and exceptions in virtual-8086 mode in the same manner as an Intel386 or Intel486 processor does. Hardware generated interrupts and exceptions are always handled by the protectedmode interrupt and exception handlers. Interrupt directed to protected-mode interrupt handler: (see method 1 processor action). The following sections describe the six methods (or mechanisms) for handling software interrupts in virtual-8086 mode. If the corresponding bit for the software interrupt in the software interrupt redirection bit map is set to 0, the interrupt is handled using method 6 (see Section 20. Method 4 software interrupt handling allows method 1 style handling when the virtual mode extension is enabled; that is, the interrupt is directed to a protected-mode handler (see Section 20. The processor performs the following actions to make an implicit call to the selected 8086 program interrupt handler: 1. Locates the 8086 program interrupt vector table at linear address 0 for the 8086-mode task. The interrupt vector table is assumed to be at linear address 0 of the current virtual-8086 task. Note that with method 5 handling, a mode switch from virtual-8086 mode to protected mode does not occur. The processor remains in virtual-8086 mode throughout the interrupt-handling operation. The method 5 handling actions are virtually identical to the actions the processor takes when handling software interrupts in real-address mode. The benefit of using method 5 handling to access the 8086 program handlers is that it avoids the overhead of methods 2 and 3 handling, which requires first going to the virtual-8086 monitor, then to the 8086 program handler, then back again to the virtual-8086 monitor, before returning to the interrupted 8086 program (see Section 20. With method 6 interrupt handling, software interrupts are handled in the same manner as was described for method 5 handling (see Section 20. These flags provide the virtual-8086 monitor with an efficient means of handling maskable hardware interrupts that occur during a virtual-8086 mode task. If the processor receives a maskable hardware interrupt, the processor invokes the protected-mode interrupt handler. As a protected-mode task, when the code, data, and stack segments for the task are all configured as a 16-bit segments. A legacy program assembled and/or compiled to run on an Intel 8086 or Intel 286 processor should run in real-address mode or virtual-8086 mode without modification. This chapter describes how to integrate 16-bit program modules with 32-bit program modules when operating in protected mode and how to mix 16-bit and 32-bit code within 32-bit code segments. The D flag in a code-segment descriptor determines the default operand-size and address-size for the instructions of a code segment. The B flag for all data descriptors also controls upper address range for expand down segments. When transferring program control to another code segment through a call gate, interrupt gate, or trap gate, the operand size used during the transfer is determined by the type of gate used (16-bit or 32-bit), (not by the D-flag or prefix of the transfer instruction). The gate type determines how return information is saved on the stack (or stacks). For most efficient and trouble-free operation of the processor, 32-bit programs or tasks should have the D flag in the code-segment descriptor and the B flag in the stack-segment descriptor set, and 16-bit programs or tasks should have these flags clear. Program control transfers from 16-bit segments to 32-bit segments (and vice versa) are handled most efficiently through call, interrupt, or trap gates. Instruction prefixes can be used to override the default operand size and address size of a code segment. These prefixes can be used in real-address mode as well as in protected mode and virtual-8086 mode. An operand-size or address-size prefix only changes the size for the duration of the instruction. The previous examples show that any instruction can generate any combination of operand size and address size regardless of whether the instruction is in a 16- or 32-bit segment. The operating system the code segment will be running on - If the operating system is a 16-bit operating system, it may not support 32-bit program modules. The B flag cannot, in general, be used to change the size of stack used by a 16-bit code segment. It does not control explicit stack references, such as accesses to parameters or local variables. A 16-bit code segment can use a 32-bit stack only if the code is modified so that all explicit references to the stack are preceded by the 32-bit address-size prefix, causing those references to use 32bit addressing and explicit writes to the stack pointer are preceded by a 32-bit operand-size prefix. Modify the 16-bit procedure, inserting an operand-size prefix before the call, to change it to a 32-bit call. Likewise, there are three ways for procedure in a 32-bit code segment to safely make a call to a 16-bit code segment: Make the call through a 16-bit call gate. Modify the 32-bit procedure, inserting an operand-size prefix before the call, changing it to a 16-bit call. If the call is to a 32-bit code segment, the instructions in that code segment will be able to read the stack coherently. The count field of the gate descriptor specifies the size of the parameter string to copy from the current stack to the stack of a more privileged (numerically lower privilege level) procedure. The count field of a 16-bit gate specifies the number of 16-bit words to be copied, whereas the count field of a 32-bit gate specifies the number of 32-bit doublewords to be copied. The count field for a 32-bit gate must thus be half the size of the number of words being placed on the stack by a 16-bit procedure. Here, the type of the gate (16-bit or 32-bit) determines the operand-size attribute used in the implicit call to the exception or interrupt handler procedure in another code segment. A 32-bit interrupt or trap gate provides a safe interface to a 32-bit exception or interrupt handler when the exception or interrupt occurs in either a 32-bit or a 16-bit code segment. It is sometimes impractical, however, to place exception or interrupt handlers in 16-bit code segments, because only 16-bit return addresses are saved on the stack. Except for this limitation, interface code can perform any format conversion between 32-bit and 16-bit pointers that may be needed. Parameters passed by value between 32-bit and 16-bit code also may require translation between 32-bit and 16bit formats. Translating parameters (data), including managing parameter strings with a variable count or an odd number of 16-bit words. The interface procedure must reside in a 32-bit code segment (the D flag for the code-segment descriptor is set). The mapping between 16- and 32-bit addresses is only performed automatically when a call gate is used, because the gate descriptor for a call gate contains a 32-bit address. Compatibility means that, within limited constraints, programs that execute on previous generations of processors will produce identical results when executed on later processors. Those enhancements have been defined with consideration for compatibility with previous and future processors. This chapter also summarizes the compatibility considerations for those extensions. Intel Xeon processors 3000, 3100, 3200, 3300, 3200, 5100, 5200, 5300, 5400, 7200, 7300 series are based on Intel Core microarchitectures and support Intel 64 architecture. Pentium D Processors - A family of dual-core Intel 64 processors that provides two processor cores in a physical package.

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For instance how long after hiv infection do symptoms show buy symmetrel on line amex, four regions held focus groups that functioned more like mini-workshops hiv infection and aids buy cheap symmetrel, designed to stages of hiv infection wiki 100 mg symmetrel overnight delivery enable participants to hiv infection during window period cheap 100 mg symmetrel with amex learn and network with each other. Several regions included live keypad polling in their public meetings to enable greater involvement and more effective real-time deliberation. The Seven50 process included summits for the general public that included keynote speakers on critical regional issues, interactive workshops, and opportunities to participate in live keypad polls. Interestingly, the General Media category included a range of artistic practices, public art, and creative placemaking initiatives. In the region surrounding Greenfield, Massachusetts, the Franklin Regional Council of Governments commissioned a public art display as a capstone to the public participation efforts. The art display was unveiled in a ceremony at the Franklin County Transit Center, which included choreographed dance and music performed by youth. The council created large posters of the mosaic, which were attached to the sides of the Franklin Regional Transit Authority buses for several weeks during the public comment period for the draft of the Sustainable Franklin County Plan, in order to help publicize it and future open houses. Websites and Online Engagement Many of the regions made effective use of innovations in web-based technologies to inform, consult, involve, and even empower and collaborate with citizens and organizations from various sectors. This metacategory included the following web-based activity codes: "Scenario Games"; "Interactive Forums"; "Implementation Toolkits";10 "Social Media Toolkits";11 "Crowdsourced Inventories"; and "General Resources, Tools, Data, Research. Nearly all the Exhibit 4 Frequency and Function of Websites and Online Engagement Tools Many regions posted Implementation Toolkits on their websites. Most grantees appeared to have some type of social media presence, but this was underreported in the inventory because of a choice to create a category focused on social media toolkits-and not just "social media"-designed to make it easy and desirable for community members to share updates and invitations through social media. It seemed that this was not happening, and social media seemed mostly to be a place for passive updates: not networking or interactive dialogue. More often, social media efforts were included as a tool under the "general resources" website classification. Generally, researchers appear to have only used this category when they have wanted to highlight an interesting tool or resource, and they classified it under the larger umbrella. Innovative, interactive web-based forums ranged from dynamically updating spreadsheets to interactive interfaces, such as Community PlanIt, MindMixer, or Ideascale. For instance, Imagine Central Arkansas employed Ideascale, an online, community-sourced forum for sharing, discussing, and rating ideas for sustainable placemaking, to reach a geographically diverse community in an interactive manner. Interfaces sometimes featured crowdsourced inventories, enabling dynamic asset mapping, needs identification, ideation, or a combination of the three through the region. New River Valley Livability in Virginia even included a crowdsourced financing mechanism for implementation through a partnership with a local community foundation, which raised more than $60,000 in donations to implement ideas in the regional plan. Web-based scenario games enabled professional planners to provide a more powerful, dataintensive interface in public meetings. For example, Utah and the Central Texas region used the Envision Tomorrow suite of web-based scenario planning support tools to provide snapshots of the possible impacts of policies, development decisions, and current growth trajectories to develop a shared vision of a sustainable future. The web-based platform integrates pop-up information windows that explain the theory and underlying research behind each indicator, explaining how the measures are connected to livability concerns, as well as providing design solutions via hyperlink text to online resources. In-Person, Interactive Workshops Beyond the traditional two-way, larger, general public meetings, grantees often used many hands-on engaging interactive workshops that enabled participants to engage with one another in smaller groups. This metacategory included the following workshops: "In-Person Scenario Games," "In-Person Workshops: General," and "Facilitation Toolkits. In-person scenario game workshops generally involved participants working in small groups situated around a regional map and deliberating together on land use, housing, and transportation choices for various future scenarios. For example, in northeastern Ohio, nearly 600 individuals participated in a series of six workshops that produced 73 maps. These interactive activities created opportunities for participants to expand their knowledge and know-how, while also building new relationships, thereby expanding human and social capital. Although these highly interactive workshops enabled people to collaborate with each other in the exercise, they generally did not appear to build the power to act. The only workshop that appeared to empower participants was an interactive workshop designed for local officials across the region. Although the activity did not empower disadvantaged groups, it did build capacity among decisionmakers to act more effectively in service of a common regional vision. The number, frequency, geographical diversity, and linguistic diversity of these smaller group activities were limited by the availability of planning professionals to lead them. Some regions saw that they could address this problem, while simultaneously strengthening civic infrastructure in the regions, by developing a distributed approach. Through "Meetings in A Box," "Convo to Go," and "Ambassador" programs, regions equipped civic leaders with tools (and often training) to lead 74 Planning Livable Communities Civic Infrastructure and Sustainable Regional Planning: Insights From the Sustainable Communities Initiative Regional Planning Grantees Exhibit 5 Frequency and Function of In-Person, Interactive Workshops smaller interactive workshops and conversations with stakeholders in their own circles. Instead of requiring people to come to a central location, public conversations could be hosted around a living room table, a coffee hour at a church, or any other ongoing meeting. This flexibility was especially valuable for geographically and socially diverse regions where centralized meetings are particularly difficult. Grant funding was also available through an application process to support those individuals and organizations. Materials provided included a video introduction, a flipbook for review of the plan and prior community meetings, and instructions for process facilitation. Capacity-Building Activities While most activities primarily intended to support the decisionmaking process for the plan, a wide range of activities were specifically intended to build capacity in the region for a more just, inclusive, and effective planning process and for long-term capacity for implementation and sustained democratic engagement. This metacategory of "Capacity-Building Activities" included Cityscape 75 Walsh, Becker, Judelsohn, and Hall four activity types: "Leadership Academies/Planning Schools,"13 "Leadership Academies/Youth,"14 "Capacity Building & Technical Assistance: Municipalities, Non-profits, and Businesses,"15 and "Grants for Implementation of Activities and Projects. Leadership academies in some regions focused on training and involving youth as community leaders in the planning process. The code was generally reserved for regions that offered a series of educational and networking events framed as an academy, school, or institute similar to those defined and reviewed by Mandarano (2015). However, some raters also used this classification for ad hoc capacity-building workshops targeted for citizens. When interpreting this code, it is important to note that the research team noted special efforts to engage youth in 16 regions, even though only five activities were coded specifically as "Leadership Academies/Youth. Because funds for project implementation are not generally included in reports on community engagement processes, the totals reported here should not be interpreted as an exhaustive survey of implementation grants. Through it, high school residents are taught, during an intensive 8-month period, about relevant urban planning issues. The Chicago Metropolitan Agency for Planning established the Local Technical Assistance program with support from the Chicago Community Trust to initiate and invest in 112 projects with local governments, nonprofits, and intergovernmental organizations to address local issues at the intersection of transportation, land use, and housing. Those organizations included community development corporations as well as social service and faith-based institutions. The metacategory includes "Citizen Advisory Committees and Working Groups"17 and "Compacts" through which regional partners signed on to advance the adopted plan as a whole. The working group members produced research and advised the Plan East Tennessee leadership team on topics related to housing and transit. Local governments, agencies, businesses, and nonprofits that sign the compact are required to participate in plan implementation committees and attend semiannual plan implementation summits. Exhibit 7 shows the frequency of activities in both of these categories, as well as the functions they served. When considering the functional ratings for Citizen Advisory Committees and Working Groups and for Compacts in the following, it is important to remember that the definition of empower used in this analysis focuses on building the capacity of diverse actors to act effectively in service of shared this code was used to capture authentic citizen participation in ongoing advisory roles and issue-specific working groups committed to collective action in key areas. It does not necessarily imply addressing structural inequality by giving (or building) power to underrepresented groups in particular, even if such affirmative action is needed to truly build capacity among diverse actors. Excellence in Equitable, Integrated Approaches to Civic Infrastructure Planning the inventory results also revealed some regions that stood out for their use of a variety of activities integrated into a synergistic, comprehensive engagement process intended to address structural barriers to opportunity and engagement in demographically and geographically diverse regions. For all but 31 of the 74 regions, researchers classified at least 5 different engagement activity types. Researchers also anecdotally noted 55 activities that made clear efforts to advance equity, both by engaging members of marginalized communities and by focusing public attention on issues of structural inequality. Four regions demonstrated exemplary efforts to creatively design coupled investments in civic infrastructure and physical infrastructure to advance equity outcomes. Each of these regions leveraged their 78 Planning Livable Communities Civic Infrastructure and Sustainable Regional Planning: Insights From the Sustainable Communities Initiative Regional Planning Grantees existing civic infrastructure by providing capacity-building grants to community-based organizations, establishing regional equity networks, and offering empowering workshops and summits. Some were particularly committed to building capacity in marginalized communities through a holistically designed engagement process. Their approach focused on socially just processes for engagement as well as socially just outcomes and implementation.

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Five-year clinical follow-up after intracoronary radiation: results of a randomized clinical trial hiv infection unprotected buy symmetrel 100mg free shipping. Evolution of angiographic restenosis rate and late lumen loss after intracoronary beta radiation for in-stent restenotic lesions hiv infection rates michigan buy 100mg symmetrel with amex. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology hiv infection in newborn buy symmetrel 100 mg fast delivery. Two-year clinical follow-up of 90Sr/90 Y radiation versus placebo control for the treatment of in-stent restenosis antiviral fruit purchase symmetrel 100 mg free shipping. A meta-analysis of randomized controlled trials of intracoronary gammaand beta-radiation therapy for in-stent restenosis. Endoluminal beta-radiation therapy for the prevention of coronary restenosis after balloon angioplasty. Five-year follow-up after intracoronary gamma radiation therapy for instent restenosis. The use of hyperthermia and concurrent radiation therapy treatment is medically necessary for any of the following: A. Recurrent cervical lymph nodes from head and neck cancer Treatment of the above conditions will be approved in the absence of both of the following: A. Metastatic disease for which chemotherapy or hormonal therapy is being given concurrently or planned B. Point measurements rather than volume mapping of thermal gradients were relied upon in planning these hyperthermia studies. Research from Duke University, Northwestern University, University of Southern California, Stanford University, Washington University, as well as centers in Holland, Germany, Norway, Austria, Italy, and Switzerland have contributed substantially to the emergence of hyperthermia as a useful treatment modality when combined with radiation therapy. It states, "Local hyperthermia is covered under Medicare when used in conjunction with radiation therapy for the treatment of primary or metastatic cutaneous or subcutaneous superficial malignancies. This is the only approval for deep heating, and only actual costs incurred in the research may be billed. There are three clinical sites in which randomized studies have documented the benefit of hyperthermia given in conjunction with radiotherapy. The control rate for radiation therapy alone was 41%, while that for combined treatment was 59%. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. In the event no target is localized, blocking and patient set-up is accomplished through typical alignment of bony structures using portal imaging; appropriate coding for port films would apply. It may be necessary to check with the individual health plan directly before billing this code for this purpose. In the hospital-outpatient setting, G6017 is considered image guidance and is packaged into the primary service payment. Radiation dose from cone beam computed tomography for image-guided radiation therapy. Key Clinical Points Neutron beam radiotherapy differs from other forms of radiation particle treatment such as protons or electrons as neutrons have no electrical charge. The treatment effects are the results of the neutron mass producing dense radiation energy distributions. Currently, the University of Washington Medical Cyclotron Facility in Seattle is the only clinical neutron facility in the United States. The effectiveness of neutrons as treatment of choice in the treatment of salivary gland tumors was most recently confirmed by Stannard et al. The patients had either unresectable tumors or had gross macroscopic residual disease. Neutrons do have limitations, especially at the skull base, which can result in an increased complication rate. Boron neutron capture therapy for advanced salivary gland carcinoma in head and neck. Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Radiotherapy for advanced adenoid cystic carcinoma: neutrons, photons or mixed beam? Chordomas and chondrosarcomas of the skull base these rare primary malignant tumors of the skull base are treated primarily by surgery and postoperative radiotherapy. It is noted that six patients developed radiation necrosis (who all survived at least four years without evidence of recurrence, but in whom the performance status had declined by 10 to 30%). The authors, however, conclude that "The overall potential clinical benefit of these dosimetric advantages in glioblastoma patients remains to be determined. The reduction in the volume of tissue receiving low doses of radiation has not clearly been associated with improved clinical outcomes. With 5-month median follow up, 12 patients had stable disease, 2 had partial or complete remission, one had progression and two had "pseudo-progression". These have shown reduction in low dose radiation distribution to some structures, such as heart and lung, and increased radiation dose to other structures, such as spinal cord and skin (Funk et al. The 3-year overall, relapse-free, distant metastasis-free, and locoregional-free survival rates were 51. All patients had initially non-metastatic cancer treated with neoadjuvant concurrent chemoradiotherapy and surgical resection. In terms of grade 3, 4 and 5 toxicity, there were no significant differences between the two modalities. Why proton beam therapy improved survival in the locally advanced stages is not clear. The dose delivered to the target is equivalent and therefore should result in equivalent control rates. This especially pertains to targets in the thorax and upper abdomen, including the distal esophagus that move as a result of diaphragmatic excursion (Mori and Chen, 2008; Mori et al. Because the diaphragm moves during respiration, this results in changes to the tissues in the beam path, which can cause significant interplay effects and dose uncertainty. Skin toxicity, fatigue and radiation pneumonitis were evaluated during radiation and at 4 and 8 weeks after completing radiation. Breast cancer Radiation Therapy Criteria mild erythema or hyperpigmentation. The authors found that 20 patients experienced grade 2 dermatitis with eight experiencing moist desquamation which ". Lastly, one patient developed a grade 3 complication of the implant requiring removal. Seven patients developed a skin infection requiring antibiotics, one of which resulted in nonlethal sepsis. This study will help determine the benefit of proton beam therapy in the treatment of breast cancer. Until such data is available and until there is clear data documenting the clinical outcomes of proton beam therapy in the treatment of breast cancer, proton beam therapy remains unproven. Prostate cancer Comparative effectiveness studies have been published comparing toxicity and oncologic outcomes between proton and photon therapies and have reported similar early toxicity rates. These tissues do not routinely contribute to the morbidity of prostate radiation, are relatively resilient to radiation injury, and so the benefit of decreased dose to these types of normal non-critical tissues has not been apparent. This may be one reason that the perceived dosimetric advantages of proton beam radiation have not translated into differences in toxicity or patient outcomes. There is a need for more well-designed registries and studies with sizable comparator cohorts to help accelerate data collection. While proton beam therapy is not a new technology, its use in the treatment of prostate cancer is evolving. Lung cancer the data on proton beam therapy in the treatment of lung cancers is limited. No clinical outcomes were reported, and no evidence that these dose differences resulted in clinically meaningful improvement in results is presented.

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As a partner with other stakeholders and organizations symptoms of hiv infection during pregnancy buy genuine symmetrel, the County can help develop consensus antiviral and antiretroviral cheap symmetrel 100 mg on line, priorities lysine antiviral buy cheap symmetrel on-line, and focus resources to antiviral used for meningitis purchase genuine symmetrel achieve collective impact across sectors and jurisdictions. The "Health in All Policies approach" can facilitate collaboration and reinforce efforts among governmental agencies, community-based organizations, businesses and individuals. Consider the use of health impact assessments or similar tools to evaluate how policies, programs, strategic plans, and capital projects can improve public health. Promoting health equity is a key strategy for addressing major population health issues based in socioeconomic inequalities. Health Element - Health Conditions, Equity, and Access Social determinants of health play as large or larger role in public health than medical care and further perpetuate inequities that result in negative health outcomes for many in our community. Improving health equity is consistent with and underlies the mission and purposes of many County services. This section further emphasizes underlying factors of education and income, race, and discrimination as critical social determinants of health. Promote awareness and recognition of the role of social determinants of health and persistent health inequities. Ensure that new policies, services, and programs improve the lives of those most vulnerable to poor health outcomes, including persons living in poverty, older adults, children, persons with disabilities, people of color, and immigrants. Education is a key determinant of future employment and income, which correlates highly with improved health outcomes. An array of educational opportunities and social and financial support are necessary for people at various stages of the life cycle and for those seeking different types of training, experience, and growth potential. Increasing inequality of income and wealth in the United States should be addressed not for achieving a more egalitarian society but also for the positive health impacts that can be achieved. Support a high quality, universal system of early childhood education, especially in low-income communities. Promote free or low cost child and family enrichment programs and after-school supplemental educational programs. Promote expansion of academic and job skills-based educational opportunities for older adults, non-English speakers, formerly incarcerated, and lower-income individuals. Support expansion of affordable and high quality child care options for parents pursuing education and/ or in the workforce. Support youth development and employment opportunities, especially for low-income youth and youth of color. Promote efforts of local schools, colleges, trade schools, and non-profit scholarship organizations to promote career pathway alternatives to traditional higher education. Living in substandard economic conditions or poverty is correlated with adverse health outcomes. It causes unhealthful stress levels, shortened life-span, depression, and it often requires households to make critical choices and trade-offs between fundamental needs, such as food, shelter, medications, and health care. Achieving health improvements among those with very low incomes requires actions that address root causes of poverty such as economic literacy, expanded job opportunities, training, and wages and benefits that allow people to meet their basic needs, particularly in areas such as Santa Clara County with higher overall costs of living. It should also be noted that without concerted efforts to fund affordable housing, improvements in economic status can be undermined by increasing housing cost burdens. Reducing income inequality through better wages, benefits, and bolstering middle-income jobs further reduces health inequities. Promote educational efforts to provide greater financial literacy in youth and adults in order to project life needs, reduce debt, and generate personal savings and investment. Support efforts to improve wages and benefits, for both entry-level employees and those supporting families, including paid sick leave. Promote business creation, retention, and entrepreneurship by providing education, technical assistance and financial support to local businesses through trainings, mentoring, small incubator programs, including access to capital and microfinance loans. Encourage community-sponsored alternatives to predatory financial institutions such as community cash checking and non-profit credit unions, including appropriate low cost suites of services and alternatives to payday loans. Support youth-employment and enhanced opportunities with pay for expanded youth-focused community service. Inequities in economic, social, physical, and service environments continue to contribute to clear patterns of poor health. Achieving racial equity requires an understanding of how historical forces have prolonged the deep-rooted legacy of racism and segregation. Structural and systemic changes are necessary to overcome these forces and to improve opportunity for those who have experienced an undue burden of neglect and disadvantages. Research has shown Revised Public Review Draft February 2015 13 Health Element - Health Conditions, Equity, and Access that persistent exposure to discrimination and racism translates into chronic levels of stress, lowering the immune response and resulting in a host of illnesses and diseases. Promote public awareness of the persistence of various forms of racism and discrimination, explicit and implicit bias, and the health inequities they exacerbate. Continue to build organizational and institutional skills and commitment in County agencies to advance racial equity and eliminate institutional and structural racism. Disseminate local, regional and national policies and best practices that promote racial equity. Strategy #3: Ensure equitable access to high quality physical and behavioral health coverage and carefor all County residents. Access to comprehensive, quality health care coverage and services is critical for achieving greater health equity and for increasing the quality of life of the entire community. Access to health care is multi-faceted and focused on more than just an adequate distribution of clinical service facilities and hospitals, including electronic records and patient access to services via the internet. Promote equitable access to high quality clinical preventive services to ensure effective health screening, education, and early intervention. Working with the medical community and providers, promote access to a regular community-based source of high quality primary care and coordination of services. Promote efforts that help achieve higher levels of patient engagement and appropriate self-management through coordinated care. Focus efforts on increasing the number of residents with health insurance coverage, including oral health, particularly for vulnerable communities, the residually uninsured, and those most likely to experience health inequities. Promote the recruitment and retention of sufficient numbers of primary care providers to meet the growing demand of those with coverage and needs for basic health services. Continue to improve the integrated treatment of cooccurring physical and behavioral health needs, such as mental health substance abuse disorders, particularly within County health settings. Support the increased availability of home care and appropriate assisted living opportunities for older adults and people with disabilities, including appropriate support and resources for caregivers of older adults and people with disabilities. Strategy #4: Educate and empower individuals, employers and communities to improve population health and advocatefor positive change. A key component of improving community health is the work of governmental and non- governmental organizations to educate, empower and enlist support from all those who can play a role in improving health outcomes. Health equity cannot be achieved without informing and involving the affected groups who best understand the assets and needs of their communities and who can offer insight into the potential effectiveness of various strategies, programs, or actions. Ultimately, insightful contributions from individuals and community organizations can be as much a part of the solution for improved community health as the direct services of public agencies and other health service providers. Continue to provide and expand innovative public education programs that support better health outcomes and help to eliminate health inequities. Maintain effective community presence, liaisons, and relationship building within communities. Provide for meaningful and purposeful participation and dialogue with health department representatives in local forums. Continue to partner with and utilize local schools and school-based organizations to provide educational and school-linked services. Continue to provide countywide, citywide, and neighborhood level health profiles and data to encourage neighborhood and community level information about health issues and trends. Support policies, initiatives and work-force collaborations that improve employee health, well-being, productive workplace engagement, and workplace satisfaction. Support expanded opportunities for youth and older adults to engage in community service that integrates community health and improvement. Promote education, training, and information for seniors, caregivers, and emergency responders regarding special needs and conditions affecting older adults, including but not limited to, falls prevention, dementia, nutrition, transportation, social isolation and social support. Revised Public Review Draft February 2015 16 Health Element - Social and Emotional Health B. In early childhood, the social emotional health of young children relates to the ability to form secure relations, selfregulate emotions, and explore and learn. During adulthood, social and emotional health involves intimate partner relationships and finding success in employment and careers.

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