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Small Clinical Trials

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309171148
Total Pages : 221 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Small Clinical Trials by : Institute of Medicine

Download or read book Small Clinical Trials written by Institute of Medicine and published by National Academies Press. This book was released on 2001-01-01 with total page 221 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical trials are used to elucidate the most appropriate preventive, diagnostic, or treatment options for individuals with a given medical condition. Perhaps the most essential feature of a clinical trial is that it aims to use results based on a limited sample of research participants to see if the intervention is safe and effective or if it is comparable to a comparison treatment. Sample size is a crucial component of any clinical trial. A trial with a small number of research participants is more prone to variability and carries a considerable risk of failing to demonstrate the effectiveness of a given intervention when one really is present. This may occur in phase I (safety and pharmacologic profiles), II (pilot efficacy evaluation), and III (extensive assessment of safety and efficacy) trials. Although phase I and II studies may have smaller sample sizes, they usually have adequate statistical power, which is the committee's definition of a "large" trial. Sometimes a trial with eight participants may have adequate statistical power, statistical power being the probability of rejecting the null hypothesis when the hypothesis is false. Small Clinical Trials assesses the current methodologies and the appropriate situations for the conduct of clinical trials with small sample sizes. This report assesses the published literature on various strategies such as (1) meta-analysis to combine disparate information from several studies including Bayesian techniques as in the confidence profile method and (2) other alternatives such as assessing therapeutic results in a single treated population (e.g., astronauts) by sequentially measuring whether the intervention is falling above or below a preestablished probability outcome range and meeting predesigned specifications as opposed to incremental improvement.

Patient Safety and Quality

Author : Ronda Hughes
Publisher : Department of Health and Human Services
ISBN 13 :
Total Pages : 592 pages
Book Rating : 4.:/5 (318 download)

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Book Synopsis Patient Safety and Quality by : Ronda Hughes

Download or read book Patient Safety and Quality written by Ronda Hughes and published by Department of Health and Human Services. This book was released on 2008 with total page 592 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

The Role of Telehealth in an Evolving Health Care Environment

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309262011
Total Pages : 159 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis The Role of Telehealth in an Evolving Health Care Environment by : Institute of Medicine

Download or read book The Role of Telehealth in an Evolving Health Care Environment written by Institute of Medicine and published by National Academies Press. This book was released on 2012-12-20 with total page 159 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.

Improving Diagnosis in Health Care

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309377722
Total Pages : 473 pages
Book Rating : 4.3/5 (93 download)

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Book Synopsis Improving Diagnosis in Health Care by : National Academies of Sciences, Engineering, and Medicine

Download or read book Improving Diagnosis in Health Care written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2015-12-29 with total page 473 pages. Available in PDF, EPUB and Kindle. Book excerpt: Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Small-Bowel Obstruction

Author : Roberto Di Mizio
Publisher : Springer Science & Business Media
ISBN 13 : 8847006678
Total Pages : 121 pages
Book Rating : 4.8/5 (47 download)

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Book Synopsis Small-Bowel Obstruction by : Roberto Di Mizio

Download or read book Small-Bowel Obstruction written by Roberto Di Mizio and published by Springer Science & Business Media. This book was released on 2007-10-15 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: The aim of this radiological atlas is to connect pathophysiology to imaging using many illustrations and examples, emphasizing the capabilities and limitations of multidetector computed tomography and its role in the correct management approach to these disorders. Furthermore, the place of allied imaging modalities (plain film and ultrasound) in the clinical algorithm is comprehensively illustrated.

Registries for Evaluating Patient Outcomes

Author : Agency for Healthcare Research and Quality/AHRQ
Publisher : Government Printing Office
ISBN 13 : 1587634333
Total Pages : 385 pages
Book Rating : 4.5/5 (876 download)

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Book Synopsis Registries for Evaluating Patient Outcomes by : Agency for Healthcare Research and Quality/AHRQ

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

Author : Jamie M. Burkitt Creedon
Publisher : John Wiley & Sons
ISBN 13 : 1119581419
Total Pages : 1092 pages
Book Rating : 4.1/5 (195 download)

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Book Synopsis Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care by : Jamie M. Burkitt Creedon

Download or read book Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care written by Jamie M. Burkitt Creedon and published by John Wiley & Sons. This book was released on 2023-05-31 with total page 1092 pages. Available in PDF, EPUB and Kindle. Book excerpt: Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care Detailed, standardized, step-by-step protocols for easy access to essential information in small animal emergency rooms and intensive care units Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care, Second Edition offers a complete and clinically oriented reference for step-by-step detail on a wide range of procedures in the small animal emergency room and intensive care unit. Each protocol provides detailed instructions grounded in the evidence. The book is carefully designed for ease of use, with concise but comprehensive explanations, useful equipment lists, protocols called out in boxes, and extensive reference lists. In the revised and expanded Second Edition, information has been updated and expanded throughout, and information and chapters have been added in many important areas, including veterinary point-of-care ultrasound (VPOCUS), veterinary CPR, blood banking and transfusion medicine, advanced techniques for mechanical ventilation, and veterinary health care team wellbeing. A companion website offers the protocols in Word for editing and use in practice and the figures from the book in PowerPoint. Specific topics covered in Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care include: The cardiovascular system, covering catheterization of the venous compartment, arterial puncture and catheterization, cardiac VPOCUS, principles of electrocardiography, and electrocardiogram interpretation The respiratory system, covering oxygen therapy, pulse oximetry and CO-oximetry, blood gas analysis, pleural space and lung VPOCUS, tracheal intubation, and temporary tracheostomy The urinary and abdominal systems, covering urethral catheterization, abdominal VPOCUS, peritoneal dialysis, technical management of hemodialysis patients, and peritoneal evaluation Transfusion medicine, covering blood banking, blood typing, cross-matching, and administration of blood and other biological products Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care presents invaluable and accessible information for emergency situations, making it a highly useful reference for veterinary practitioners, veterinary technicians and nurses, veterinary students, small animal emergency and critical care residents, small animal emergency and critical care specialists, and emergency and critical care veterinary technicians and nurse specialists.

Small Animal Pediatrics

Author : Michael E. Peterson
Publisher : Elsevier Health Sciences
ISBN 13 : 1437701957
Total Pages : 545 pages
Book Rating : 4.4/5 (377 download)

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Book Synopsis Small Animal Pediatrics by : Michael E. Peterson

Download or read book Small Animal Pediatrics written by Michael E. Peterson and published by Elsevier Health Sciences. This book was released on 2010-06-22 with total page 545 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical reference for the general veterinary clinician, Small Animal Pediatrics: The First 12 Months of Life compiles into a single location the latest information in the rapidly developing field of canine and feline pediatrics. Editors Michael Peterson, DVM, MS, and Michelle Kutzler, DVM, PhD, DACT are joined by more than 40 expert contributors in providing coverage from prenatal care to one year of age. For ease of use, the text is divided into four sections. A General Considerations section opens the book by covering prenatal care of the bitch and queen, birth, normal physical examinations, growth, husbandry, nutrition, care of orphans, neonatal mortality, behavior, emergency and critical care, and immunology. The second section, Common Infectious Diseases, covers bacterial, viral, fungal, rickettsial, and parasitic infections. The third section describes diagnostic and therapeutic approaches to the young patient including radiology, ultrasound, aesthetic and surgical considerations, pain management, pharmacology, and clinical pathology. Finally, the fourth section covers a variety of organ systems with discussions on normal development, congenital conditions, and acquired diseases. The text also includes information that is usually difficult to find, including a pediatric formulary, care of orphan puppies, clinical pathology values, prenatal care, and normal growth and development guidelines. This book will be a significant asset to any veterinary library! - Offers a practical, clinically oriented resource for the unique diagnostic and treatment challenges posed by pediatric and juvenile animal patients. - Includes comprehensive coverage of all special problems encountered in pet management from birth through the first 12 months of life. - Provides clear, step-by-step guidelines for important clinical procedures and techniques for the most vulnerable of small animal patients. - Covers procedures such as intraosseous catheterization and fluid therapy, venipuncture, and tube feeding. - Includes guidelines for designing and implementing a successful pediatric wellness program tailored to your own practice. - Discusses infectious diseases in young animals, zoonotic potential, and human public health concerns. - Provides key new information on puppy and kitten behavioral development including guidance for prevention and intervention for problem behaviors, the leading cause of pet euthanasia. - Includes guidelines for kennel and cattery health management as well as shelter medicine health considerations. - Discusses controversial health and ethical issues in veterinary pediatrics, such as ear cropping, tail docking, declawing, and early spay/neuter surgery (including both pro and con positions). - Includes the latest recommendations for nutritional care of healthy and "special needs" puppies and kittens as well as the post-parturient and nursing dam. - Offers an easy-to-use, well-organized format for quick and easy access to the most relevant information.

Unequal Treatment

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 030908265X
Total Pages : 781 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Unequal Treatment by : Institute of Medicine

Download or read book Unequal Treatment written by Institute of Medicine and published by National Academies Press. This book was released on 2009-02-06 with total page 781 pages. Available in PDF, EPUB and Kindle. Book excerpt: Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Care Without Coverage

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309083435
Total Pages : 213 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Care Without Coverage by : Institute of Medicine

Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Preventing Medication Errors

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309133734
Total Pages : 480 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Preventing Medication Errors by : Institute of Medicine

Download or read book Preventing Medication Errors written by Institute of Medicine and published by National Academies Press. This book was released on 2006-12-11 with total page 480 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation's quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the seriesâ€"To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004)â€"this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.

Surgical Treatment

Author : René Holzheimer
Publisher :
ISBN 13 :
Total Pages : 880 pages
Book Rating : 4.6/5 (211 download)

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Book Synopsis Surgical Treatment by : René Holzheimer

Download or read book Surgical Treatment written by René Holzheimer and published by . This book was released on 2001 with total page 880 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Health Professions Education

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 030913319X
Total Pages : 191 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Health Professions Education by : Institute of Medicine

Download or read book Health Professions Education written by Institute of Medicine and published by National Academies Press. This book was released on 2003-07-01 with total page 191 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

Small Bites

Author : Katie Jay
Publisher :
ISBN 13 : 9780977228911
Total Pages : 416 pages
Book Rating : 4.2/5 (289 download)

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Book Synopsis Small Bites by : Katie Jay

Download or read book Small Bites written by Katie Jay and published by . This book was released on 2007-10-01 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Small Animal Fluid Therapy

Author : Edward Cooper
Publisher : CABI
ISBN 13 : 1789243386
Total Pages : 159 pages
Book Rating : 4.7/5 (892 download)

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Book Synopsis Small Animal Fluid Therapy by : Edward Cooper

Download or read book Small Animal Fluid Therapy written by Edward Cooper and published by CABI. This book was released on 2022-12-21 with total page 159 pages. Available in PDF, EPUB and Kindle. Book excerpt: Fluid therapy is one of the most important aspects of patient management in veterinary medicine, and this book provides guidelines for its safe implementation in clinical practice. It describes fluid compartments of the body and considers the factors that affect movement of administered water, electrolytes and colloids. It also covers characteristics of different fluid types, routes of fluid administration and how to approach fluid supplementation. Finally, this book provides information regarding both general application and monitoring of fluid therapy, as well as consideration of an assortment of specific clinical circumstances. With multiple case study examples to help translate theory into practical advice, this valuable book provides a comprehensive and informative resource for veterinarians facing a range of clinical circumstances.

Health-Care Utilization as a Proxy in Disability Determination

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 030946921X
Total Pages : 161 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Health-Care Utilization as a Proxy in Disability Determination by : National Academies of Sciences, Engineering, and Medicine

Download or read book Health-Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

CDC Yellow Book 2018: Health Information for International Travel

Author : Centers for Disease Control and Prevention CDC
Publisher : Oxford University Press
ISBN 13 : 0190628634
Total Pages : 705 pages
Book Rating : 4.1/5 (96 download)

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Book Synopsis CDC Yellow Book 2018: Health Information for International Travel by : Centers for Disease Control and Prevention CDC

Download or read book CDC Yellow Book 2018: Health Information for International Travel written by Centers for Disease Control and Prevention CDC and published by Oxford University Press. This book was released on 2017-04-17 with total page 705 pages. Available in PDF, EPUB and Kindle. Book excerpt: THE ESSENTIAL WORK IN TRAVEL MEDICINE -- NOW COMPLETELY UPDATED FOR 2018 As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, practical information about the health challenges posed by travel has never been greater. For both international travelers and the health professionals who care for them, the CDC Yellow Book 2018: Health Information for International Travel is the definitive guide to staying safe and healthy anywhere in the world. The fully revised and updated 2018 edition codifies the U.S. government's most current health guidelines and information for international travelers, including pretravel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. The 2018 Yellow Book also addresses the needs of specific types of travelers, with dedicated sections on: · Precautions for pregnant travelers, immunocompromised travelers, and travelers with disabilities · Special considerations for newly arrived adoptees, immigrants, and refugees · Practical tips for last-minute or resource-limited travelers · Advice for air crews, humanitarian workers, missionaries, and others who provide care and support overseas Authored by a team of the world's most esteemed travel medicine experts, the Yellow Book is an essential resource for travelers -- and the clinicians overseeing their care -- at home and abroad.