Releases Ngc
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| 2007 W 1 Silver American Eagle NGC MS 69 Early Releases | |
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| 2011D OLYMPIC NGC MS66 EARLY RELEASE | |
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| 2011 25TH ANNIVERSARY SILVER EAGLE 5 COIN SET NGC PF70 MS70 EARLY RELEASES | |
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| 2007 American Eagle Gem Uncirculated NGC Early Releases | |
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| 2008 W AMERICAN SILVER EAGLE 1 EARLY RELEASES MS70 GRADED BY NGC BLUE LABEL | |
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| 2007 American Eagle Gem Uncirculated NGC Early Releases | |
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| 2007 NGC MS 70 EARLY RELEASES 5 GOLD EAGLE | |
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| 2008 W SILVER EAGLE NGC PF 70 ULTRA CAMEO EARLEY RELEASE | |
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| 2007 American Eagle Gem Uncirculated NGC Early Releases | |
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| 2007 NGC MS70 Early Releases 5 American Gold Eagle | |
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| 2009 NGC Early Releases MS70 5 American Gold Eagle | |
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| 2011 MS70 NGC RED LABEL 25TH ANNIVERSARY EARLY RELEASES SILVER EAGLE | |
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$52.02 (6 Bids) Time Remaining: 12h 3m |
| 2011 American Eagle 25th Anniversary Set NGC MS70 PF70 Early Release | |
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| 2010 Grand Canyon NP 25 Cent 5 oz Silver NGC Gem Uncirculated Early Release | |
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| 2010 Yellowstone NP 25 Cent 5 oz Silver NGC Gem Uncirculated Early Release | |
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$200.00 (1 Bid) Time Remaining: 12h 29m |
| CHINA PANDA 999SILVER 1oz 201110YUAN NGC MS70 PERFECT PANDA EARLY RELEASE | |
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| 2011P NGC MS68 Early Release Olympic NPQ High End | |
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| 2010 MS70 SILVER EAGLEEARLY RELEASEPERFECT GRADE NGC | |
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| 2012 MS70 SILVER EAGLEEARLY RELEASEPERFECT GRADE NGC | |
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$51.00 (7 Bids) Time Remaining: 13h 9m |
| 2012 NGC MS69 ER 1 American SILVER Eagle EARLY RELEASES Blue insert 2012 MS 69 | |
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$36.00 (4 Bids) Time Remaining: 13h 30m |
| 2010 9999 GOLD American Buffalo 50 Early Release NGC MS70 FREE Ship | |
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$1,876.51 (17 Bids) Time Remaining: 13h 34m |
| 2 2007 NGC PF69 MS69 Eagle Proof U CAM EARLY RELEASE | |
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| 2011 W SILVER EAGLE 25TH ANNIVERSARY NGC PF69 ULTRA CAMEO Early Release | |
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| 2010 P Yosemite America The Beautiful NGC SP69 Early Releases | |
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| 2011 P CHICKASAW QUARTER NGC MS68 UNCIRCULATED BUSINESS STRIKE EARLY RELEASES | |
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| 2010 W American Eagle Proof 1 NGC PF 69 Early Release | |
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$51.00 (9 Bids) Time Remaining: 14h 33m |
| 2012 SILVER EAGLE NGC FIRST RELEASES MS 69 NO RESERVE | |
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$38.05 (5 Bids) Time Remaining: 14h 33m |
| 2010 D 25 MOUNT HOOD NATIONAL FOREST RELEASE CEREMONY NOV 17 2010 NGC MS66 | |
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| 2011 W 25th annivproof silver eagle NGC proof 70 early release blue lable | |
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$76.02 (5 Bids) Time Remaining: 14h 45m |
| 2012 NGC MS69 ER 1 American SILVER Eagle EARLY RELEASES Blue insert 2012 MS 69 | |
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$22.38 (4 Bids) Time Remaining: 15h 11m |
| 2011 P VICKSBURG QUARTER NGC MS68 UNCIRCULATED BUSINESS STRIKE EARLY RELEASES | |
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| 2007 American Silver Eagle NGC MS 69 Early Releases | |
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| 2011W Silver Eagle from 25th Anniversary set NGC MS68 Early Release | |
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| 2011S Silver Eagle from 25th Anniversary set NGC MS68 Early Release | |
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$178.25 (2 Bids) Time Remaining: 15h 27m |
| 2011 NATIONAL PARKS 25 RELEASE CEREMONY 5 COIN SET NGC MS66 PD LOCATION | |
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| 2011 NATIONAL PARKS 25 RELEASE CEREMONY 5 COIN SET NGC MS65 PD LOCATION | |
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| 2011 100 Dollar 1 ounce Platinum Eagle Early Release Ultra Cameo PF70 NGC w OGP | |
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| 2 ounces of Fine Silver 2007 W 1 Silver Eagle Early Releases NGC MS69 | |
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$69.51 (11 Bids) Time Remaining: 15h 38m |
| 2011 D 25 CHICKASAW RELEASE CEREMONY NOVEMBER 16 2011 QUARTER NGC MS65 | |
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| 2011 D 25 CHICKASAW RELEASE CEREMONY NOVEMBER 16 2011 QUARTER NGC MS66 | |
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| 2011 P GETTYSBURG QUARTER NGC MS68 UNCIRCULATED BUSINESS STRIKE EARLY RELEASES | |
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| 2007 American Buffalo Gold 50 Coin in NGC MS69 Early Release Condition | |
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$1,813.88 (23 Bids) Time Remaining: 15h 58m |
| 2011 S ANDREW JOHNSON PRESIDENTIAL PROOF DOLLAR NGC PF69 EARLY RELEASES US MINT | |
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$4.25 (4 Bids) Time Remaining: 16h 4m |
| 2010 W Proof Silver Eagle NGC PF69UC Early Release | |
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$56.00 (31 Bids) Time Remaining: 16h 13m |
| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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$43.06 (5 Bids) Time Remaining: 16h 34m |
| 2012 W SILVER EAGLE NGC MS 70 FIRST RELEASES WEST POINT LABEL | |
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$75.70 (4 Bids) Time Remaining: 16h 34m |
| CHINA PANDA NGC 2011 MS69PL EARLY RELEASE P L UNC | |
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| 2012 W SILVER EAGLE 1 STRUCK AT WEST POINT MINT NGC MS70 EARLY RELEASES | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS70 | |
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| 2012 S SILVER QUARTER SET EARLY RELEASES NGC PF70 ULTRA CAMEO | |
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| 2012SSILVER EAGLE NGC MS69 EARLY RELEASES STRUCK AT SAN FRANCISCO MINT BLUE | |
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| 2012WSILVER EAGLE NGC MS70 FIRST RELEASES STRUCK AT WEST POINT MINT BLUE LABEL | |
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| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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| 2012 S SILVER QUARTER SET EARLY RELEASES NGC PF69 ULTRA CAMEO | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS70 | |
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| 2012 W SILVER EAGLE 1 NGC MS69 EARLY RELEASES STRUCK AT WEST POINT MINT | |
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| 2012 S SAN FRANCISCO SILVER EAGLE NGC MS69 EARLY RELEASES | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS69 IN STOCK | |
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| 2012 S SILVER QUARTER SET EARLY RELEASES NGC PF70 ULTRA CAMEO | |
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| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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| 2011 S SILVER 10C EARLY RELEASES NGC PF70 ULTRA CAMEO | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS69 | |
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| 2012 S SAN FRANCISCO SILVER EAGLE NGC MS70 EARLY RELEASES | |
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| 2012WSILVER EAGLE NGC MS70 FIRST RELEASES STRUCK AT WEST POINT MINT BLUE LABEL | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS70 | |
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| 2012SSILVER EAGLE NGC MS69 EARLY RELEASES STRUCK AT SAN FRANCISCO MINT BLUE | |
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| 3 2011 D US Army Commemorative Half Dollar Clad Coin NGC MS69 Early Release Mint | |
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| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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| 2011 S Clad ROOSEVELT DIME NGC PR70 UCAM Early Releases REGISTRY | |
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| 2011 S Silver ROOSEVELT DIME NGC PR70 UCAM Early Releases REGISTRY | |
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| 2012 W SILVER EAGLE 1 STRUCK AT WEST POINT MINT NGC MS70 EARLY RELEASES | |
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| 2010 P 5oz ER HOT SPRINGS ATB Silver NGC SP70 Early Releases 5oz silver | |
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| 2012WSILVER EAGLE NGC MS70 FIRST RELEASES STRUCK AT WEST POINT MINT BLUE LABEL | |
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| 2012SSILVER EAGLE NGC MS69 EARLY RELEASES STRUCK AT SAN FRANCISCO MINT BLUE | |
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| 2011 D 1 Andrew Johnson NGC MS67 Early Releases Position A | |
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| 2010 P 5oz ER Grand Canyon Silver NGC SP70 Early Releases 5oz silver ATB | |
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| 2012 S SILVER QUARTER SET EARLY RELEASES NGC PF70 ULTRA CAMEO | |
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| 2012 W SILVER EAGLE 1 NGC MS69 EARLY RELEASES STRUCK AT WEST POINT MINT | |
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| 2011 W Proof American Silver Eagle NGC PF 70 Ultra Cameo Early Releases | |
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| 2012 SILVER EAGLE NGC FIRST RELEASES MS 69 NO RESERVE | |
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| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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| 2011 S Early Releases 25th Anniversary SET Silver eagle NGC MS69 S MINT MARK | |
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| 2012WSILVER EAGLE NGC MS70 FIRST RELEASES STRUCK AT WEST POINT MINT BLUE LABEL | |
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| 2012 S SAN FRANCISCO SILVER EAGLE NGC MS70 EARLY RELEASES | |
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| 2011 Early Releases 25th Anniversary SET Silver eagle NGC MS69 | |
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| 2012SSILVER EAGLE NGC MS69 EARLY RELEASES STRUCK AT SAN FRANCISCO MINT BLUE | |
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| 2011 D CHICKASAW QUARTER BUSINESS NGC MS67 EARLY RELEASES UNCIRCULATED US MINT | |
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| 2011 D VICKSBURG QUARTER BUSINESS NGC MS67 EARLY RELEASES UNCIRCULATED US MINT | |
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$10.50 (4 Bids) Time Remaining: 17h 47m |
| 2012 W Silver Eagle Struck at West Point Mint NGC MS69 ER Early Releases Star | |
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$44.00 (5 Bids) Time Remaining: 17h 48m |
| 2011 25th Anniversary Silver Eagle 5 Coin Set NGC MS 69 PF 69 P Early Releases | |
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| 2012 W SILVER EAGLE 1 NGC MS69 EARLY RELEASES STRUCK AT WEST POINT MINT | |
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| 2012SSILVER EAGLE NGC MS69 EARLY RELEASES STRUCK AT SAN FRANCISCO MINT BLUE | |
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| 2012WSILVER EAGLE NGC MS70 FIRST RELEASES STRUCK AT WEST POINT MINT BLUE LABEL | |
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| 2011 D 25 GLACIER NATIONAL PARK RELEASE CEREMONY APRIL 13 2011 NGC MS66 | |
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| 2012 SILVER EAGLE S1 EARLY RELEASES BLUE LABEL NGC MS70 | |
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$36.51 (4 Bids) Time Remaining: 17h 54m |
| 2010 D Hotsprings National Park Quarter NGC MS65 Release Ceremony 3 shipping | |
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Has Nasa released pictures of the recent supernova caught with Hubble in NGC 2770?
http://news.yahoo.com/s/nm/20080521/sc_nm/supernova_dc
Space.com is good source for stuff like this. Here it is, X-ray and visable light.
http://www.space.com/php/multimedia/imagedisplay/img_display.php?pic=080521-snova-before-02.jpg&cap=NASA%92s+Swift+satellite+took+these+images+of+SN+2007uy+in+galaxy+NGC+2770+before+SN+2008D+exploded.+An+X-ray+image+is+on+the+left%2C+the+right+is+in+visible+light.%0D%0ACredit%3A+NASA%2FSwift+Science+Team%2FStefan+Immler.
Applying the 4 Quadrant Healthcare Model and Evidence-Based Practices to Behavioral Health
APPLICATION OF THE FOUR QUADRANT HEALTHCARE MODEL TO VARIOUS POPULATIONS -
The examples used in the diagram of the Four Quadrant Integration model are for adult populations; the same template can be used to create models that are specific for children and adolescents, or older adults, reflecting the unique issues of serving those populations (for example, the role of schools and school based services in serving children). Older adults, particularly, have been shown to utilize primary care settings for psychosocial, non-organic somatic complaints and to be underrepresented in specialty behavioral health populations -- research suggests they are willing to receive behavioral health services in a primary care setting and that targeted interventions can make a difference in depression symptoms. Ethnic, language and racial groups also have unique issues in receiving language and culturally appropriate behavioral health services. Primary care based behavioral health services can improve access for these populations and lead to appropriate engagement with behavioral health specialty services as needed. For example, the Bridge Program in metropolitan New York has been successful in reaching the Asian-American community via their primary care settings.
There are also differences between rural and urban environments and among regional markets in terms of the resources available and ease or difficulty of access to services. The Four Quadrant Integration model provides a template for considering the resources locally available and developing alternative methods of coordination (for example, telemedicine) that may be required when specialty care (either physical or behavioral health) is delivered in another community.
The Four Quadrant Clinical Integration model is not diagnosis specific; it looks at degree of clinical complexity and risk/level of functioning. Further, the evidence-base is at different levels of development in each of the Quadrants. The model is intended to provide a conceptual construct for how to integrate services. Diagnosis specific guidelines should be used to provide detailed guidance for the scope of the primary care provider, the primary care based behavioral health provider, and the specialty behavioral health provider.
THE FOUR QUADRANT MODEL AND EVIDENCE-BASED PRACTICES IN HEALTHCARE AND BEHAVIORAL HEALTH -
In the healthcare system, there are numerous evidence-based practice guidelines that are diagnosis/condition specific. The National Guideline Clearinghouse (NGC) is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, in partnership with the American Medical Association and the American Association of Health Plans. There are over 1000 disease/condition guidelines that can be accessed through their website (www.guideline.gov).
The Chronic Care Model (CCM) (http://www.improvingchroniccare.org/change/index.html) was developed under the Improving Chronic Illness Care Program. The CCM is in use in a variety of healthcare settings, providing a structured approach for clinical improvement.
The CCM has been used to develop specific approaches for serving patients with diabetes, cardiovascular disease, asthma and depression in a project sponsored by the Bureau of Primary Health Care (BPHC) with the Institute for Healthcare Improvement (IHI), a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. The Health Disparities Collaboratives (http://www.healthdisparities.net/) are a multi-year national initiative to implement models of patient care and change management in order to transform the system of care for underserved populations.
The organizing principles for each of Health Disparities Manuals follows the key elements of the CCM; many of the components apply to each disease entity (e.g., diabetes, asthma, depression), while specific tasks and tools are unique to the specific disease entity. The key change concepts found in the Depression Collaborative manual include:
Organization of Health Care/Leadership -
> Make sure senior leaders and staff visibly support and promote the effort to improve chronic care
> Make improving chronic care a part of the organization's vision, mission, goals, performance improvement, and business plan
> Make sure senior leaders actively support the improvement effort by removing barriers and providing necessary resources
> Assign day-to-day leadership for continued clinical improvement
> Integrate collaborative models into the quality improvement program
Decision Support -
> Embed evidence-based guidelines in the care delivery system
> Establish linkages with key specialists to assure that primary care providers have access to expert support
> Provide skill oriented interactive training programs for all staff in support of chronic illness improvement
> Educate patients about guidelines
Delivery System Design -
> Identify depressed patients during visits for other purposes
> Use the registry to proactively review care and plan visits
> Assign roles, duties and tasks for planned visits to a multidisciplinary care team. Use cross training to expand staff capability
> Use planned visits in individual and group settings
> Make designated staff responsible for follow-up by various methods, including outreach workers, telephone calls and home visits
Clinical Information System -
> Establish a registry
> Develop processes for use of the registry, including designating personnel to enter data, assure data integrity, and maintain the registry
> Use the registry to generate reminders and care planning tools for individual patients
> Use the registry to provide feedback to care team and leaders
Self- Management -
> Use depression self management tools that are based on evidence of effectiveness
> Set and document self management goals collaboratively with patients
> Train providers and other key staff on how to help patients with self management goals
> Follow up and monitor self management goals
> Use group visits to support self management
Community -
> Establish links with organizations to develop support programs and policies
> Link to community resources for defrayed medication costs, education and materials
> Encourage participation in community education classes and support groups
> Raise community awareness through networking, outreach and education
> Provide a list of community resources to patients, families and staff
EVIDENCE-BASED PRACTICES IN THE BEHAVIORAL HEALTH SYSTEM -
The Chronic Care Model (CCM) has also been adapted by The National Program Office for Depression in Primary Care (http://www.wpic.pitt.edu/dppc/), to develop a clinical framework for all partnering organizations to follow. Its Flexible Blueprint was developed after a review of published interventions used to treat depression, interviews with a variety of primary care physicians, mental health specialists and other experts in the field, and selected site visits to view elements of the Chronic Care Model in action.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting the Implementing Evidence Based Practices Project. This project is focused on people who have severe mental illness; these people are most frequently served in the public mental health system (http://www.mentalhealthpractices.org/).
There are six areas that have been researched. Toolkits have been developed based on the multi-state demonstrations that have been underway. The six areas are described below, based on the website materials:
Illness Management and Recovery -
This is a program of weekly sessions where specially trained MH practitioners help people develop personal strategies for coping with mental illness and moving forward in their lives. The program emphasizes helping people set and pursue personal goals and become better able to realize their vision of recovery.
Medication Management Approaches In Psychiatry (Medmap) -
This focuses on using medication in a systematic and effective way, providing guidelines and steps for decision-making based on current evidence and outcomes, monitoring and recording information about medication results, and involving consumers in the decision-making process.
Assertive Community Treatment (ACT) -
This program is for people who experience the most severe symptoms of mental illness. The goal is to help people stay out of the hospital and develop skills for living in the community. Services are provided by a team of practitioners, are available whenever and wherever needed, 24-hours a day, and are provided for as long as they are wanted and needed.
Family Psychoeducation -
This involves a strong partnership between consumers, families and supporters, and practitioners. People work toward recovery by developing better skills for overcoming everyday problems and illness-related issues, developing social support, and improving communication with treatment providers.
Supported Employment -
This is a well-defined approach to helping people with mental illness find and keep competitive employment. These programs are for anyone who expresses the desire to work. The programs are staffed by employment specialists who work with the treatment team to integrate services. They help people look for jobs soon after entering the program, and provide support as long as consumers want the assistance.
Integrated Dual Disorders Treatment -
This treatment approach is for people who have mental illness and addiction disorders, offering mental health and substance abuse services together, in one setting, at the same time. A wide variety of services are offered in a stage-wise fashion because some services are important early in treatment, while others are important later on.
The EBPs described above are intended for use in the public mental health system, serving people with severe mental illness; they are not diagnosis specific. The American Association of Community Psychiatrists (http://www.wpic.pitt.edu/aacp/default.htm) has released guidelines, such as Guidelines for Recovery Oriented Services that also address this target population rather than a diagnosis specific population.
The American Psychiatric Association has developed diagnosis specific practice guidelines (http://www.psych.org/) that are applicable in a wide variety of settings, as have other professional groups. The following list of behavioral healthcare guidelines and protocols is from the National Guideline Clearinghouse:
> Adjustment Disorders
> Anxiety Disorders
> Delirium, Dementia, Amnestic, Cognitive Disorders
> Dissociative Disorders
> Eating Disorders
> Factitious Disorders
> Impulse Control Disorders
> Mental Disorders Diagnosed in Childhood
> Mood Disorders
> Neurotic Disorders
> Personality Disorders
> Schizophrenia and Disorders with Psychotic Features
> Sexual and Gender Disorders
> Sleep Disorders
> Somatoform Disorders
> Substance-Related Disorders
EVIDENCE-BASED PRACTICES FOR ALL POPULATIONS -
There are evidence-based practices in clinical preventive services that should be utilized with all populations, whether or not they are receiving services related to a particular diagnosis or condition. This is an area for improvement in services to persons with severe mental illness, who historically have had difficult accessing healthcare services for acute or chronic medical conditions, not to mention clinical screening and prevention services.
The U.S. Preventive Services Task Force (USPSTF) (http://www.ahcpr.gov/clinic/uspstfix.htm) was convened by the U.S. Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and chemoprevention. The USPSTF consists of 15 experts from the specialties of family medicine, pediatrics, internal medicine, obstetrics and gynecology, geriatrics, preventive medicine, public health, behavioral medicine, and nursing. The recommended clinical prevention services are organized into the following clinical categories:
> Cancer
> Heart and Vascular Diseases
> Injury and Violence-Related Disorders
> Infectious Diseases
> Mental Disorders and Substance Abuse
> Metabolic, Nutritional, and Endocrine Disorders
> Musculoskeletal Disorders
> Obstetric Disorders
> Pediatric Disorders
> Vision and Hearing Disorders
The original Task Force's efforts culminated in the 1989 Guide to Clinical Preventive Services. A second edition of the Guide was published in 1996. In November 1998, the Agency for Healthcare Research and Quality (then the Agency for Health Care Policy and Research) convened the current USPSTF to update existing Task Force assessments and recommendations and to address new topics.
CONCLUSION -
The Institute of Medicine's Improving the Quality of Healthcare for Mental and Substance-Use Conditions states: "A large body of research and other published work on organizational change, for example, consistently calls attention to five predominantly human resource management practices (and one other organizational practice) that are key to successful change implementation (1) ongoing communication about the desired change with those who are to effect it; (2) training in the new practice; (3) worker involvement in designing the change process; (4) sustained attention to progress in making the change; (5) use of mechanisms for measurement, feedback, and redesign; and (6) functioning as a learning organization. All of these practices require the exercise of effective leadership."
About the Author
Linda Rosenberg is the president and CEO of the National Council for Community Behavioral Healthcare. TNC specializes in lobbying for research toward the diagnosis and treatment of mental illness and substance abuse, pioneering the Four Quadrant Model for integrating health care. Lean more at www.thenationalcouncil.org.
Black Hole/Vortex in the Center Heart of Galaxy NGC 4261
