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Therefore, for purposes of sick pay, California employers should look to Labor Code sections 246(k)(1) or (2)- which articulate the two methods used to calculate sick pay for nonexempt employees-when determining how to calculate sick time for commissioned employees, even if they qualify as exempt from overtime as either an outside salesperson or a commissioned employee. Wage Order 14 entitles agricultural employees to daily overtime for hours worked in excess of ten hours in a day. And, under 2016 legislation, gradual annual changes-beginning in 2019 and culminating in 2025-will give all agricultural workers the same daily overtime and daily doubletime entitlements that apply to non-agricultural workers. A literal interpretation of Section 512, however, could extend a general meal-period entitlement to all employees, exempt as well as nonexempt. The Court of Appeal has held that an employer can rely on a collective bargaining agreement as a means for employees to waive their first meal period for shifts that do not exceed six hours. The waiver of the second meal period must be in a writing signed by both employer and employee and applies only for a shift in which the employee works 12 or fewer hours. Superior Court decision, that an employer timely provides meal breaks so long as the first meal period is provided no later than the end of the fifth hour of work (for work shifts exceeding five hours) and so long as the second meal period (for work shifts exceeding ten hours) is provided no later than the end of the tenth hour of work. The basis for applying the de minimis doctrine was absent, the Court of Appeal reasoned, because "there is no indication of a practical administrative difficulty recording small amounts of time for payroll purposes" and thus rejected the de minimis claim. One Court of Appeal decision indicated that a rounding policy might apply to meal periods. The Ninth Circuit thus upheld a special program that gave employees the option to buy discounted meals so long as they followed a rule to eat the meal on premises (to prevent employees from abusing their privileges by buying discounted meals for others). Union-friendly California has created some meal-period exemptions for certain employees covered by collective bargaining agreements. The meal-period requirements do not apply to certain construction workers, commercial truck drivers, security officers, and gas or electrical utility workers if (1) their employment is governed by a "valid collective bargaining agreement" that expressly provides for such things as meal periods and final and binding arbitration of meal-period disputes and (2) their regular wage is 30% more than the state minimum wage. Truck drivers transporting commercial livestock feed to "remote, rural areas" may take a meal period after the sixth hour if their regular rate of pay is at least one and a half times the state minimum wage and the driver is subject to overtime pay. Failure to provide a required rest break makes the employer liable for an extra hour of pay for each day in which a required rest break is not authorized and permitted. Yet in 2016 the California Supreme Court upset long-standing employer expectations on this issue in Augustus v. A Los Angeles trial judge ruled, in 2012, that security guards who must carry their pagers while on break were thereby denied their rest breaks, regardless of whether they were ever paged. The result was a judgment against the security company in an amount exceeding $100 million. In 2015, the Court of Appeal reversed the trial court, holding that on-call rest breaks are still valid rest breaks, unless the employer actually interrupts the break by calling the employee to duty during the break. The Court of Appeal noted that the standard was whether the employer had breached its duty "not to require an employee to work during a meal or rest or recovery period. The result was an unexpected opinion that disrupted the sensible outcome reached by the Court of Appeal. The simplistic view adopted in Augustus is that a "rest period" must be "a period of rest," which to the high court means a period wholly free of any work duty. Augustus thus overturned long-settled employer expectations by announcing that rest breaks, like meal periods, must be completely "duty free": an employee on a rest break who must be "at the ready, tethered by time and policy to particular locations or communications devices," has not been afforded the statutorily required rest break. Under this radical view, as the dissenting opinion suggests, merely requiring an employee on break to stay on premises, or to carry a radio in the case of an emergency, may make the rest break non-compliant, even if the employee on break is never interrupted. No, your employer cannot impose any restraints not inherent in the rest period requirement itself. That is, during rest periods employers must relieve employees of all duties and relinquish control over how employees spend their time. As a practical matter, however, if an employee is provided a ten minute rest period, the employee can only travel five minutes from a work post before heading back to return in time. The exemption applies only to workers covered by a collective bargaining agreement and subject to Wage Order No. As discussed below, "penalty" is the characterization that employer-defendants have preferred. Kenneth Cole Productions, erased all of that proemployer authority by ruling, unanimously, that the extra hour of pay is what the plaintiffs always said it is: a "premium wage. Murphy held that the limitations period for a meal-pay claim is now at least three years. California does have a Labor Code provision authorizing the award of attorney fees in a case claiming unpaid wages, but the California Supreme Court, in a case where the employer won and sought attorney fees, held that a claim for meal pay is not a claim for wages and that therefore the employer could not recover its attorney fees. Although the Labor Code specifies a particular way to measure the extra hour of pay-the "regular rate of compensation"-plaintiffs have argued that the proper measure is the "regular rate" used for overtime-pay purposes.

A patient may live in a wealthy suburb, own several cars, and have no problem accessing health care, even at a distance. Conversely, a seemingly shorter distance for a patient who has to walk or cannot afford public transit may prove to be too far of a distance, and hence be identified as a barrier by the patient. Special Populations Existing studies on the elderly suggest that transportation is a less significant barrier to health care access compared to younger populations. However, these studies lacked inclusion of lower-income elderly populations and did not address concerns that may be more relevant to the elderly, such as safety and disability access. It is possible that the elderly may have fewer competing demands, such as not having to share a car with family members who need a car for work or transporting children. However, additional studies are needed with more representative samples of elderly adults before any conclusions can be drawn about transportation barriers to health care access in this population. Traveling Forward: Interventions and Public Policy Collaboration between health policy makers, urban planners, and transportation experts could lead to creative Discussion this literature review on transportation barriers and access to health care yielded several important findings. Additionally, transportation barriers impacted access to pharmacies and thus medication fills and adherence. Finally, while distance from a patient to a provider would intuitively seem to be a barrier to health care access, the evidence is inconclusive. Poorer populations face more barriers to health care access in general, and transportation barriers are no exception. This is very significant because when patients cannot get to their health care provider, they miss the opportunity for evaluation and treatment of chronic disease states, changes to treatment regimens, escalation or de-escalation of care and, as a result, delay interventions that may reduce or prevent disease complications. Such collaboration could also lead to studies in areas that are lacking research, such as research on transportation policy and its impact on health outcomes outside of injury prevention [8]. These collaborations could also use prior research to guide interventions and public policy. Future interventions should consider this link in addition to public transit discounts or medical transportation services. For example, there have been interventions that provide access to cars to improve access to jobs, and these programs could be used as models for providing cars to improve health care access [69]. Additionally, reimbursement for travel should be investigated further to determine the role it plays in keeping appointments and avoiding fragmented care. These included an increase in community clinic use and hospitalizations, with a decrease in visits to urgent care clinics and emergency departments [66]. New technological innovations such as telehealth may also address transportation barriers by reducing travel needs over time. Telehealth services may include video conferencing, remote monitoring, and other disease management support at a distance. One approach to providing patient-centered care is to evaluate transportation and other barriers to ongoing health care encounters, and provide telehealth services when beneficial and cost-effective. Medication access may also be improved as more services for home medication delivery become available. Additionally, the studies on transportation barriers to health care access rely largely on self-report, and lacked an exploration of whether patients were unaware of available services or assistance. While some studies investigated the impact of transportation barriers on objective outcomes such as missed appointments or medication fills, these studies were in the minority. Whether transportation barriers contribute to differences in health outcomes needs to be explored further with objective outcome measures. By demonstrating that transportation barriers lead to missed appointments, poorer medication adherence, and thus poorer diabetes or blood pressure control, transportation barriers could be more strongly linked to health access and outcomes. Conclusion Transportation barriers to health care access are common, and greater for vulnerable populations. The studies reviewed may help guide both the design of interventions that address transportation barriers and the choice of measures used in assessing their effectiveness. Future studies should focus on both the details that make transportation a barrier. Such studies would help clarify both the impact of transportation barriers and the types of transportation interventions needed. Millions of Americans face transportation barriers to health care access, and addressing these barriers may help transport them to improved health care access and a better chance at improved health [3].

A systematic literature search of peerreviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes. Chronic disease care requires clinician visits, medication access, and changes to treatment plans in order to provide evidence-based care. Such delays in care may lead to a lack of appropriate medical treatment, chronic disease exacerbations or unmet health care needs, which can accumulate and worsen health outcomes [1, 2]. Patients with transportation barriers carry a greater burden of disease which may, in part, reflect the relationship between poverty and transportation availability [3]. As a result, understanding the relationship between transportation barriers and health may be important to addressing health in the most vulnerable who live in poverty. Studies have found transportation barriers impacting health care access in as little as 3 % or as much as S. Syed (&) Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, 1819 W. The wide variability in study findings makes it difficult to determine the ultimate impact that transportation barriers have on health. This review summarizes and critically evaluates the empirical evidence on transportation barriers to health care access for primary and chronic disease care. For each of the 61 studies reviewed, we evaluated the population characteristics, methods, measures of transportation barriers and results (Table 1). Results are organized into three sections: (1) measurement of transportation barriers, (2) transportation barriers and demographic differences, and (3) measurement of the impact of transportation barriers. Additionally, we define a research agenda based on gaps in the literature and discuss potential intervention opportunities and public policy considerations. Abstracts were reviewed for inclusion criteria, and if necessary, full text articles were also reviewed. Vehicle access refers to either owning a car or having access to a car through a family member or friend. Patients who were significantly less likely to receive first line chemotherapy lived in neighborhoods that had a higher percentage of households without any vehicle. Methods We searched for peer-reviewed studies that addressed transportation barriers in relation to ongoing health care access. Articles dealing with access to prenatal care, emergency or acute care, or exclusive attention to general screening and prevention were excluded as they may represent a single visit or limited time period of care. We used PubMed with the following keyword search terms (number of articles returned): transportation barriers (963), transportation barriers clinic (129), transportation barriers pharmacy (13), transportation barriers hospital (183), transportation barriers doctor (69), transportation barriers health access (276), and transportation barriers chronic disease (33). Hispanics (90 %) could usually get transportation to clinic Not having a way to get to the doctor (3 %); travel difficulties associated with lower income, being female, living alone, having less education ``Difficulties with transportation' (1) American Indians (39 %) vs. Whites (18 %) have difficulties with transportation Retrospective survey interviews on barriers to health care access ``You did not have a way to travel to the doctor' (1) Mailed survey on barriers to health care access Face to face survey on barriers to followup appointments Obstacles for follow-up included distance to travel and availability of transportation (2) Non-compliance with appointments associated with distance to travel (P = 0. Massachusetts, 95 % Medicare, 17 % Medicaid, 61 % privately insured, 64 % female Race not reported Call et al. Vermont, 58 % with private insurance/ 58 % Medicare/20 % Medicaid/5 % military/2 % uninsured, 54 % female, 97 % white Malmgren et al. Rural (Orleans County, Vermont), income less than 50,000 dollars, gender and race not specified Mailed surveys on measures of health care association Okoro et al.

Syndromes

• In a normal heart, the aorta comes from the left side of the heart, and the pulmonary artery comes from the right side. In transposition of the great vessels, these arteries come from the opposite sides of the heart. The child may also have other birth defects. 
• Glucose level in the blood
• Clip off an aneurysm to prevent blood flow
• Referral to a mental health provider
• Tremor
• Anticholinesterase medications such as neostigmine or pyridostigmine (although these are not very effective when given alone)
• Dizziness
• Inflammation or injury of the testicle or epididymis

Does your state allow for no-excuse absentee ballots (residents may vote absentee even if they would be able to go to the polls on Election Day) The Months and Weeks Before Election Day If time allows, request an updated list of registered voters from your Board of Elections to ensure the voters you registered are included. Host voting-related events on the first Tuesday of the month to get residents accustomed to participating in civic engagement activities on that day. Prepare captains to turn out all registered people on their floor or in their building, etc. Once the deadline for registering new voters has passed, obtain an updated voter registration list from your county. One To Two Weeks Before Election Day Make your second contact with voters in your database. Call them, remind them to vote on Election Day, and provide them with their polling place. From your database, print lists of all of your registered clients whose doors will be knocked on when Election Day comes. Print in groups of 20-30 people, based on geography and the number of Election Day volunteers. Remind them of the location of their polling place and the times that polls will be open. Other: Post-Election Day Thank voters and volunteers, and share your success stories. Use your new influence by meeting with newly elected officials and discussing your priority issues. Consider if there are staff or residents who should be encouraged to run for office. Whether simple or more involved, all voter engagement projects will involve some level of resources. Now that you know what you would like to accomplish, you should identify what funding sources you can access and how you might work with other organizations to leverage resources. This funding should cover things like voter databases, supplies, transportation, training, events, etc. Student groups may be interested in registering voters as part of a community service project. A civic group may already be providing rides to the polls, and could include your clients in their plans. To have a successful mobilization operation, you must contact your newly registered voters in the weeks and days leading up to the election. To do this effectively, you will need to have a record of who is registered to vote. Many people find Microsoft Excel and Microsoft Access to be the easiest platforms to use. Your database should include the following fields: First Name Last Name Street Number Street Name City State Zip Code Phone Email Polling Place Note that street number and street name are kept as two separate fields. If you plan to knock doors on Election Day, being able to sort by street number will make organizing an Election Day plan easier. One way is to enter the data straight from the voter registration card once the new registrant fills it out. Once you have this information recorded you are well on your way towards a successful Get Out the Vote operation. Passage of national Housing Trust Fund legislation was a major victory for the lowest income people who have the most serious needs, including people who are homeless. In addition, at least 75% of the funds used for rental housing must benefit extremely low income households. The foreclosure crisis, the recession, and persistent low wages have made millions more at risk of homelessness, including families with children, seniors, people with disabilities, and veterans. The statute specified an initial dedicated source of revenue to come from an assessment of 4. The funds are to be distributed by formula to states based four factors that only consider renter household needs.