WorldWideScience

Sample records for assessment guidelines quantification

  1. EPA`s program for risk assessment guidelines: Quantification issues

    Energy Technology Data Exchange (ETDEWEB)

    Dourson, M.L. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    The quantitative procedures associated with noncancer risk assessment include reference dose (RfD), benchmark dose, and severity modeling. The RfD, which is part of the EPA risk assessment guidelines, is an estimation of a level that is likely to be without any health risk to sensitive individuals. The RfD requires two major judgments: the first is choice of a critical effect(s) and its No Observed Adverse Effect Level (NOAEL); the second judgment is choice of an uncertainty factor. This paper discusses major assumptions and limitations of the RfD model.

  2. Small Wind Site Assessment Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Tim [Advanced Energy Systems LLC, Eugene, OR (United States); Preus, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    Site assessment for small wind energy systems is one of the key factors in the successful installation, operation, and performance of a small wind turbine. A proper site assessment is a difficult process that includes wind resource assessment and the evaluation of site characteristics. These guidelines address many of the relevant parts of a site assessment with an emphasis on wind resource assessment, using methods other than on-site data collection and creating a small wind site assessment report.

  3. Uncertainty quantification in flood risk assessment

    Science.gov (United States)

    Blöschl, Günter; Hall, Julia; Kiss, Andrea; Parajka, Juraj; Perdigão, Rui A. P.; Rogger, Magdalena; Salinas, José Luis; Viglione, Alberto

    2017-04-01

    Uncertainty is inherent to flood risk assessments because of the complexity of the human-water system, which is characterised by nonlinearities and interdependencies, because of limited knowledge about system properties and because of cognitive biases in human perception and decision-making. On top of the uncertainty associated with the assessment of the existing risk to extreme events, additional uncertainty arises because of temporal changes in the system due to climate change, modifications of the environment, population growth and the associated increase in assets. Novel risk assessment concepts are needed that take into account all these sources of uncertainty. They should be based on the understanding of how flood extremes are generated and how they change over time. They should also account for the dynamics of risk perception of decision makers and population in the floodplains. In this talk we discuss these novel risk assessment concepts through examples from Flood Frequency Hydrology, Socio-Hydrology and Predictions Under Change. We believe that uncertainty quantification in flood risk assessment should lead to a robust approach of integrated flood risk management aiming at enhancing resilience rather than searching for optimal defense strategies.

  4. Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks.

    Directory of Open Access Journals (Sweden)

    Shabnam Ansari

    . The findings help decision makers in identifying the necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes.

  5. Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks.

    Science.gov (United States)

    Ansari, Shabnam; Rashidian, Arash

    2012-01-01

    necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes.

  6. Final Accessibility Guidelines for Play Areas: Economic Assessment.

    Science.gov (United States)

    Architectural and Transportation Barriers Compliance Board, Washington, DC.

    This economic assessment informs the public about the implications of the final accessibility guidelines for play areas issued by the Access Board. The guidelines include scoping and technical provisions, which specify when and how access is to be provided to ground level and elevated play components. The guidelines also address soft contained…

  7. European Fissure Sealant Guidelines: assessment using AGREE II.

    Science.gov (United States)

    San Martin-Galindo, L; Rodríguez-Lozano, F J; Abalos-Labruzzi, C; Niederman, R

    2017-02-01

    Pit and fissure sealants are effective in reducing the incidence of occlusal caries, and multiple clinical practice guidelines (CPGs) have been developed for recommending their proper use. The usefulness of CPGs depends on their quality and on the rigour of the guideline development process. A study was made to assess the quality of current European CPGs based on the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, which uses 23 key items rated on a 7-point scale to assess practice guideline development and the quality of reporting. A search was conducted for fissure sealant guidelines for preventing caries in children and adults at high and low risk published in the last 10 years. Calibration was carried out before scoring to assess agreement between the appraisers using the AGREE II instrument. The searches identified 19 relevant guidelines, and following application of the inclusion/exclusion criteria, three guidelines were retained for evaluation. The proportion of observed agreement was calculated, expressed by the agreement separately for positive and negative ratings (PA = 0.89, NA = 0-91). The results of the guideline assessments revealed the highest score for the Irish guideline, a moderate score for the French guideline and the lowest score for the European guideline. Based on the AGREE II instrument, the results obtained show significant variation in the quality assessment of the three European Fissure Sealant Guidelines. Future studies should be carried out both to develop quality dental CPGs and to investigate effective ways of adopting them. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Guidelines for rating Global Assessment of Functioning (GAF

    Directory of Open Access Journals (Sweden)

    Aas IH Monrad

    2011-01-01

    Full Text Available Abstract Background Global Assessment of Functioning (GAF is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines. Methods A thorough literature search was conducted. Results Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1 general points about guidelines for rating GAF; (2 introduction to guidelines, with ground rules; (3 starting scoring at the top, middle or bottom level of the scale; (4 scoring for different time periods and of different values (highest, lowest or average; (5 the finer grading of the scale; (6 different guidelines for different conditions; and (7 different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding. Conclusions Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and

  9. Assessing Spontaneous Combustion Instability with Recurrence Quantification Analysis

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    Eberhart, Chad J.; Casiano, Matthew J.

    2016-01-01

    Spontaneous instabilities can pose a significant challenge to verification of combustion stability, and characterizing its onset is an important avenue of improvement for stability assessments of liquid propellant rocket engines. Recurrence Quantification Analysis (RQA) is used here to explore nonlinear combustion dynamics that might give insight into instability. Multiple types of patterns representative of different dynamical states are identified within fluctuating chamber pressure data, and markers for impending instability are found. A class of metrics which describe these patterns is also calculated. RQA metrics are compared with and interpreted against another metric from nonlinear time series analysis, the Hurst exponent, to help better distinguish between stable and unstable operation.

  10. Quantification of Human Movement for Assessment in Automated Exercise Coaching

    CERN Document Server

    Hagler, Stuart; Bajczy, Ruzena; Pavel, Misha

    2016-01-01

    Quantification of human movement is a challenge in many areas, ranging from physical therapy to robotics. We quantify of human movement for the purpose of providing automated exercise coaching in the home. We developed a model-based assessment and inference process that combines biomechanical constraints with movement assessment based on the Microsoft Kinect camera. To illustrate the approach, we quantify the performance of a simple squatting exercise using two model-based metrics that are related to strength and endurance, and provide an estimate of the strength and energy-expenditure of each exercise session. We look at data for 5 subjects, and show that for some subjects the metrics indicate a trend consistent with improved exercise performance.

  11. Facilitating pre-operative assessment guidelines representation using SNOMED CT.

    Science.gov (United States)

    Ahmadian, Leila; Cornet, Ronald; de Keizer, Nicolette F

    2010-12-01

    To investigate whether SNOMED CT covers the terms used in pre-operative assessment guidelines, and if necessary, how the measured content coverage can be improved. Pre-operative assessment guidelines were retrieved from the websites of (inter)national anesthesia-related societies. The recommendations in the guidelines were rewritten to "IF condition THEN action" statements to facilitate data extraction. Terms were extracted from the IF-THEN statements and mapped to SNOMED CT. Content coverage was measured by using three scores: no match, partial match and complete match. Non-covered concepts were evaluated against the SNOMED CT editorial documentation. From 6 guidelines, 133 terms were extracted, of which 71% (n=94) completely matched with SNOMED CT concepts. Disregarding the vague concepts in the included guidelines SNOMED CT's content coverage was 89%. Of the 39 non-completely covered concepts, 69% violated at least one of SNOMED CT's editorial principles or rules. These concepts were categorized based on four categories: non-reproducibility, classification-derived phrases, numeric ranges, and procedures categorized by complexity. Guidelines include vague terms that cannot be well supported by terminological systems thereby hampering guideline-based decision support systems. This vagueness reduces the content coverage of SNOMED CT in representing concepts used in the pre-operative assessment guidelines. Formalization of the guidelines using SNOMED CT is feasible but to optimize this, first the vagueness of some guideline concepts should be resolved and a few currently missing but relevant concepts should be added to SNOMED CT. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Guidelines for Conducting Socially Valid Systematic Preference Assessments.

    Science.gov (United States)

    Lohrmann-O'Rourke, Sharon; Browder, Diane M.; Brown, Fredda

    2000-01-01

    This paper translates research findings on systematic preference assessment with individuals with nonsymbolic or limited symbolic communication skills into guidelines for planning such assessments to reduce the risk of missing or misinterpreting the person's preferences. It offers four questions for guiding the planning of preference assessments,…

  13. Guidelines for a Scientific Approach to Critical Thinking Assessment

    Science.gov (United States)

    Bensley, D. Alan; Murtagh, Michael P.

    2012-01-01

    Assessment of student learning outcomes can be a powerful tool for improvement of instruction when a scientific approach is taken; unfortunately, many educators do not take full advantage of this approach. This article examines benefits of taking a scientific approach to critical thinking assessment and proposes guidelines for planning,…

  14. Assessing Visualization: An analysis of Chilean teachers’ guidelines

    DEFF Research Database (Denmark)

    Andrade-Molina, Melissa; Díaz, Leonora

    2017-01-01

    The aim of this paper is to argue on how visualization is recommended, by official curricular guidelines, to be assessed in schools. We contend that spatial abilities have been granted with the status of a key element to improve students’ performances by research and also by policy makers. Howeve...... do not help teachers while assessing visualization in schools; rather its focus is embedded in a tradition of training that leads to a reduction of space.......The aim of this paper is to argue on how visualization is recommended, by official curricular guidelines, to be assessed in schools. We contend that spatial abilities have been granted with the status of a key element to improve students’ performances by research and also by policy makers. However......, this importance seems to fade when it comes to assessing students while learning school mathematics and geometry. We conducted an analysis of the official guidelines for the assessment school mathematics in Chile. The analysis of two of those guides is considered here. The results revealed that these guidelines...

  15. Factors controlling volume errors through 2D gully erosion assessment: guidelines for optimal survey design

    Science.gov (United States)

    Castillo, Carlos; Pérez, Rafael

    2017-04-01

    The assessment of gully erosion volumes is essential for the quantification of soil losses derived from this relevant degradation process. Traditionally, 2D and 3D approaches has been applied for this purpose (Casalí et al., 2006). Although innovative 3D approaches have recently been proposed for gully volume quantification, a renewed interest can be found in literature regarding the useful information that cross-section analysis still provides in gully erosion research. Moreover, the application of methods based on 2D approaches can be the most cost-effective approach in many situations such as preliminary studies with low accuracy requirements or surveys under time or budget constraints. The main aim of this work is to examine the key factors controlling volume error variability in 2D gully assessment by means of a stochastic experiment involving a Monte Carlo analysis over synthetic gully profiles in order to 1) contribute to a better understanding of the drivers and magnitude of gully erosion 2D-surveys uncertainty and 2) provide guidelines for optimal survey designs. Owing to the stochastic properties of error generation in 2D volume assessment, a statistical approach was followed to generate a large and significant set of gully reach configurations to evaluate quantitatively the influence of the main factors controlling the uncertainty of the volume assessment. For this purpose, a simulation algorithm in Matlab® code was written, involving the following stages: - Generation of synthetic gully area profiles with different degrees of complexity (characterized by the cross-section variability) - Simulation of field measurements characterised by a survey intensity and the precision of the measurement method - Quantification of the volume error uncertainty as a function of the key factors In this communication we will present the relationships between volume error and the studied factors and propose guidelines for 2D field surveys based on the minimal survey

  16. Assessing Clinical Microbiology Practice Guidelines: American Society for MicrobiologyAd HocCommittee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment.

    Science.gov (United States)

    Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney

    2017-11-01

    As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.

  17. Assessing biocomputational modelling in transforming clinical guidelines for osteoporosis management.

    Science.gov (United States)

    Thiel, Rainer; Viceconti, Marco; Stroetmann, Karl

    2011-01-01

    Biocomputational modelling as developed by the European Virtual Physiological Human (VPH) Initiative is the area of ICT most likely to revolutionise in the longer term the practice of medicine. Using the example of osteoporosis management, a socio-economic assessment framework is presented that captures how the transformation of clinical guidelines through VPH models can be evaluated. Applied to the Osteoporotic Virtual Physiological Human Project, a consequent benefit-cost analysis delivers promising results, both methodologically and substantially.

  18. 77 FR 45350 - Notice of Availability of Microbial Risk Assessment Guideline: Pathogenic Microorganisms With...

    Science.gov (United States)

    2012-07-31

    ... to develop this guideline. Clear and credible microbial risk assessment methods will leverage limited... this guideline, agencies assessing a similar microbial medium or pathogen are able to more readily... for microbial risk assessment in a wide range of media and scenarios. The MRA Guideline applies to...

  19. Expert consensus panel guidelines on geriatric assessment in oncology.

    Science.gov (United States)

    O'Donovan, A; Mohile, S G; Leech, M

    2015-07-01

    Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. © 2015 John Wiley & Sons Ltd.

  20. Expert Consensus Panel Guidelines on Geriatric Assessment in Oncology

    Science.gov (United States)

    O'Donovan, A.; Mohile, S.G.; Leech, M.

    2015-01-01

    Introduction Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. Methods A four round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations in order to gain consensus on a given topic Results Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cutoff for assessment represented a higher degree of disagreement. Discussion The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients. PMID:25757457

  1. Greenhouse Gas Emissions from Waste Management-Assessment of Quantification Methods.

    Science.gov (United States)

    Mohareb, Eugene A; MacLean, Heather L; Kennedy, Christopher A

    2011-05-01

    Of the many sources of urban greenhouse gas (GHG) emissions, solid waste is the only one for which management decisions are undertaken primarily by municipal governments themselves and is hence often the largest component of cities' corporate inventories. It is essential that decision-makers select an appropriate quantification methodology and have an appreciation of methodological strengths and shortcomings. This work compares four different waste emissions quantification methods, including Intergovernmental Panel on Climate Change (IPCC) 1996 guidelines, IPCC 2006 guidelines, U.S. Environmental Protection Agency (EPA) Waste Reduction Model (WARM), and the Federation of Canadian Municipalities- Partners for Climate Protection (FCM-PCP) quantification tool. Waste disposal data for the greater Toronto area (GTA) in 2005 are used for all methodologies; treatment options (including landfill, incineration, compost, and anaerobic digestion) are examined where available in methodologies. Landfill was shown to be the greatest source of GHG emissions, contributing more than three-quarters of total emissions associated with waste management. Results from the different landfill gas (LFG) quantification approaches ranged from an emissions source of 557 kt carbon dioxide equivalents (CO2e) (FCM-PCP) to a carbon sink of -53 kt CO2e (EPA WARM). Similar values were obtained between IPCC approaches. The IPCC 2006 method was found to be more appropriate for inventorying applications because it uses a waste-in-place (WIP) approach, rather than a methane commitment (MC) approach, despite perceived onerous data requirements for WIP. MC approaches were found to be useful from a planning standpoint; however, uncertainty associated with their projections of future parameter values limits their applicability for GHG inventorying. MC and WIP methods provided similar results in this case study; however, this is case specific because of similarity in assumptions of present and future

  2. Greenhouse gas emissions from waste management--assessment of quantification methods.

    Science.gov (United States)

    Mohareb, Eugene A; MacLean, Heather L; Kennedy, Christopher A

    2011-05-01

    Of the many sources of urban greenhouse gas (GHG) emissions, solid waste is the only one for which management decisions are undertaken primarily by municipal governments themselves and is hence often the largest component of cities' corporate inventories. It is essential that decision-makers select an appropriate quantification methodology and have an appreciation of methodological strengths and shortcomings. This work compares four different waste emissions quantification methods, including Intergovernmental Panel on Climate Change (IPCC) 1996 guidelines, IPCC 2006 guidelines, U.S. Environmental Protection Agency (EPA) Waste Reduction Model (WARM), and the Federation of Canadian Municipalities-Partners for Climate Protection (FCM-PCP) quantification tool. Waste disposal data for the greater Toronto area (GTA) in 2005 are used for all methodologies; treatment options (including landfill, incineration, compost, and anaerobic digestion) are examined where available in methodologies. Landfill was shown to be the greatest source of GHG emissions, contributing more than three-quarters of total emissions associated with waste management. Results from the different landfill gas (LFG) quantification approaches ranged from an emissions source of 557 kt carbon dioxide equivalents (CO2e) (FCM-PCP) to a carbon sink of -53 kt CO2e (EPA WARM). Similar values were obtained between IPCC approaches. The IPCC 2006 method was found to be more appropriate for inventorying applications because it uses a waste-in-place (WIP) approach, rather than a methane commitment (MC) approach, despite perceived onerous data requirements for WIP. MC approaches were found to be useful from a planning standpoint; however, uncertainty associated with their projections of future parameter values limits their applicability for GHG inventorying. MC and WIP methods provided similar results in this case study; however, this is case specific because of similarity in assumptions of present and future landfill

  3. Regulatory assessment of proposed accessibility guidelines for pedestrians in the public right-of-way

    Science.gov (United States)

    2011-06-30

    This report assesses the potential costs and benefits of proposed accessibility guidelines issued by the Access Board for pedestrian facilities in the public right-of-way. The report also analyzes the potential impacts of the proposed guidelines on s...

  4. Forest Carbon Leakage Quantification Methods and Their Suitability for Assessing Leakage in REDD

    Directory of Open Access Journals (Sweden)

    Sabine Henders

    2012-01-01

    Full Text Available This paper assesses quantification methods for carbon leakage from forestry activities for their suitability in leakage accounting in a future Reducing Emissions from Deforestation and Forest Degradation (REDD mechanism. To that end, we first conducted a literature review to identify specific pre-requisites for leakage assessment in REDD. We then analyzed a total of 34 quantification methods for leakage emissions from the Clean Development Mechanism (CDM, the Verified Carbon Standard (VCS, the Climate Action Reserve (CAR, the CarbonFix Standard (CFS, and from scientific literature sources. We screened these methods for the leakage aspects they address in terms of leakage type, tools used for quantification and the geographical scale covered. Results show that leakage methods can be grouped into nine main methodological approaches, six of which could fulfill the recommended REDD leakage requirements if approaches for primary and secondary leakage are combined. The majority of methods assessed, address either primary or secondary leakage; the former mostly on a local or regional and the latter on national scale. The VCS is found to be the only carbon accounting standard at present to fulfill all leakage quantification requisites in REDD. However, a lack of accounting methods was identified for international leakage, which was addressed by only two methods, both from scientific literature.

  5. Optical coherence tomography assessment and quantification of intracoronary thrombus: Status and perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Porto, Italo, E-mail: italo.porto@gmail.com [Interventional Cardiology Unit, San Donato Hospital, Arezzo (Italy); Mattesini, Alessio; Valente, Serafina [Interventional Cardiology Unit, Careggi Hospital, Florence (Italy); Prati, Francesco [Interventional Cardiology San Giovanni Hospital, Rome (Italy); CLI foundation (Italy); Crea, Filippo [Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome (Italy); Bolognese, Leonardo [Interventional Cardiology Unit, San Donato Hospital, Arezzo (Italy)

    2015-04-15

    Coronary angiography is the “golden standard” imaging technique in interventional cardiology and it is still widely used to guide interventions. A major drawback of this technique, however, is that it is inaccurate in the evaluation and quantification of intracoronary thrombus burden, a critical prognosticator and predictor of intraprocedural complications in acute coronary syndromes. The introduction of optical coherence tomography (OCT) holds the promise of overcoming this important limitation, as near-infrared light is uniquely sensitive to hemoglobin, the pigment of red blood cells trapped in the thrombus. This narrative review will focus on the use of OCT for the assessment, evaluation and quantification of intracoronary thrombosis. - Highlights: • Thrombotic burden in acute coronary syndromes Is not adequately evaluated by standard coronary angiography, whereas Optical Coherence Tomography is exquisitely sensitive to the hemoglobin contained in red blood cells and can be used to precisely quantify thrombus. • Both research and clinical applications have been developed using the OCT-based evaluation of thrombus. In particular, whereas precise quantification scores are useful for comparing antithrombotic therapies in randomized trials, both pharmacological and mechanical, the most important practical applications for OCT-based assessment of thrombus are the individuation of culprit lesions in the context of diffuse atheromata in acute coronary syndromes, and the so-called “delayed stenting” strategies. • Improvements in 3D rendering techniques are on the verge of revolutionizing OCT-based thrombus assessment, allowing extremely precise quantification of the thrombotic burden.

  6. Assessing physicians' compliance with guidelines for Papanicolaou testing.

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    Cohen, M M; Roos, N P; MacWilliam, L; Wajda, A

    1992-06-01

    In this study, population-based data were used to examine the appropriateness of Papanicolaou (Pap) testing from the perspective of the women being tested and their physicians. The approach used is unique in its assessment of overtesting and undertesting in the primary care setting. From the data base of the province of Manitoba's universal health insurance plan, 4-year health histories (1981 to 1984) were constructed for each woman from a random sample of the population of women who, in 1982, were between the ages of 25 to 64 years (n = 22,287). At the last visit to a general practitioner, gynecologist, or general surgeon in 1984 (termed the current visit), the authors determined whether a Pap test was given for each woman. Using decision rules from a Canadian task force report on cervical screening and previous health history, the authors evaluated the appropriateness of screening by determining whether a Pap test was given and was needed, or whether a women who had not received a Pap test required one. Overall, 55.7% of women were tested appropriately. Of the 5352 women who received a Pap test at the current visit, 62.8% were overtested. Of the 16,935 women not tested at the current visit, 38.5% required screening (i.e. were undertested). Characteristics of a physician's practice that were significantly related to compliance with the guidelines included having a high proportion of patients visiting for obstetric or gynecologic reasons. Variables that were associated with negative compliance were 1) being a gynecologist; and 2) having a high proportion of patients who lived in inner city or rural areas. Because physicians are paid a fee for every Pap smear taken and the guidelines were well disseminated, these results should be reasonably representative of fee-for-service practice in North America, where preventive care is not subject to user charges. This study supports previous findings that a passive approach to dissemination of guidelines is insufficient to

  7. The quantification of levator muscle resting tone by digital assessment.

    Science.gov (United States)

    Dietz, H P; Shek, K L

    2008-11-01

    The biomechanical properties of the puborectalis muscle are likely to be important for pelvic organ support. However, neither elasticity nor its clinical correlate, muscle resting tone, have received much attention to date. We therefore conducted a prospective study to test a newly developed resting tone scale for validity and reproducibility. Ninety-eight patients underwent a physical examination including prolapse staging and palpation of the levator ani. They were also assessed by 4D translabial ultrasound for levator hiatal dimensions and prolapse assessment. Resting tone was negatively associated with anterior and posterior compartment prolapse. An independent test-retest series yielded a weighted kappa of 0.55 (CI 0.44-0.66), implying "moderate" repeatability. Resting tone of the puborectalis muscle can be determined by digital palpation. It is moderately repeatable and associated with pelvic organ prolapse. Palpation of resting tone may be a useful new tool for assessing women with pelvic floor dysfunction.

  8. Quantification of uncertainties in global grazing systems assessment

    Science.gov (United States)

    Fetzel, T.; Havlik, P.; Herrero, M.; Kaplan, J. O.; Kastner, T.; Kroisleitner, C.; Rolinski, S.; Searchinger, T.; Van Bodegom, P. M.; Wirsenius, S.; Erb, K.-H.

    2017-07-01

    Livestock systems play a key role in global sustainability challenges like food security and climate change, yet many unknowns and large uncertainties prevail. We present a systematic, spatially explicit assessment of uncertainties related to grazing intensity (GI), a key metric for assessing ecological impacts of grazing, by combining existing data sets on (a) grazing feed intake, (b) the spatial distribution of livestock, (c) the extent of grazing land, and (d) its net primary productivity (NPP). An analysis of the resulting 96 maps implies that on average 15% of the grazing land NPP is consumed by livestock. GI is low in most of the world's grazing lands, but hotspots of very high GI prevail in 1% of the total grazing area. The agreement between GI maps is good on one fifth of the world's grazing area, while on the remainder, it is low to very low. Largest uncertainties are found in global drylands and where grazing land bears trees (e.g., the Amazon basin or the Taiga belt). In some regions like India or Western Europe, massive uncertainties even result in GI > 100% estimates. Our sensitivity analysis indicates that the input data for NPP, animal distribution, and grazing area contribute about equally to the total variability in GI maps, while grazing feed intake is a less critical variable. We argue that a general improvement in quality of the available global level data sets is a precondition for improving the understanding of the role of livestock systems in the context of global environmental change or food security.

  9. Guidelines for assessing the knowledge management maturity of organizations

    Directory of Open Access Journals (Sweden)

    C. J. Kruger

    2007-11-01

    Full Text Available In a recent article Kruger and Snyman hypothesized that progressions in knowledge management maturity (from a strategic perspective are directly related to an increased ability to speed up the strategic cycle of imitation, consolidation and innovation. The arguments proposed, however, neglected to supply the reader with a practical toolkit or even a roadmap (a time-related matrix, or questionnaire to successfully measure succession in knowledge management maturity. This article builds on the previous one and proposes a questionnaire consisting of six sections, containing 101 descriptive questions, to enable organizations to test and assess their knowledge management maturity empirically. The development of an instrument to measure knowledge management maturity required adhering to a research design that combined theoretical propositions with practical experimentation. As a point of departure, a knowledge management maturity matrix consisting of seven maturity levels was formulated. All questions contained within the matrix were benchmarked against a survey questionnaire developed by the public management service of the OECD (PUMA and were also pre-tested and validated. This process of refinement led to the formulation of the Knowledge Management Maturity Questionnaire. To avoid any taint of this research being based only on theoretical propositions, the questionnaire was tested by 178 master students of the University of Pretoria, South Africa, in nine different industries. The proposed questionnaire provides a bridge between theoretical propositions and practical usability, not only enabling knowledge management practitioners to assess the level of knowledge management maturity reached successfully but, more importantly, also serving as a guideline to institutionalize further and future knowledge management endeavours.

  10. 77 FR 3450 - Guidelines for Assessing Marine Mammal Stocks

    Science.gov (United States)

    2012-01-24

    ... electronic comments in Microsoft Word, Excel, WordPerfect, or Adobe PDF file formats only. FOR FURTHER... guidelines specify that when biological information is sufficient to identify the stock from which a dead or...

  11. Comparative assessment of bioanalytical method validation guidelines for pharmaceutical industry.

    Science.gov (United States)

    Kadian, Naveen; Raju, Kanumuri Siva Rama; Rashid, Mamunur; Malik, Mohd Yaseen; Taneja, Isha; Wahajuddin, Muhammad

    2016-07-15

    The concepts, importance, and application of bioanalytical method validation have been discussed for a long time and validation of bioanalytical methods is widely accepted as pivotal before they are taken into routine use. United States Food and Drug Administration (USFDA) guidelines issued in 2001 have been referred for every guideline released ever since; may it be European Medical Agency (EMA) Europe, National Health Surveillance Agency (ANVISA) Brazil, Ministry of Health and Labour Welfare (MHLW) Japan or any other guideline in reference to bioanalytical method validation. After 12 years, USFDA released its new draft guideline for comments in 2013, which covers the latest parameters or topics encountered in bioanalytical method validation and approached towards the harmonization of bioanalytical method validation across the globe. Even though the regulatory agencies have general agreement, significant variations exist in acceptance criteria and methodology. The present review highlights the variations, similarities and comparison between bioanalytical method validation guidelines issued by major regulatory authorities worldwide. Additionally, other evaluation parameters such as matrix effect, incurred sample reanalysis including other stability aspects have been discussed to provide an ease of access for designing a bioanalytical method and its validation complying with the majority of drug authority guidelines. Copyright © 2016. Published by Elsevier B.V.

  12. Assessment of methods for organic and inorganic carbon quantification in carbonate-containing Mediterranean soils

    Science.gov (United States)

    Apesteguia, Marcos; Virto, Iñigo; Plante, Alain

    2014-05-01

    Quantification of soil organic matter (SOM) stocks and fluxes continues to be an important endeavor in assessments of soil quality, and more broadly in assessments of ecosystem functioning. The quantification of SOM in alkaline, carbonate-containing soils, such as those found in Mediterranean areas, is complicated by the need to differentiate between organic carbon (OC) and inorganic carbon (IC), which continues to present methodological challenges. Acidification is frequently used to eliminate carbonates prior to soil OC quantification, but when performed in the liquid phase, can promote the dissolution and loss of a portion of the OC. Acid fumigation (AF) is increasingly preferred for carbonate removal, but its effectiveness is difficult to assess using conventional elemental and isotopic analyses. In addition, the potential effects of AF on SOM are not well characterized. The objective of the current study was to apply a multi-method approach to determine the efficacy of carbonate removal by AF and its effects on the residual SOM. We selected a set of 24 surface agricultural soils representing a large range of textures, SOM contents and presumed carbonate contents. For each soil, OC was determined using wet combustion (Walkley-Black) and IC was determined using the calcimeter method. Samples were then subjected to elemental (total C) and isotopic (δ13C) analyses by dry combustion using a Costech autoanalyzer coupled to a Thermo Finnigan Delta Plus isotope ratio mass spectrometer (IRMS) before and after AF. IC was equated to total C determined after fumigation, and OC was estimated as the different in total C before and after AF. Samples were also subjected to ramped oxidation using a Netzsch STA109 PC Luxx thermal analyzer coupled to a LICOR 820A infrared gas analyzer (IRGA). Quantification of OC was performed using evolved gas analysis of CO2 (CO2-EGA) in the exothermic region 200-500° C associated with organic matter combustion. IC was quantified by CO2-EGA

  13. Assessing pulmonary perfusion in emphysema: automated quantification of perfused blood volume in dual-energy CTPA.

    Science.gov (United States)

    Meinel, Felix G; Graef, Anita; Thieme, Sven F; Bamberg, Fabian; Schwarz, Florian; Sommer, Wieland H; Helck, Andreas D; Neurohr, Claus; Reiser, Maximilian F; Johnson, Thorsten R C

    2013-02-01

    The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. We retrospectively analyzed 40 consecutive patients (mean age, 67 [13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than -900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = -0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P global PBV values and parenchymal hypodensity both in a per-patient (r = -0.63; P reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters.

  14. Assessment of probiotic viability during Cheddar cheese manufacture and ripening using propidium monoazide-PCR quantification

    Directory of Open Access Journals (Sweden)

    Emilie eDesfossés-Foucault

    2012-10-01

    Full Text Available The use of a suitable food carrier such as cheese could significantly enhance probiotic viability during storage. The main goal of this study was to assess viability of commercial probiotic strains during Cheddar cheesemaking and ripening (four to six months by comparing the efficiency of microbiological and molecular approaches. Molecular methods such as quantitative PCR (qPCR allow bacterial quantification, and DNA-blocking molecules such as propidium monoazide (PMA select only the living cells’ DNA. Cheese samples were manufactured with a lactococci starter and with one of three probiotic strains (Bifidobacterium animalis subsp. lactis BB-12, Lactobacillus rhamnosus RO011 or Lactobacillus helveticus RO052 or a mixed culture containing B. animalis subsp. lactis BB-12 and L. helveticus RO052 (MC1, both lactobacilli strains (MC2 or all three strains (MC3. DNA extractions were then carried out on PMA-treated and non-treated cell pellets in order to assess PMA treatment efficiency, followed by quantification using the 16S rRNA gene, the elongation factor Tu gene (tuf or the transaldolase gene (tal. Results with intact/dead ratios of bacteria showed that PMA-treated cheese samples had a significantly lower bacterial count than non-treated DNA samples (P<0.005, confirming that PMA did eliminate dead bacteria from PCR quantification. For both quantification methods, the addition of probiotic strains seemed to accelerate the loss of lactococci viability in comparison to control cheese samples, especially when L. helveticus RO052 was added. Viability of all three probiotic strains was also significantly reduced in mixed culture cheese samples (P<0.0001, B. animalis subsp. lactis BB-12 being the most sensitive to the presence of other strains. However, all probiotic strains did retain their viability (log nine cfu/g of cheese throughout ripening. This study was successful in monitoring living probiotic species in Cheddar cheese samples through PMA-qPCR.

  15. Assessment of the real-time PCR and different digital PCR platforms for DNA quantification.

    Science.gov (United States)

    Pavšič, Jernej; Žel, Jana; Milavec, Mojca

    2016-01-01

    Digital PCR (dPCR) is beginning to supersede real-time PCR (qPCR) for quantification of nucleic acids in many different applications. Several analytical properties of the two most commonly used dPCR platforms, namely the QX100 system (Bio-Rad) and the 12.765 array of the Biomark system (Fluidigm), have already been evaluated and compared with those of qPCR. However, to the best of our knowledge, direct comparison between the three of these platforms using the same DNA material has not been done, and the 37 K array on the Biomark system has also not been evaluated in terms of linearity, analytical sensitivity and limit of quantification. Here, a first assessment of qPCR, the QX100 system and both arrays of the Biomark system was performed with plasmid and genomic DNA from human cytomegalovirus. With use of PCR components that alter the efficiency of qPCR, each dPCR platform demonstrated consistent copy-number estimations, which indicates the high resilience of dPCR. Two approaches, one considering the total reaction volume and the other considering the effective reaction size, were used to assess linearity, analytical sensitivity and variability. When the total reaction volume was considered, the best performance was observed with qPCR, followed by the QX100 system and the Biomark system. In contrast, when the effective reaction size was considered, all three platforms showed almost equal limits of detection and variability. Although dPCR might not always be more appropriate than qPCR for quantification of low copy numbers, dPCR is a suitable method for robust and reproducible quantification of viral DNA, and a promising technology for the higher-order reference measurement method.

  16. Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification.

    Science.gov (United States)

    Shrivastava, Amresh; Bureau, Yves; Rewari, Nitika; Johnston, Megan

    2013-04-01

    Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be one of the greatest barriers to regaining a normal lifestyle and health. Research advances have defined stigma and assessed its implications and have even examined intervention strategies for dealing with stigma. We are of the opinion that stigma is a potential clinical risk factor. It delays treatment seeking, worsens course and outcome, reduces compliance, and increases the risk of relapse; causing further disability, discrimination, and isolation even in persons who have accessed mental health services. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others, and deterioration in capacity to look after one's physical health. These are preventable clinical complications. In order to deal with the impact of stigma on an individual basis, it needs to be (i) assessed during routine clinical examination, (ii) assessed for quantification in order to obtain measurable objective deliverables, and (iii) examined if treatment can reduce stigma and its impact on individuals. New and innovative anti-stigma programs are required that are clinically driven in order to see the change in life of an individual by removing potential risks. The basic requirement for dealing with an individual's stigma perception/experience is its proper assessment for origin and impact in both a qualitative and quantitative manner. We further argue that quantification would allow for regular assessment and offer more effective intervention for patients. It will also be helpful in identifying modifiable social factors to enhance quality of care planning for management in hospitals and communities. The objective of quantification is to facilitate developing an approach to bring the assessment of stigma into clinical work and formulating customized strategies to deal with stigma at the patient level. It

  17. Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification

    Science.gov (United States)

    Shrivastava, Amresh; Bureau, Yves; Rewari, Nitika; Johnston, Megan

    2013-01-01

    Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be one of the greatest barriers to regaining a normal lifestyle and health. Research advances have defined stigma and assessed its implications and have even examined intervention strategies for dealing with stigma. We are of the opinion that stigma is a potential clinical risk factor. It delays treatment seeking, worsens course and outcome, reduces compliance, and increases the risk of relapse; causing further disability, discrimination, and isolation even in persons who have accessed mental health services. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others, and deterioration in capacity to look after one's physical health. These are preventable clinical complications. In order to deal with the impact of stigma on an individual basis, it needs to be (i) assessed during routine clinical examination, (ii) assessed for quantification in order to obtain measurable objective deliverables, and (iii) examined if treatment can reduce stigma and its impact on individuals. New and innovative anti-stigma programs are required that are clinically driven in order to see the change in life of an individual by removing potential risks. The basic requirement for dealing with an individual's stigma perception/experience is its proper assessment for origin and impact in both a qualitative and quantitative manner. We further argue that quantification would allow for regular assessment and offer more effective intervention for patients. It will also be helpful in identifying modifiable social factors to enhance quality of care planning for management in hospitals and communities. The objective of quantification is to facilitate developing an approach to bring the assessment of stigma into clinical work and formulating customized strategies to deal with stigma at the patient level. It

  18. Motion corrected LV quantification based on 3D modelling for improved functional assessment in cardiac MRI.

    Science.gov (United States)

    Liew, Y M; McLaughlin, R A; Chan, B T; Abdul Aziz, Y F; Chee, K H; Ung, N M; Tan, L K; Lai, K W; Ng, S; Lim, E

    2015-04-07

    Cine MRI is a clinical reference standard for the quantitative assessment of cardiac function, but reproducibility is confounded by motion artefacts. We explore the feasibility of a motion corrected 3D left ventricle (LV) quantification method, incorporating multislice image registration into the 3D model reconstruction, to improve reproducibility of 3D LV functional quantification. Multi-breath-hold short-axis and radial long-axis images were acquired from 10 patients and 10 healthy subjects. The proposed framework reduced misalignment between slices to subpixel accuracy (2.88 to 1.21 mm), and improved interstudy reproducibility for 5 important clinical functional measures, i.e. end-diastolic volume, end-systolic volume, ejection fraction, myocardial mass and 3D-sphericity index, as reflected in a reduction in the sample size required to detect statistically significant cardiac changes: a reduction of 21-66%. Our investigation on the optimum registration parameters, including both cardiac time frames and number of long-axis (LA) slices, suggested that a single time frame is adequate for motion correction whereas integrating more LA slices can improve registration and model reconstruction accuracy for improved functional quantification especially on datasets with severe motion artefacts.

  19. Assessment of current mass spectrometric workflows for the quantification of low abundant proteins and phosphorylation sites

    Directory of Open Access Journals (Sweden)

    Manuel Bauer

    2015-12-01

    Full Text Available The data described here provide a systematic performance evaluation of popular data-dependent (DDA and independent (DIA mass spectrometric (MS workflows currently used in quantitative proteomics. We assessed the limits of identification, quantification and detection for each method by analyzing a dilution series of 20 unmodified and 10 phosphorylated synthetic heavy labeled reference peptides, respectively, covering six orders of magnitude in peptide concentration with and without a complex human cell digest background. We found that all methods performed very similarly in the absence of background proteins, however, when analyzing whole cell lysates, targeted methods were at least 5–10 times more sensitive than directed or DDA methods. In particular, higher stage fragmentation (MS3 of the neutral loss peak using a linear ion trap increased dynamic quantification range of some phosphopeptides up to 100-fold. We illustrate the power of this targeted MS3 approach for phosphopeptide monitoring by successfully quantifying 9 phosphorylation sites of the kinetochore and spindle assembly checkpoint component Mad1 over different cell cycle states from non-enriched pull-down samples. The data are associated to the research article ‘Evaluation of data-dependent and data-independent mass spectrometric workflows for sensitive quantification of proteins and phosphorylation sites׳ (Bauer et al., 2014 [1]. The mass spectrometry and the analysis dataset have been deposited to the ProteomeXchange Consortium (http://proteomecentral.proteomexchange.org via the PRIDE partner repository with the dataset identifier PXD000964.

  20. Assessing adherence to the 2010 antiretroviral guidelines in the ...

    African Journals Online (AJOL)

    These clinical practice guidelines can be defined as systematically developed statements for both practitioners and patients, to assist with appropriate healthcare decisions for specific clinical circumstances.[2] Their intention is to improve healthcare processes, decrease practice variation and optimise use of resources.

  1. European clinical guidelines for Tourette Syndrome and other tic disorders. Part I : assessment

    NARCIS (Netherlands)

    Cath, Danielle C.; Hedderly, Tammy; Ludolph, Andrea G.; Stern, Jeremy S.; Murphy, Tara; Hartmann, Andreas; Czernecki, Virginie; Robertson, Mary May; Martino, Davide; Munchau, A.; Rizzo, R.

    A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS

  2. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines

    NARCIS (Netherlands)

    Yokoe, Masamichi; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Mayumi, Toshihiko; Gomi, Harumi; Pitt, Henry A.; Gouma, Dirk J.; Garden, O. James; Büchler, Markus W.; Kiriyama, Seiki; Kimura, Yasutoshi; Tsuyuguchi, Toshio; Itoi, Takao; Yoshida, Masahiro; Miura, Fumihiko; Yamashita, Yuichi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Higuchi, Ryota; Windsor, John A.; Bornman, Philippus C.; Fan, Sheung-Tat; Singh, Harijt; de Santibanes, Eduardo; Kusachi, Shinya; Murata, Atsuhiko; Chen, Xiao-Ping; Jagannath, Palepu; Lee, Sunggyu; Padbury, Robert; Chen, Miin-Fu

    2012-01-01

    Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world's first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over

  3. Qualitative assessment of agritourism safety guidelines: a demonstration project.

    Science.gov (United States)

    Tutor-Marcom, Robin; Greer, Annette; Clay, Maria; Ellis, Tammy; Thompson, Tami; Adam-Samura, Esther Seisay

    2013-01-01

    In 2007, the National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS) published Agritourism Health and Safety Guidelines for Children to provide helpful recommendations for protecting the health and safety of children visiting agritourism farms. Supplement A: Policies and Procedures Guide and Supplement B: Worksite Guide were subsequently published in 2009 and provided agritourism farms with checklists to use in reviewing, planning, and implementing their own health and safety practices. In order to better understand what would be required of a farm wishing to implement the guidelines using Supplements A and B, the North Carolina Agromedicine Institute conducted a single-family farm demonstration project with support from the NCCRAHS. The aims of the project were to (1) determine child health and safety risks associated with an existing agritourism farm; (2) determine the cost of making improvements necessary to reduce risks; and (3) use project findings to motivate other agritourism farms, Cooperative Extension agents, and agritourism insurers to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work. At the conclusion of the study, the target farm was in compliance with an average of 86.9% of items in Supplements A and B. Furthermore, 89% of individuals self-identifying as farmers or farm workers and 100% of Cooperative Extension agents and agritourism insurers attending an end-of-project workshop indicated their intent to adopt or recommend Agritourism Health and Safety Guidelines for Children for their own farms or farms with which they work.

  4. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment

    DEFF Research Database (Denmark)

    Cath, Danielle C; Hedderly, Tammy; Ludolph, Andrea G

    2011-01-01

    members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities...

  5. Technical Review Guidelines for Environmental Impact Assessments in the Tourism, Energy and Mining Sectors

    Science.gov (United States)

    EPA coordinated a regional collaborative process with Central America and Dominican Republic Free Trade Agreement (CAFTA-DR) partners to develop Environmental Impact Assessment (EIA) Technical Review Guidelines for three sectors.

  6. In vivo assessment of human burn scars through automated quantification of vascularity using optical coherence tomography

    Science.gov (United States)

    Liew, Yih Miin; McLaughlin, Robert A.; Gong, Peijun; Wood, Fiona M.; Sampson, David D.

    2013-06-01

    In scars arising from burns, objective assessment of vascularity is important in the early identification of pathological scarring, and in the assessment of progression and treatment response. We demonstrate the first clinical assessment and automated quantification of vascularity in cutaneous burn scars of human patients in vivo that uses optical coherence tomography (OCT). Scar microvasculature was delineated in three-dimensional OCT images using speckle decorrelation. The diameter and area density of blood vessels were automatically quantified. A substantial increase was observed in the measured density of vasculature in hypertrophic scar tissues (38%) when compared against normal, unscarred skin (22%). A proliferation of larger vessels (diameter≥100 μm) was revealed in hypertrophic scarring, which was absent from normal scars and normal skin over the investigated physical depth range of 600 μm. This study establishes the feasibility of this methodology as a means of clinical monitoring of scar progression.

  7. [European Association of Urology guidelines on assessment and nonsurgical management of urinary incontinence].

    Science.gov (United States)

    Lucas, M G; Bosch, R J L; Burkhard, F C; Cruz, F; Madden, T B; Nambiar, A K; Neisius, A; de Ridder, D J M K; Tubaro, A; Turner, W H; Pickard, R S

    2013-04-01

    The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology. We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination. Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice. These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion. Copyright © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.

  8. Development and Assessment of a Gas Chromatographic Based Method for the Quantification of Thymol from Cream Based Formulation.

    Science.gov (United States)

    Samani, Soliman Mohammadi; Moein, Mahmoodreza; Petramfar, Peyman; Zarshenas, Mohammad M

    2016-01-01

    Herbal medicines have been used for different illnesses. However, standardization of these medicaments should be done before introducing for treatment purposes. Ajwain an essential oil, is traditionally used for neuropathic pain. To develop and assess a gas chromatographic-based method for the quantification of thymol in Ajwain essential oil, current work was performed. Both pure thymol and Ajwain creams were prepared and subjected to hydrodistillation method under temperature-controlled procedure to re-extract the applied essential oil and pure thymol. Previously, Ajwain seeds essential oil composition was analyzed and identified using GC/MS. After re-extraction, GC/FID was applied quantitatively to determine the thymol content in the Ajwain and thymol creams. The parameters represented in International Conference on Harmonization (ICH) guidelines were considered for the determination. Thymol content in a 50 g laminated tube of Ajwain cream was calculated as 2.34 g ± 0.02. Regarding the total thymol content of a 50 g laminated tube of Thymol cream (2.43 g), recovery percent for Ajwain cream was calculated as 96.29 %. Using hydrodistillation for an essential oil- containing cream sample via Clevenger proved to be a simple and convenient method to work up and extract active volatile components of such semisolid formulation. However, the extraction yield was profoundly related to the condenser temperature. The current employed determination method is introduced as a rapid and reliable method and thus, can be suggested for the quality control assessment of phytopharmaceutical semisolid preparations containing thymol and similar volatile constituents.

  9. Going DEEP: guidelines for building simulation-based team assessments.

    Science.gov (United States)

    Grand, James A; Pearce, Marina; Rench, Tara A; Chao, Georgia T; Fernandez, Rosemarie; Kozlowski, Steve W J

    2013-05-01

    Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation. The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments. Information and actionable recommendations associated with creating assessments of team processes (non-technical 'teamwork' activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP). The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.

  10. Study on quantification method based on Monte Carlo sampling for multiunit probabilistic safety assessment models

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Kye Min [KHNP Central Research Institute, Daejeon (Korea, Republic of); Han, Sang Hoon; Park, Jin Hee; Lim, Ho Gon; Yang, Joon Yang [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Heo, Gyun Young [Kyung Hee University, Yongin (Korea, Republic of)

    2017-06-15

    In Korea, many nuclear power plants operate at a single site based on geographical characteristics, but the population density near the sites is higher than that in other countries. Thus, multiunit accidents are a more important consideration than in other countries and should be addressed appropriately. Currently, there are many issues related to a multiunit probabilistic safety assessment (PSA). One of them is the quantification of a multiunit PSA model. A traditional PSA uses a Boolean manipulation of the fault tree in terms of the minimal cut set. However, such methods have some limitations when rare event approximations cannot be used effectively or a very small truncation limit should be applied to identify accident sequence combinations for a multiunit site. In particular, it is well known that seismic risk in terms of core damage frequency can be overestimated because there are many events that have a high failure probability. In this study, we propose a quantification method based on a Monte Carlo approach for a multiunit PSA model. This method can consider all possible accident sequence combinations in a multiunit site and calculate a more exact value for events that have a high failure probability. An example model for six identical units at a site was also developed and quantified to confirm the applicability of the proposed method.

  11. Study on Quantification Method Based on Monte Carlo Sampling for Multiunit Probabilistic Safety Assessment Models

    Directory of Open Access Journals (Sweden)

    Kyemin Oh

    2017-06-01

    Full Text Available In Korea, many nuclear power plants operate at a single site based on geographical characteristics, but the population density near the sites is higher than that in other countries. Thus, multiunit accidents are a more important consideration than in other countries and should be addressed appropriately. Currently, there are many issues related to a multiunit probabilistic safety assessment (PSA. One of them is the quantification of a multiunit PSA model. A traditional PSA uses a Boolean manipulation of the fault tree in terms of the minimal cut set. However, such methods have some limitations when rare event approximations cannot be used effectively or a very small truncation limit should be applied to identify accident sequence combinations for a multiunit site. In particular, it is well known that seismic risk in terms of core damage frequency can be overestimated because there are many events that have a high failure probability. In this study, we propose a quantification method based on a Monte Carlo approach for a multiunit PSA model. This method can consider all possible accident sequence combinations in a multiunit site and calculate a more exact value for events that have a high failure probability. An example model for six identical units at a site was also developed and quantified to confirm the applicability of the proposed method.

  12. Elastic Characteristics of the Normal Achilles Tendon Assessed by Virtual Touch Imaging Quantification Shear Wave Elastography.

    Science.gov (United States)

    Fu, Shuai; Cui, Ligang; He, Xiaoxi; Sun, Yang

    2016-09-01

    To assess the elastic properties of the normal Achilles tendon in different age groups by Virtual Touch imaging quantification (VTIQ; Siemens Medical Solutions, Malvern, PA) shear wave elastography. A total of 326 healthy volunteers older than 18 years were divided into different groups by sex and age. The thickness, shear wave velocity (SWV) in sagittal and axial sections, and anisotropic coefficient of the Achilles tendon in a state of relaxation were obtained by conventional sonography and Virtual Touch imaging quantification elastography. These parameters were compared in different age and sex groups, and their correlations with age were evaluated. The thickness of the Achilles tendon in men and women increased gradually with age, and it was larger in men than in women in each age group (P tendon in the sagittal section decreased slightly with age, but the sagittal and axial SWVs and anisotropic coefficient had no significant differences among different age groups (P > .05), and they also had no significant differences between men and women within any group (P > .05). The SWVs in the sagittal and axial sections and anisotropic coefficient had no correlation with age. Intraclass correlation coefficients for sagittal and axial SWVs obtained by 2 independent observers were 0.923 and 0.870, respectively. The thickness of the Achilles tendon increased gradually with age. We confirmed that tendinous elastographic anisotropy and the stiffness of the tendon had no significant correlation with age.

  13. Meeting the International Conference on Harmonisation's Guidelines on Validation of Analytical Procedures: quantification as exemplified by a near-infrared reflectance assay of paracetamol in intact tablets.

    Science.gov (United States)

    Moffat, A C; Trafford, A D; Jee, R D; Graham, P

    2000-07-01

    This Perspective explains how the International Conference on Harmonisation's Guidelines on Validation of Analytical Procedures for quantitative methods can be met by near-infrared (NIR) assays of intact pharmaceutical products. Each of the validation characteristics (accuracy, precision, specificity, detection limit, quantification limit, linearity, range, robustness and system suitability testing) is defined, examined for their relevance to quantitative methods and examples given on how they may be used to demonstrate that near-infrared assays are fit for purpose. Methods for preparing samples for calibration are given in detail. The intention is to provide information so that a pharmaceutical manufacturer could validate a method suitable for an application for a variation of a marketing authorisation for an existing product and use a NIR assay instead of the previous method. The perspective is illustrated in detail using a NIR reflectance assay of paracetamol in intact tablets. This proven assay gives results comparable to the British Pharmacopeia ultraviolet assay for paracetamol, the standard errors of calibration and prediction for the NIR method being 0.48% w/w and 0.71% w/w respectively. The method is also precise, the standard deviation and coefficient of variation for six NIR assays on the same day being 0.14% w/w and 0.16% w/w respectively, while measurements over six consecutive days gave 0.31% w/w and 0.36% w/w respectively.

  14. Design guidelines for self-assessment support for adult academic distance learning

    DEFF Research Database (Denmark)

    Menendez Blanco, Maria; van der Veer, Gerrit; Benvenuti, Laura

    2011-01-01

    This contribution focuses on adult distance learning. Based on experiences at the Open University of the Netherlands we investigate specific problems that our students have with self-assessment and metacognition while studying. Starting from a literature review and complementing this with available...... student data from our teaching research center, we developed a conceptual framework that was iteratively adjusted and assessed by a questionnaire study and interviews. This allowed us to develop design guidelines for self-assessment support in distance learning environments. These guidelines were reviewed...

  15. Quantification of adherent platelets on polymer-based biomaterials. Comparison of colorimetric and microscopic assessment.

    Science.gov (United States)

    Braune, S; Zhou, S; Groth, B; Jung, F

    2015-01-01

    Platelet adhesion to artificial surfaces is one of the most important indicators for the thrombogenicity of implant materials. Currently, a variety of enzyme activity-based colorimetric assays or microscopy-based techniques are commonly in use to assess this characteristic. Studies about how data of colorimetric assays correlate with the image-based quantification of adherent platelets are scarce. To address this question, the present study compared two colorimetric assays (lactate dehydrogenase (LDH) and acid phosphatase (ACP)) with an image-based quantification of the density of platelets adhering on polymer-based biomaterial surfaces. Tri-sodium citrated whole blood was collected from apparently healthy subjects and platelet rich plasma (PRP) was prepared according to a standardized protocol. An in vitro static thrombogenicity test was applied to study platelet adhesion from PRP adjusted to 50,000 platelets per μL on three different polymers: medical grade polytetrafluoroethylene (PTFE), silicone and polyethylene terephthalate (PET). For the direct image-based approach, surface adherent platelets were fixed, fluorescently labelled and microscopically visualized. The image-based determination of platelet densities provided reference values for the comparison with data of the colorimetric assays. Correlation between standard platelet concentrations and ACP/LDH absorbance measurements were analysed to estimate accuracy and association of both parameters. ACP and LDH release from resting and ADP-stimulated platelets was studied to estimate how platelet activation influences colorimetric assay results. The density of adherent platelets ranged from 15,693 ± 2,487 platelets·mm-2 (PTFE) to 423 ± 99 platelets·mm-2 (silicone) and 4,621 ± 1,427 platelets·mm-2 (PET) and differed significantly between the three polymers (ANOVA: p platelet densities ranged between r = 0.93 (LDH, p platelet standards with different concentrations corresponded well to an ideal

  16. A practical guideline for human error assessment: A causal model

    Science.gov (United States)

    Ayele, Y. Z.; Barabadi, A.

    2017-12-01

    To meet the availability target and reduce system downtime, effective maintenance have a great importance. However, maintenance performance is greatly affected in complex ways by human factors. Hence, to have an effective maintenance operation, these factors needs to be assessed and quantified. To avoid the inadequacies of traditional human error assessment (HEA) approaches, the application of Bayesian Networks (BN) is gaining popularity. The main purpose of this paper is to propose a HEA framework based on the BN for maintenance operation. The proposed framework aids for assessing the effects of human performance influencing factors on the likelihood of human error during maintenance activities. Further, the paper investigates how operational issues must be considered in system failure-rate analysis, maintenance planning, and prediction of human error in pre- and post-maintenance operations. The goal is to assess how performance monitoring and evaluation of human factors can effect better operation and maintenance.

  17. Reductions in Long-Term Suspensions Following Adoption of the Virginia Student Threat Assessment Guidelines

    Science.gov (United States)

    Cornell, Dewey G.; Gregory, Anne; Fan, Xitao

    2011-01-01

    This quasi-experimental study examined the adoption of the Virginia Student Threat Assessment Guidelines in 23 high schools. After training, school administrators and other staff members demonstrated substantial increases in knowledge of threat assessment principles and decreased commitment to zero tolerance approaches. Schools using the…

  18. Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology.

    Science.gov (United States)

    Cicchetti, Domenic V.

    1994-01-01

    In the context of developing assessment instruments in psychology, issues of standardization, norming procedures, and test reliability and validity are discussed. Criteria, guidelines, and rules of thumb are provided to help the clinician with instrument selection for a given psychological assessment. (SLD)

  19. Canada’s Guideline 9: improving SOGIE claims assessment?

    Directory of Open Access Journals (Sweden)

    Moira Dustin

    2017-10-01

    Full Text Available Asylum seekers making claims relating to their sexual orientation and gender identity often face unfair refusal. New guidance from the Immigration and Refugee Board of Canada takes admirable steps towards improving claims assessment, and offers a model for practitioners elsewhere.

  20. EPa`s program for risk assessment guidelines: Exposure issues

    Energy Technology Data Exchange (ETDEWEB)

    Callahan, M.A. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    Three major issues to be dealt with over the next ten years in the exposure assessment field are: consistency in terminology, the impact of computer technology on the choice of data and modeling, and conceptual issues such as the use of time-weighted averages.

  1. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines

    NARCIS (Netherlands)

    Hirota, Masahiko; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Miura, Fumihiko; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Strasberg, Steven; Pitt, Henry; Gadacz, Thomas R.; de Santibanes, Eduardo; Gouma, Dirk J.; Solomkin, Joseph S.; Belghiti, Jacques; Neuhaus, Horst; Buechler, Markus W.; Fan, Sheung-Tat; Ker, Chen-Guo; Padbury, Robert T.; Liau, Kui-Hin; Hilvano, Serafin C.; Belli, Giulio; Windsor, John A.; Dervenis, Christos

    2007-01-01

    The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and

  2. Assessing adherence to the 2010 antiretroviral guidelines in the ...

    African Journals Online (AJOL)

    what combinations of drugs to use when a change was indicated. • what laboratory ... 1 Infectious Disease Clinic,1 Military Hospital, Pretoria, South Africa. 2 Department of ... rollout clinic of the Infectious Diseases Clinic Pharmacy at 1 Military Hospital (1MH) over a period of 3 years to assess clinicians' adherence to the ...

  3. Quantification for Complex Assessment: Uncertainty Estimation in Final Year Project Thesis Assessment

    Science.gov (United States)

    Kim, Ho Sung

    2013-01-01

    A quantitative method for estimating an expected uncertainty (reliability and validity) in assessment results arising from the relativity between four variables, viz examiner's expertise, examinee's expertise achieved, assessment task difficulty and examinee's performance, was developed for the complex assessment applicable to final…

  4. Development of a technique for quantification of reticulocytes and assessment of erythrocyte regenerative capacity in birds.

    Science.gov (United States)

    Johns, Jennifer L; Shooshtari, Mahrokh P; Christopher, Mary M

    2008-08-01

    To develop a reticulocyte classification scheme, optimize an avian reticulocyte staining protocol, and compare the percentages of reticulocyte types with polychromatophil percentage in blood samples from birds. Blood samples from a red-tailed hawk and 31 ill birds. A single blood sample obtained from a red-tailed hawk (Buteo jamaicensis) was used to optimize the staining protocol. For optimization of the staining protocol, 4 dilutions of whole blood with new methylene blue stain and 4 incubation times were evaluated. From samples submitted for avian CBCs, EDTA-anticoagulated whole blood samples from 31 ill birds were randomly selected and examined to compare polychromatophil and reticulocyte percentages. Reticulocyte staining was performed in all samples by use of a 1:3 (whole blood to new methylene blue) dilution with incubation for 10 minutes at room temperature (approx 22 degrees C); reticulocytes were assessed as a percentage of 1,000 RBCs by 2 independent observers. In Wright-Giemsa-stained blood smears, a polychromatophil percentage was similarly determined. 4 avian reticulocyte types were defined: ring-form reticulocytes, aggregate reticulocytes, and 2 subcategories of punctate reticulocytes. A reticulocyte-staining protocol was optimized. Interobserver and intraobserver variations in assessment of reticulocyte and polychromatophil percentages were not significant. A strong positive correlation (Spearman coefficient of rank correlation [rho] = 0.978) was identified between the percentage of polychromatophils and the percentage of ring-form reticulocytes. Results indicated that quantification of ring-form reticulocytes provides an accurate assessment of erythrocyte regenerative capacity in birds.

  5. DIET@NET: Best Practice Guidelines for dietary assessment in health research.

    Science.gov (United States)

    Cade, Janet E; Warthon-Medina, Marisol; Albar, Salwa; Alwan, Nisreen A; Ness, Andrew; Roe, Mark; Wark, Petra A; Greathead, Katharine; Burley, Victoria J; Finglas, Paul; Johnson, Laura; Page, Polly; Roberts, Katharine; Steer, Toni; Hooson, Jozef; Greenwood, Darren C; Robinson, Sian

    2017-11-15

    Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report. The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131 experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines. Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases. The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGs provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies. These guidelines will be accessible through the Nutritools website, www.nutritools.org .

  6. Clinical assessment of chest pain and guidelines for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, J., E-mail: joachim.gruettner@umm.de [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Sueselbeck, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Borggrefe, M.; Walter, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany)

    2012-12-15

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  7. Modeling and Quantification of Team Performance in Human Reliability Analysis for Probabilistic Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Jeffrey C. JOe; Ronald L. Boring

    2014-06-01

    Probabilistic Risk Assessment (PRA) and Human Reliability Assessment (HRA) are important technical contributors to the United States (U.S.) Nuclear Regulatory Commission’s (NRC) risk-informed and performance based approach to regulating U.S. commercial nuclear activities. Furthermore, all currently operating commercial NPPs in the U.S. are required by federal regulation to be staffed with crews of operators. Yet, aspects of team performance are underspecified in most HRA methods that are widely used in the nuclear industry. There are a variety of "emergent" team cognition and teamwork errors (e.g., communication errors) that are 1) distinct from individual human errors, and 2) important to understand from a PRA perspective. The lack of robust models or quantification of team performance is an issue that affects the accuracy and validity of HRA methods and models, leading to significant uncertainty in estimating HEPs. This paper describes research that has the objective to model and quantify team dynamics and teamwork within NPP control room crews for risk informed applications, thereby improving the technical basis of HRA, which improves the risk-informed approach the NRC uses to regulate the U.S. commercial nuclear industry.

  8. Lead (Pb) quantification in potable water samples: implications for regulatory compliance and assessment of human exposure.

    Science.gov (United States)

    Triantafyllidou, Simoni; Nguyen, Caroline K; Zhang, Yan; Edwards, Marc A

    2013-02-01

    Assessing the health risk from lead (Pb) in potable water requires accurate quantification of the Pb concentration. Under worst-case scenarios of highly contaminated water samples, representative of public health concerns, up to 71-98 % of the total Pb was not quantified if water samples were not mixed thoroughly after standard preservation (i.e., addition of 0.15 % (v/v) HNO(3)). Thorough mixing after standard preservation improved recovery in all samples, but 35-81 % of the total Pb was still un-quantified in some samples. Transfer of samples from one bottle to another also created high errors (40-100 % of the total Pb was un-quantified in transferred samples). Although the United States Environmental Protection Agency's standard protocol avoids most of these errors, certain methods considered EPA-equivalent allow these errors for regulatory compliance sampling. Moreover, routine monitoring for assessment of human Pb exposure in the USA has no standardized protocols for water sample handling and pre-treatment. Overall, while there is no reason to believe that sample handling and pre-treatment dramatically skew regulatory compliance with the US Pb action level, slight variations from one approved protocol to another may cause Pb-in-water health risks to be significantly underestimated, especially for unusual situations of "worst case" individual exposure to highly contaminated water.

  9. Tumour assessment and staging: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Roland, N; Porter, G; Fish, B; Makura, Z

    2016-05-01

    In general, the first decision to be made in a patient with a confirmed head and neck cancer is whether or not to treat the patient before deciding what form of management strategy is appropriate. There is no more important an aspect of head and neck cancer care than the initial evaluation of the patient and the patient's tumour. The practice requires specific expertise and judgement. The current tumour-node-metastasis system relies on morphology of the tumour (anatomical site and extent of disease) but the final decision on treatment hinges on a full assessment of the patient including physiological age and general condition. The aim of this paper is primarily to describe why and how we appraise a patient and their tumour. It addresses the general principles applicable to the topic of evaluation, classification and staging. In addition, the limitations and pitfalls of this process are described. Recommendations • All patients with head and neck cancer (HNC) should undergo tumour classification and staging prior to treatment. (R) • Pre-therapeutic clinical staging of HNCs should be based on at least a C2 factor (evidence obtained by special diagnostic means, e.g. radiographic imaging (e.g. computed tomography, magnetic resonance imaging or ultrasound scan), endoscopy, biopsy and cytology). (R) • Imaging to evaluate the primary site should be performed prior to biopsy to avoid the effect of upstaging from the oedema caused by biopsy trauma. (G) • Panendoscopy is only recommended for symptomatic patients or patients with primary tumours known to have a significant risk of a second (synchronous) primary tumour. (G).

  10. The assessment of genetic risk of breast cancer : a set of GP guidelines

    NARCIS (Netherlands)

    de Bock, GH; Vlieland, TPMV; Hageman, GCHA; Oosterwijk, JC; Springer, MP; Kievit, J

    Background. Assessing a genetic risk for developing breast cancer is not an easy task for a GP. Current expert guidelines for referring and counselling women with a family history positive for breast cancer are complex and difficult to apply in general practice, and have only two strategies (to

  11. Multicentre evaluation of prescribing concurrence with anti-infective guidelines : epidemiological assessment of indicators

    NARCIS (Netherlands)

    Fijn, R; Chow, MC; Schuur, PMH; De Jong-Van den Berg, LTW; Brouwers, JRBJ

    2002-01-01

    Purpose To assess indicators for anti-infective prescribing not concurrent with regional pharmacotherapeutic treatment guidelines (PTGs) on infectious diseases. Methods A retrospective explorative cohort study based on hospital-wide anti-infective prescription data of a 2-month cross-sectional

  12. Guidelines for Preparing Psychological Specialists: An Entry-Level Course on Intellectual Assessment

    Science.gov (United States)

    Oakland, Thomas; Wechsler, Solange Muglia

    2016-01-01

    This article provides guidelines for an entry-level course that prepares psychology students and practitioners to acquire entry-level skills, abilities, knowledge, and attitudes important to the individual assessment of intellectual abilities of children and youth. The article reviews prominent international, regional, and national policies,…

  13. Early Intervention Evaluation Reports: Guidelines for Writing User-Friendly and Strength-Based Assessments

    Science.gov (United States)

    Towle, Patricia; Farrell, Anne F.; Vitalone-Raccaro, Nancy

    2008-01-01

    Assessment and evaluation activities are an integral part of early intervention services. These activities culminate in written evaluation reports that include information such as observations of skills and deficits, diagnosis, and recommendations for intervention. However, few guidelines exist to help guide early intervention providers in writing…

  14. Guidelines for the Design of Digital Closed Questions for Assessment and Learning in Higher Education

    Science.gov (United States)

    Draaijer, Silvester; Hartog, R. J. M.; Hofstee, J.

    2007-01-01

    Systems for computer based assessment as well as learning management systems offer a number of innovative closed question types, which are used more and more in higher education. These closed questions are used in computer based summative exams, in diagnostic tests, and in computer based activating learning material. Guidelines focusing on the…

  15. Food allergy guidelines and assessing allergic reaction risks: a regulatory perspective.

    Science.gov (United States)

    Luccioli, Stefano

    2012-06-01

    To review information in food allergy guidelines and the literature on assessing and understanding food allergic reaction risks. Current food allergy guidelines have focused on tools for better diagnosis of food allergy and treatment of reactions. These guidelines have not addressed the growing body of literature on risk assessment and diagnostic tools being used to assess dose-response relationships in relation to food-allergen exposures. The literature includes substantial data from food-allergen challenges performed in sensitive individuals, and probabilistic modeling of these data may help to elucidate the relationship between allergen dose exposures, including thresholds, and reaction risk in allergic individuals. Understanding this relationship has potential to improve the health-related quality of life of allergic consumers. Recent findings in the literature have highlighted improved diagnostic tools and other information that can be used to assess risks for allergic reaction to low-dose allergen exposures (thresholds) and reaction severity in food allergic consumers. Recommendations to better define and stratify allergic reaction risks for consumers could be adopted into guidelines for the diagnosis and clinical management of food allergy.

  16. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

    NARCIS (Netherlands)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P

    2017-01-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  17. Guidelines for assessing favourable conservation status of Natura 2000 species and habitat types in Bulgaria

    NARCIS (Netherlands)

    Zingstra, H.L.; Kovachev, A.; Kitnaes, K.; Tzonev, R.; Dimova, D.; Tzvetkov, P.

    2009-01-01

    This executive summary describes the methodology for assessing the favourable conservation status of N2000 habitats and species on site level in Bulgaria and gives guidelines for its application. The methodology was developed in the frame of the BBI/Matra project 2006/014 “Favourable Conservation

  18. 49 CFR Appendix B to Part 209 - Federal Railroad Administration Guidelines for Initial Hazardous Materials Assessments

    Science.gov (United States)

    2010-10-01

    ... were International Maritime Dangerous Goods (IMDG) labels instead of 10″ placards. (Unit of violation... 49 Transportation 4 2010-10-01 2010-10-01 false Federal Railroad Administration Guidelines for Initial Hazardous Materials Assessments B Appendix B to Part 209 Transportation Other Regulations Relating...

  19. Guidelines for Assessing the Need for Adaptive Devices for Visually Impaired Pedestrians at Signalized Intersections.

    Science.gov (United States)

    Gallagher, Brian R.; de Oca, Patricia Montes

    1998-01-01

    Presents guidelines for orientation and mobility instructors and traffic engineers to assess the need for adaptive devices to make crosswalks at signalized intersections accessible to pedestrians with visual impairments. The discussions of audible and tactile pedestrian devices, along with case examples, distinguish when each device should be…

  20. Design guidelines for an umbilical cord blood stem cell therapy quality assessment model

    Science.gov (United States)

    Januszewski, Witold S.; Michałek, Krzysztof; Yagensky, Oleksandr; Wardzińska, Marta

    The paper enlists the pivotal guidelines for producing an empirical umbilical cord blood stem cell therapy quality assessment model. The methodology adapted was single equation linear model with domain knowledge derived from MEDAFAR classification. The resulting model is ready for therapeutical application.

  1. Best Practices for Mental Health in Child Welfare: Screening, Assessment, and Treatment Guidelines

    Science.gov (United States)

    Romanelli, Lisa Hunter; Landsverk, John; Levitt, Jessica Mass; Leslie, Laurel K.; Hurley, Maia M.; Bellonci, Christopher; Gries, Leonard T.; Pecora, Peter J.; Jensen, Peter S.

    2009-01-01

    The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the…

  2. Harvesting forest biomass for energy in Minnesota: An assessment of guidelines, costs and logistics

    Science.gov (United States)

    Saleh, Dalia El Sayed Abbas Mohamed

    The emerging market for renewable energy in Minnesota has generated a growing interest in utilizing more forest biomass for energy. However, this growing interest is paralleled with limited knowledge of the environmental impacts and cost effectiveness of utilizing this resource. To address environmental and economic viability concerns, this dissertation has addressed three areas related to biomass harvest: First, existing biomass harvesting guidelines and sustainability considerations are examined. Second, the potential contribution of biomass energy production to reduce the costs of hazardous fuel reduction treatments in these trials is assessed. Third, the logistics of biomass production trials are analyzed. Findings show that: (1) Existing forest related guidelines are not sufficient to allow large-scale production of biomass energy from forest residue sustainably. Biomass energy guidelines need to be based on scientific assessments of how repeated and large scale biomass production is going to affect soil, water and habitat values, in an integrated and individual manner over time. Furthermore, such guidelines would need to recommend production logistics (planning, implementation, and coordination of operations) necessary for a potential supply with the least site and environmental impacts. (2) The costs of biomass production trials were assessed and compared with conventional treatment costs. In these trials, conventional mechanical treatment costs were lower than biomass energy production costs less income from biomass sale. However, a sensitivity analysis indicated that costs reductions are possible under certain site, prescriptions and distance conditions. (3) Semi-structured interviews with forest machine operators indicate that existing fuel reduction prescriptions need to be more realistic in making recommendations that can overcome operational barriers (technical and physical) and planning and coordination concerns (guidelines and communications

  3. True North: Building Imaginary Worlds with the Revised Canadian (CADTH Guidelines for Health Technology Assessment

    Directory of Open Access Journals (Sweden)

    Paul C Langley

    2017-05-01

    Full Text Available In March 2017 the Canadian Agency for Drugs and Technologies in Health (CADTH released the 4th edition of their Guidelines for the Economic Evaluation of Health Technologies: Canada. These guidelines, which were first published and revised for a 3rd edition in 2006 are intended to help decision makers, health systems leaders and policy makers make well-informed decisions. They are designed, apparently, to support best practice in conducting health technology assessments in Canada. The purpose of this commentary is to consider whether or not the evidence standards proposed and the consequent modeled claims for economic effectiveness meet the standards of normal science: are the CADTH standards capable of generating claims for competing products that are credible, evaluable and replicable? The review argues that the standards proposed by CADTH do not meet the standards expected in normal science. Technical sophistication in building reference case imaginary worlds is not a substitute for claims that are experimentally evaluable or capable of assessment through systematic observation. There is no way of judging whether imaginary claims are right or even if they are wrong. CADTH is not alone in setting standards that fail to meet the standards of normal science. Recent commentaries on formulary submission guidelines in a number of other countries, to include Ireland, the Netherlands, France, Australia, the UK and New Zealand conclude that they are subject to the same criticism. If the CADTH guidelines were never intended to support feedback to health system decision makers, then this should be made clear. If not, then consideration should be given to withdrawing the guidelines to ensure they conform to these standards. Hopefully, future versions of the CADTH guidelines will address this issue and focus on a rigorous research program of claims assessment and feedback and not the building of imaginary worlds.   Type:  Commentary

  4. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

    OpenAIRE

    Peter, W.F.H.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, H.M.; Vos, R.J. de; Schoones, J.W.; Vliet Vlieland, T.P.M.

    2011-01-01

    BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and...

  5. Assessment and quantification of plastics waste generation in major 60 cities of India.

    Science.gov (United States)

    Nalini, R; Srinivasulu, B; Shit, Subhas C; Nigam, Suneel Kumar; Akolkar, A B; Dwivedfi, R K

    2013-04-01

    Polymers or plastics materials registered rapid growth in 1970s, 1980s and 1990s at the rate of 2-2.5 times the GDP growth in India. The demand for plastic raw material got more than doubled from 3.3 Million Metric Ton to 6.8 Million Metric Tons in 2010 attributed mainly to rapid urbanization, spread of retail chains, plastics based packaging from grocery to food and vegetable products to cosmetics and consumer items. Plastics packages have its merits over many of conventional materials in the related sector but unless they are collected back effectively after their use to go into recycling process, they become an eyesore in the stream of Municipal Solid Waste (MSW) due to high visibility. As the synthetic and conventional plastics are non-biodegradable in nature, these remain in the dump yards/ landfills for several years, if not collected properly. Due to non- biodegradability, plastics waste remains in the environment for several years, if not collected and disposing plastics wastes at landfills are unsafe since toxic chemicals leach out into the soil and as they contaminate soil and underground water quality. The municipal solid waste also increasing day-by-day due to the inefficient source collection, segregation and transmission of plastics waste for recycling and reusing. In order to find out the realistic plastics waste generation, a study on assessment and quantification of plastics waste has been carried out by CPCB in collaboration with CIPET on selected 60 major cities of India.

  6. Critical appraisal guidelines for assessing the quality and impact of user involvement in research.

    Science.gov (United States)

    Wright, David; Foster, Claire; Amir, Ziv; Elliott, Jim; Wilson, Roger

    2010-12-01

    The involvement of service users in the design and conduct of health research has developed significantly in the UK in recent years. Involving service users is now seen as a core component of good research practice for all forms of health research. Given the important role that users have in health research, it is necessary to develop guidelines for their effective involvement. Whilst guidelines are currently being formulated, there remain no criteria with which to assess user involvement in published studies and funding applications. This study offers guidelines for appraising the quality and impact of user involvement in published papers and grant applications. Appraisal guidelines for user involvement have been developed on the basis of available literature and experiences from studies involving cancer patients and carers in the design and conduct of research. Nine appraisal criteria have been developed. Criteria include issues such as 'Is the rationale for involving users clearly demonstrated?', 'Is the level of user involvement appropriate?', 'Is the recruitment strategy appropriate?', and 'Is the nature of training appropriate?' Generating and applying guidelines is vital if the impact of user involvement agenda in health research is to be understood. © 2010 University of Southampton. Health Expectations © 2010 Blackwell Publishing Ltd.

  7. Assessing the methodological quality of clinical guidelines for preventing falls of patients

    Directory of Open Access Journals (Sweden)

    Kamila Majkusová

    2016-12-01

    Full Text Available Aim: The study aimed to assess the methodological quality of selected clinical practice guidelines (CPGs for preventing risk of falling in adult patients in acute and long-term institutional care. Design: Descriptive study using qualitative research techniques. Methods: CPGs were systematically searched in databases of clinical guidelines, systematic reviews, electronic databases, and websites of organizations and professional societies, based on predefined criteria and keywords fo the period 2000-2015. After sorting and analysing 53 documents, the methodological quality of seven selected CPGs were assessed with the AGREE II generic instrument. Results: All CPGs obtained highest domain scores in the dimensions Clarity and Framework, and Purpose, while the lowest standardized scores were achieved by the Applicability and Editorial independence domains. The Rigor of development and Stakeholder Involvement domains achieved an average score. A total of three recommended guidelines showed high methodological quality: Falls. Assessment and prevention of falls in older people - 572 b., 84 % (NICE, 2013; Preventing Falls and Harm From Falls in Older People. Best Practice Guidelines for Australian Hospitals - 556 b., 84 % (ACSQHC, 2009; and Prevention of falls and fall injuries in the older adult - 559 b., 82 % (RNAO, 2005. Conclusion: Assessing the methodological quality of clinical guidelines using the AGREE instrument is one of the key steps in the process of their adaptation for other socio-cultural and organizational conditions. It would be possible to adapt and use all of the three most highly-rated CPGs to reduce risk of falling of inpatients in the Czech organizational and socio-cultural context.

  8. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults.

    Science.gov (United States)

    Leung, Alexander A; Daskalopoulou, Stella S; Dasgupta, Kaberi; McBrien, Kerry; Butalia, Sonia; Zarnke, Kelly B; Nerenberg, Kara; Harris, Kevin C; Nakhla, Meranda; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Gryn, Steven E; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Penner, S Brian; Burgess, Ellen; Sivapalan, Praveena; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Kline, Gregory; Leiter, Lawrence A; Jones, Charlotte; Côté, Anne-Marie; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Tsuyuki, Ross T; Hiremath, Swapnil; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Grégoire, Jean C; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Lear, Scott A; Moullec, Gregory; Gupta, Milan; Magee, Laura A; Logan, Alexander G; Dionne, Janis; Fournier, Anne; Benoit, Geneviève; Feber, Janusz; Poirier, Luc; Padwal, Raj S; Rabi, Doreen M

    2017-05-01

    Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  9. A medication assessment tool to evaluate prescribers' adherence to evidence-based guidelines in bipolar disorder.

    Science.gov (United States)

    Al-Taweel, Dalal M; Alsuwaidan, Mohammad

    2017-08-01

    Background The goal of evidence-based clinical practice has led to an increased interest in the development of tools to measure adherence to national guidelines in different diseases. This aids in detecting and measuring inappropriate prescribing to specific patient groups by using quality standards extracted from evidence-based guidelines, and ultimately provide the basis of consistent standardized prescribing. Objective To design and validate a medication assessment tool to assess prescribers' adherence to international guideline recommendations in the management of bipolar disorder (MATBD). Setting Outpatient psychiatry clinic at a secondary healthcare setting in Kuwait. Method International guidelines concerned with the management of bipolar disorder were reviewed in order to develop MATBD. Face and content validity of the developed tool (MATBD) was performed with a research and expert group. A 4-point Likert scale was used to assess the expert group's level of agreement to individual criterion. Content validity ratio (CVR) was calculated for each criterion (n = 54) and the content validity index (CVI) was calculated for each section (n = 5) of the MATBD. Finally, feasibility testing was performed on 19 patient records to confirm the tool's fitness for purpose. Main Outcomes Measure Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical settings. Results Face validity and content validity were achieved with a research and expert group (n = 14). Content validity ratio (CVR) was demonstrated for 54 criteria; criteria with a negative CVR were removed. This resulted in a draft MATBD comprising of 52 criteria (CVI: 0.814). Feasibility testing on 19 patients' records resulted in a final MATBD comprising of 49 criteria divided into 3 sections: initial assessment, acute management and monitoring. Conclusion A medication assessment tool was developed and validated to be used as a means of profiling

  10. Technical Guidelines on Performing a Sediment Erosion and Deposition Assessment (SEDA) at Superfund Sites

    Science.gov (United States)

    2014-09-01

    ER D C TR -1 4- 9 Technical Guidelines on Performing a Sediment Erosion and Deposition Assessment (SEDA) at Superfund Sites En gi ne er... Superfund Sites Earl Hayter and Karl Gustavson Environmental Laboratory U.S. Army Engineer Research and Development Center 3909 Halls Ferry Road...Vicksburg, MS 39180-6199 Steve Ells Office of Superfund Remediation and Technology Innovation US Environmental Protection Agency, OSRTI 1200

  11. Assessing Palliative Care Content in Dementia Care Guidelines: A Systematic Review.

    Science.gov (United States)

    Durepos, Pamela; Wickson-Griffiths, Abigail; Hazzan, Afeez Abiola; Kaasalainen, Sharon; Vastis, Vasilia; Battistella, Lisa; Papaioannou, Alexandra

    2017-04-01

    Families of persons with dementia continue to report unmet needs during end of life (EOL). Strategies to improve care and quality of life for persons with dementia include development of clinical practice guidelines (CPGs) and an integrative palliative approach. We aimed to assess palliative care content in dementia CPGs to identify the presence or limitations of recommendations and discussion pertaining to common issues or domains affected by illness as described by the Canadian Hospice Palliative Care Association "Square of Care." A systematic review of databases and gray literature was conducted for recent CPGs. Guidelines meeting inclusion criteria were evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument. Quality CPGs were analyzed through organizational template analysis using illness domains described by the "Canadian Hospice Palliative Care Association Model." The study protocol is registered at PROSPERO (CRD 42015025369). Eleven CPGs were selected and analyzed from 3779 citations. Nine guidelines demonstrated the maximum level of content regarding physical, psychological, and social care. Conversely, spiritual care was either absent (three) or minimal (three) in CPGs. Six CPGs did not address loss or grief, and seven CPGs did not address or had minimal content regarding EOL care. The lack of content surrounding grief represents a gap for this population at high risk for complicated grief and chronic sorrow. Results of this review require attention by CPG developers and researchers to develop evidence-based recommendations surrounding spiritual care, EOL, and grief. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  12. Ambiguity in guideline definitions introduces assessor bias and influences consistency in IUCN Red List status assessments

    Directory of Open Access Journals (Sweden)

    Matt W Hayward

    2015-07-01

    Full Text Available The IUCN Red List is the most widely used tool to measure extinction risk and report biodiversity trends. Accurate and standardised conservation status assessments for the IUCN Red List are limited by a lack of adequate information; and need consistent and unbiased interpretation of that information. Variable interpretation stems from a lack of quantified thresholds in certain areas of the Red List guidelines. Thus, even in situations with sufficient information to make a Red List assessment, inconsistency can occur when experts, especially from different regions, interpret the guidelines differently, thereby undermining the goals and credibility of the process. In such an information vacuum, assessors make assumptions depending on their level of Red List experience (subconscious bias and their personal values or agendas (conscious bias. We highlight two major issues where such bias influences assessments: relating to fenced subpopulations that require intensive management; and defining benchmark geographic distributions and thus the inclusion/exclusion of introduced subpopulations. We suggest assessor bias can be reduced by refining the Red List guidelines to include quantified thresholds for when to include fenced/intensively managed subpopulations or subpopulations outside the benchmark distribution; publishing case studies of difficult assessments to enhance cohesion between Specialist Groups; developing an online accreditation course on applying Red List criteria as a prerequisite for assessors; and ensuring that assessments of species subject to trade and utilisation are represented by all dissenting views (for example, both utilitarian and preservationist and reviewed by relevant Specialist Groups. We believe these interventions would ensure consistent, reliable assessments of threatened species between regions and across assessors with divergent views, and will thus improve comparisons between taxa and counteract the use of Red List

  13. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments.

    Directory of Open Access Journals (Sweden)

    Wiebke Hoffmann-Eßer

    Full Text Available The Appraisal of Guidelines for Research & Evaluation (AGREE II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use. The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments.A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: "yes", "yes, with modifications", "no" was examined using a multinomial regression model.118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 ("yes" vs. "no" and Domains 3 and 5 ("yes, with modifications" vs. "no".The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of

  14. A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue.

    Science.gov (United States)

    Howell, D; Keller-Olaman, S; Oliver, T K; Hack, T F; Broadfield, L; Biggs, K; Chung, J; Gravelle, D; Green, E; Hamel, M; Harth, T; Johnston, P; McLeod, D; Swinton, N; Syme, A; Olson, K

    2013-06-01

    The purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (crf) in adults. The internationally endorsed adapte methodology was used to develop a practice guideline for pan-Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of crf. The search included medline, embase, cinahl, the Cochrane Library, and other guideline and data sources to December 2009. Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process. Practice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care.

  15. Geoethical and socio-political aspects of seismic and tsunami hazard assessment, quantification and mapping

    Science.gov (United States)

    Tinti, Stefano; Armigliato, Alberto

    2016-04-01

    Seismic hazard and, more recently, tsunami hazard assessments have been undertaken in several countries of the world and globally for the whole Earth planet with the aim of providing a scientifically sound basis to the engineers, technicians, urban and industrial planners, politicians, civil protection operators and in general to the authorities for devising rational risk mitigation strategies and corresponding adequate policies. The main point of this presentation is that the chief-value of all seismic and tsunami hazard studies (including theory, concept, quantification and mapping) resides in the social and political values of the provided products, which is a standpoint entailing a number of relevant geoethical implications. The most relevant implication regards geoscientists who are the subjects mainly involved in carrying out hazard evaluations. Viewed from the classical perspective, the main ethical obligations of geoscientists are restricted to performing hazard estimations in the best possible way from a scientific point of view, which means selecting the "best" available data, adopting sound theoretical models, making use of rigorous methods… What is outlined here, is that this is an insufficient minimalistic position, since it overlooks the basic socio-political and therefore practical value of the hazard-analysis final products. In other words, if one views hazard assessment as a production process leading from data and theories (raw data and production means) to hazard maps (products), the criterion to judge whether it is good or bad needs also to include the usability factor. Seismic and tsunami hazard reports and maps are products that should be usable, which means that they should meet user needs and requirements, and therefore they should be evaluated according to how much they are clearly understandable to, and appropriate for, making-decision users. In the traditional view of a science serving the society, one could represent the interaction

  16. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines)

    NARCIS (Netherlands)

    Madersbacher, Stephan; Alivizatos, Gerasimos; Nordling, Jorgen; Sanz, Carlos Rioja; Emberton, Mark; de La Rosette, Jean J. M. C. H.

    2004-01-01

    Objective: To provide the first update of the EAU guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). Methods: A systematic literature review was conducted based on the results of a MEDLINE(R) search

  17. Quality assessment of clinical practice guidelines on the treatment of hepatocellular carcinoma or metastatic liver cancer.

    Directory of Open Access Journals (Sweden)

    Yingqiang Wang

    Full Text Available OBJECTIVES: To assess the quality of the currently available clinical practice guidelines (CPGs for hepatocellular carcinoma, and provide a reference for clinicians in selecting the best available clinical protocols. METHODS: The databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM, China National Knowledge Infrastructure (CNKI, WanFang, and relevant CPGs websites were systematically searched through March 2014. CPGs quality was appraised using the Appraisal of Guidelines for Research & Evaluation (AGREE II instrument, and data analysis was performed using SPSS 13.0 software. RESULTS: A total of 20 evidence-based and 20 expert consensus-based guidelines were included. The mean percentage of the domain scores were: scope and purpose 83% (95% confidence interval (CI, 81% to 86%, clarity of presentation 79% (95% CI, 73% to 86%, stakeholder involvement 39% (95% CI, 30% to 49%, editorial independence 58% (95% CI, 52% to 64%, rigor of development 39% (95% CI, 31% to 46%, and applicability 16% (95% CI, 10% to 23%. Evidence-based guidelines were superior to those established by consensus for the domains of rigor of development (p<0.001, clarity of presentation (p = 0.01 and applicability (p = 0.021. CONCLUSIONS: The overall methodological quality of CPGs for hepatocellular carcinoma and metastatic liver cancer is moderate, with poor applicability and potential conflict of interest issues. The evidence-based guidelines has become mainstream for high quality CPGs development; however, there is still need to further increase the transparency and quality of evidence rating, as well as the recommendation process, and to address potential conflict of interest.

  18. Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check?

    NARCIS (Netherlands)

    Ferket, Bart S.; Colkesen, Ersen B.; Visser, Jacob J.; Spronk, Sandra; Kraaijenhagen, Roderik A.; Steyerberg, Ewout W.; Hunink, M. G. Myriam

    2010-01-01

    To appraise guidelines on cardiovascular risk assessment to guide selection of screening interventions for a health check. Guidelines in the English language published between January 1, 2003, and May 2, 2009, were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National

  19. Critical assessment of three high performance liquid chromatography analytical methods for food carotenoid quantification

    NARCIS (Netherlands)

    Dias, M.G.; Oliveira, L.; Camoes, M.F.G.F.C.; Nunes, B.; Versloot, P.; Hulshof, P.J.M.

    2010-01-01

    Three sets of extraction/saponification/HPLC conditions for food carotenoid quantification were technically and economically compared. Samples were analysed for carotenoids a-carotene, ß-carotene, ß-cryptoxanthin, lutein, lycopene, and zeaxanthin. All methods demonstrated good performance in the

  20. Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams.

    Science.gov (United States)

    Creed, Michael; Whitley, Rob

    2017-05-01

    Mindset is a short recently-published booklet funded by the Mental Health Commission of Canada outlining evidence-based guidelines and best practices for journalists writing about mental health and suicide. Our study aimed to assess fidelity to Mindset recommendations in Canadian newspaper reports of a recent celebrity suicide. A secondary aim is to identify common themes discussed in these newspaper articles. Articles about Robin Williams' suicide from major Canadian newspapers were gathered and coded for presence or absence of each of the 14 recommendations in the "Covering Suicide" section of Mindset. A threshold of 80% was set to test for high fidelity to the guidelines. A qualitative content analysis of the articles was also undertaken to discern common themes and social issues discussed in the articles. Fifty-five per cent of articles surpassed the 80% threshold for high fidelity, while 85% applied at least 70% of the recommendations. The recommendation most commonly overlooked was "Do tell others considering suicide how they can get help," which was absent in 73% of articles. The most common themes discussed were those of addictions and stigma. The news articles generally follow the evidence-based guidelines regarding the reporting of suicide set out in Mindset. This is a welcome development. Future research should continue to examine reporting of suicide to assess for further improvements, while also examining the wider impact of Mindset on the reporting of mental illness per se.

  1. APPLICATION OF SEDIMENT QUALITY GUIDELINES IN THE ASSESSMENT OF MANGROVE SURFACE SEDIMENT IN MENGKABONG LAGOON, SABAH, MALAYSIA

    Directory of Open Access Journals (Sweden)

    S. M. Praveena, M. Radojevic, M. H. Abdullah, A. Z. Aris

    2008-01-01

    Full Text Available There have been numerous sediment quality guidelines developed to monitor the sediments. Sediment quality guidelines are very useful to screen sediment contamination by comparing sediment contaminant concentration with the corresponding quality guideline, provide useful tools for screening sediment chemical data to identify pollutants of concern and prioritise problem sites and relatively good predictors of contaminations. However, these guidelines are chemical specific and do not include biological parameters. Aquatic ecosystems, including sediments, must be assessed in multiple components (biological data, toxicity, physicochemistry by using intregrated approaches in order to establish a complete and comprehensive set of sediment quality guidelines. Numerous sediment quality guidelines Washington Department of Ecology Sediment Quality Guideline, Australian and New Zealand Environment and Conservation Council, Swedish Environmental Sediment Quality, Screening Quick Reference Table, Portuguese Legislation on the Classification of Dredged Materials in Coastal Zones and Interim Sediment Quality Guideline for Hong Kong have been applied to the Mengkabong lagoon mangrove sediment and discussed. The most appropriate guideline that meets the prioritization criteria consistent with international initiatives and regulations is interim sediment quality values for Hong Kong. The guideline verifies that all the metals are below the Interim Sediment Quality Value-low. However, site-specific, biological testing and ecological analysis of exisiting benthics community structure related to sediment contamination are needed for final decision making in the case of Mengkabong lagoon.

  2. Preliminary Guideline for the High Temperature Structure Integrity Assessment Procedure Part I. High Temperature Structure Design Guide

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Han; Kim, J. B.; Lee, H. Y.; Park, C. G.; Joo, Y. S.; Koo, G. H.; Kim, S. H

    2007-02-15

    A preliminary guideline for the design and evaluation of LMR high temperature structure is presented based upon ASME B and PV Code, Section III, Subsection NH. The main contents of this guideline are the materials, general design, vessel, piping, core support structure, pumps, valves, fabrication, examination, and testing for the class 1 components. The ratcheting evaluation, enhanced creep assessment, welds design and evaluation, inelastic analysis approach, piping design alternatives, and bellows design method are described in appendices. A user of this guideline should follow the essential procedures and may refer to other pertinent codes, standards, laws, regulations, or other pertinent documents when this guideline does not lead to proper design of the structure. While this guideline adopts major procedures of Subsection NH, it refers to the RCC-MR and/or DDS in some amount for the items where these codes have excellency to improve this guideline.

  3. A systematic review of recent clinical practice guidelines on the diagnosis, assessment and management of hypertension.

    Directory of Open Access Journals (Sweden)

    Lubna A Al-Ansary

    Full Text Available BACKGROUND: Despite the availability of clinical practice guidelines (CPGs, optimal hypertension control is not achieved in many parts of the world; one of the challenges is the volume of guidelines on this topic and their variable quality. To systematically review the quality, methodology, and consistency of recommendations of recently-developed national CPGs on the diagnosis, assessment and the management of hypertension. METHODOLOGY/PRINCIPAL FINDINGS: MEDLINE, EMBASE, guidelines' websites and Google were searched for CPGs written in English on the general management of hypertension in any clinical setting published between January 2006 and September 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data. Conflicts were resolved by discussion or the involvement of an additional reviewer. Eleven CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7 on the AGREE-II tool. The highest scores were for "clarity of presentation" (44.4%-88.9% and the lowest were for "rigour of development" (8.3%-30% for 9 CGPs. None of them clearly reported being newly developed or adapted. Only one reported having a patient representative in its development team. Systematic reviews were not consistently used and only 2 up-to-date Cochrane reviews were cited. Two CPGs graded some recommendations and related that to levels (but not quality of evidence. The CPGs' recommendations on assessment and non-pharmacological management were fairly consistent. Guidelines varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (e.g. resistant hypertension were ignored by 6/11 CPGs. The CPGs varied in methodological quality, suggesting that their implementation might not result in less variation of care or in better health-related outcomes. CONCLUSIONS/SIGNIFICANCE: More efforts are needed to promote the realistic

  4. Systematic review of guidelines for the assessment and management of high-grade anal intraepithelial neoplasia (AIN II/III).

    Science.gov (United States)

    Alam, N N; White, D A; Narang, S K; Daniels, I R; Smart, N J

    2016-02-01

    There is ambiguity with regard to the optimal management of anal intraepithelial neoplasia (AIN) III. The aim of this review was to assess and compare international/national society guidelines currently available in the literature on the management, treatment and surveillance of AIN III. We also aimed to assess the quality of the studies used to compile the guidelines and to clarify the terminology used in histological assessment. An electronic search of PubMed and Embase was performed using the search terms 'anal intraepithelial neoplasia', 'AIN', 'anal cancer', 'guidelines', 'surveillance' and 'management'. Literature reviews and guidelines or practice guidelines in peer reviewed journals from 1 January 2000 to 31 December 2014 assessing the treatment, surveillance or management of patients with AIN related to human papilloma virus were included. The guidelines identified by the search were assessed for the quality of evidence behind them using the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. The database search identified 5159 articles and two further guidelines were sourced from official body guidelines. After inclusion criteria were applied, 28 full-text papers were reviewed. Twenty-five of these were excluded, leaving three guidelines for inclusion in the systematic review: those published by the Association of Coloproctology of Great Britain and Ireland, the American Society of Colon and Rectal Surgeons and the Italian Society of Colorectal Surgery. No guidelines were identified on the management of AIN III from human papilloma virus associations and societies. All three guidelines agree that a high index of clinical suspicion is essential for diagnosing AIN with a disease-specific history, physical examination, digital rectal examination and anal cytology. There is interchange of terminology from high-grade AIN (HGAIN) (which incorporates AIN II/III) and AIN III in the literature leading to confusion in therapy use. Treatment varies

  5. Reducing aquatic hazards of industrial chemicals: probabilistic assessment of sustainable molecular design guidelines.

    Science.gov (United States)

    Connors, Kristin A; Voutchkova-Kostal, Adelina M; Kostal, Jakub; Anastas, Paul; Zimmerman, Julie B; Brooks, Bryan W

    2014-08-01

    Basic toxicological information is lacking for the majority of industrial chemicals. In addition to increasing empirical toxicity data through additional testing, prospective computational approaches to drug development aim to serve as a rational basis for the design of chemicals with reduced toxicity. Recent work has resulted in the derivation of a "rule of 2," wherein chemicals with an octanol-water partition coefficient (log P) less than 2 and a difference between the lowest unoccupied molecular orbital and the highest occupied molecular orbital (ΔE) greater than 9 (log P9 eV) are predicted to be 4 to 5 times less likely to elicit acute or chronic toxicity to model aquatic organisms. The present study examines potential reduction of aquatic toxicity hazards from industrial chemicals if these 2 molecular design guidelines were employed. Probabilistic hazard assessment approaches were used to model the likelihood of encountering industrial chemicals exceeding toxicological categories of concern both with and without the rule of 2. Modeling predicted that utilization of these molecular design guidelines for log P and ΔE would appreciably decrease the number of chemicals that would be designated to be of "high" and "very high" concern for acute and chronic toxicity to standard model aquatic organisms and end points as defined by the US Environmental Protection Agency. For example, 14.5% of chemicals were categorized as having high and very high acute toxicity to the fathead minnow model, whereas only 3.3% of chemicals conforming to the design guidelines were predicted to be in these categories. Considerations of specific chemical classes (e.g., aldehydes), chemical attributes (e.g., ionization), and adverse outcome pathways in representative species (e.g., receptor-mediated responses) could be used to derive future property guidelines for broader classes of contaminants. © 2014 SETAC.

  6. Appraisal of the Glasgow assessment and management of alcohol guideline: a comprehensive alcohol management protocol for use in general hospitals.

    Science.gov (United States)

    McPherson, A; Benson, G; Forrest, E H

    2012-07-01

    Guidelines exist for the management of alcohol withdrawal syndrome (AWS) but few have been assessed as to their suitability for general hospitals. The Glasgow Assessment and Management guideline for alcohol has been specifically developed for use in this context. To determine if this alcohol assessment guideline aids the management of AWS in general hospitals. The four components of the Glasgow Assessment and Management of Alcohol guideline were evaluated. This included the use of the Fast Alcohol Screening Test (FAST) to identify at risk patients, a risk stratification strategy to indicate fixed dose or symptom-triggered benzodiazepine treatment, the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) for symptom-triggered treatment and a clear recommendation for vitamin prophylaxis of Wernicke's encephalopathy. FAST scores were assessed along with the CAGE (cut down, annoyed, guilty and eye-opener) screening tool to ascertain if a single screening tool could identify hazardous and dependent drinking. The GMAWS and Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) were compared between two medical units. A staff survey of the two AWS tools was also carried out. FAST was able to identify both probable hazardous and dependent drinking. The GMAWS was reliable and gauged both physical and cognitive aspects of AWS. Staff generally preferred the GMAWS-based treatment as opposed to CIWA-Ar management and welcomed the Guideline as a whole. The Glasgow Guideline aids the management of patients with AWS in an acute hospital setting. It allows early identification of at risk patients and directs effective therapeutic intervention.

  7. Guidelines for the assessment and acceptance of potential brain-dead organ donors.

    Science.gov (United States)

    Westphal, Glauco Adrieno; Garcia, Valter Duro; Souza, Rafael Lisboa de; Franke, Cristiano Augusto; Vieira, Kalinca Daberkow; Birckholz, Viviane Renata Zaclikevis; Machado, Miriam Cristine; Almeida, Eliana Régia Barbosa de; Machado, Fernando Osni; Sardinha, Luiz Antônio da Costa; Wanzuita, Raquel; Silvado, Carlos Eduardo Soares; Costa, Gerson; Braatz, Vera; Caldeira Filho, Milton; Furtado, Rodrigo; Tannous, Luana Alves; Albuquerque, André Gustavo Neves de; Abdala, Edson

    2016-09-01

    Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

  8. Procedures of assessment on the quantification of thoracic kyphosis and lumbar lordosis by radiography and photogrammetry: A literature review.

    Science.gov (United States)

    Porto, Alessandra Beggiato; Okazaki, Victor Hugo Alves

    2017-10-01

    The quantification of thoracic kyphosis and lumbar lordosis can be assessed in different ways; among them radiography and photogrammetry. However, the assessment procedures are not consistent in the literature for either method. The objective of this study was to conduct a literature review about postural assessment through radiography and photogrammetry, for delineating the procedures for both methods. In total 38 studies were selected by an online search in the MEDLINE and LILACS databases with the keywords: radiograph and posture, postural alignment, photogrammetry or photometry or biophotogrammetry. For the radiographic method, the results showed divergences in arm positioning and in the calculation of thoracic and lumbar angles. The photogrammetry demonstrated differences in relation to the camera, tripod, plumb line and feet positioning, angle calculation, software utilization, and the use of footwear. Standardization is proposed for both methods to help establish normative values and comparisons between diagnoses. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Assessing the IADC Space Debris Mitigation Guidelines: A Case for Ontology-based Data Management

    Science.gov (United States)

    Walls, R.; Gaylor, D.; Reddy, V.; Furfaro, R.; Jah, M.

    2016-09-01

    As the population of man-made debris orbiting the Earth increases, so does the risk of damaging collisions. The Inter-Agency Space Debris Coordination Committee (IADC) has issued space debris mitigation guidelines including a key recommendation that before mission's end, spacecraft should move far enough from GEO so as not to be an operational hazard to other objects in active missions. It can be extremely difficult to determine if a spacecraft or operator is in compliance with this guideline, as it requires prediction of future actions based upon many data types. Furthermore, there has been no comprehensive assessment of the adequacy or validity of the IADC recommendations. The EU strives for a Code of Conduct in space, the United Nations-Committee On Peaceful Uses of Outer Space (UN-COPUOS) strives for guidelines to ensure the Long Term Sustainability of Space Activities (LTSSA), the FAA is concerned with Space Traffic Management (STM), etc. If rules, policies, guidelines, and laws are put in place, how can any entity know who and what is adhering to them, when we don't even know how to quantify and assess behavior of space objects? The University of Arizona aims to address this salient issue. As part of its new Space Object Behavioral Sciences (SOBS) initiative, the University of Arizona is developing an ontology-based system to support integration, use, and sharing of space domain data. As a first use-case, we will test the system's ability to assess compliance with the IADC recommendation to move beyond GEO at the end of a mission as well as the adequacy and validity of recommendations. We describe the relevant data types gathered for this use-case, present a prototype ontology, and outline methods for combining semantic analysis with astrodynamics modeling. Without loss of generality, we present this method as an approach that will form the foundation of SOBS and be used to address pressing challenges in Space Situational Awareness (SSA), Orbital Safety

  10. 78 FR 14510 - Notice of Availability of New Guidelines for Pest Risk Assessments of Imported Fruits and Vegetables

    Science.gov (United States)

    2013-03-06

    ... Assessments of Imported Fruits and Vegetables AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION... health pest risk assessments for imported fruit and vegetable commodities. These new guidelines are...-initiated, qualitative pest risk assessments (PRAs) for imports of fruits and vegetables. A PRA is defined...

  11. Disease quantification in dermatology: in vivo near-infrared spectroscopy measures correlate strongly with the clinical assessment of psoriasis severity

    Science.gov (United States)

    Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B. E.

    2013-03-01

    Accurate documentation of disease severity is a prerequisite for clinical research and the practice of evidence-based medicine. The quantification of skin diseases such as psoriasis currently relies heavily on clinical scores. Although these clinical scoring methods are well established and very useful in quantifying disease severity, they require an extensive clinical experience and carry a risk of subjectivity. We explore the opportunity to use in vivo near-infrared (NIR) spectra as an objective and noninvasive method for local disease severity assessment in 31 psoriasis patients in whom selected plaques were scored clinically. A partial least squares (PLS) regression model was used to analyze and predict the severity scores on the NIR spectra of psoriatic and uninvolved skin. The correlation between predicted and clinically assigned scores was R=0.94 (RMSE=0.96), suggesting that in vivo NIR provides accurate clinical quantification of psoriatic plaques. Hence, NIR may be a practical solution to clinical severity assessment of psoriasis, providing a continuous, linear, numerical value of severity.

  12. Quantification of peptides from immunoglobulin constant and variable regions by LC-MRM MS for assessment of multiple myeloma patients.

    Science.gov (United States)

    Remily-Wood, Elizabeth R; Benson, Kaaron; Baz, Rachid C; Chen, Y Ann; Hussein, Mohamad; Hartley-Brown, Monique A; Sprung, Robert W; Perez, Brianna; Liu, Richard Z; Yoder, Sean J; Teer, Jamie K; Eschrich, Steven A; Koomen, John M

    2014-10-01

    Quantitative MS assays for Igs are compared with existing clinical methods in samples from patients with plasma cell dyscrasias, for example, multiple myeloma (MM). Using LC-MS/MS data, Ig constant region peptides, and transitions were selected for LC-MRM MS. Quantitative assays were used to assess Igs in serum from 83 patients. RNA sequencing and peptide-based LC-MRM are used to define peptides for quantification of the disease-specific Ig. LC-MRM assays quantify serum levels of Igs and their isoforms (IgG1-4, IgA1-2, IgM, IgD, and IgE, as well as kappa (κ) and lambda (λ) light chains). LC-MRM quantification has been applied to single samples from a patient cohort and a longitudinal study of an IgE patient undergoing treatment, to enable comparison with existing clinical methods. Proof-of-concept data for defining and monitoring variable region peptides are provided using the H929 MM cell line and two MM patients. LC-MRM assays targeting constant region peptides determine the type and isoform of the involved Ig and quantify its expression; the LC-MRM approach has improved sensitivity compared with the current clinical method, but slightly higher inter-assay variability. Detection of variable region peptides is a promising way to improve Ig quantification, which could produce a dramatic increase in sensitivity over existing methods, and could further complement current clinical techniques. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Methodology Guidelines on Life Cycle Assessment of Photovoltaic Electricity: 3rd Edition

    Energy Technology Data Exchange (ETDEWEB)

    Frischknecht, Rolf; Heath, Garvin; Raugei, Marco; Sinha, Parikhit; de Wild-Scholten, Mariska

    2016-01-01

    Life Cycle Assessment (LCA) is a structured, comprehensive method of quantifying material- and energy-flows and their associated emissions caused in the life cycle of goods and services. The ISO 14040 and 14044 standards provide the framework for LCA. However, this framework leaves the individual practitioner with a range of choices that can affect the results and thus the conclusions of an LCA study. The current IEA guidelines were developed to provide guidance on assuring consistency, balance, and quality to enhance the credibility and reliability of the results from LCAs on photovoltaic (PV) electricity generation systems. The guidelines represent a consensus among the authors - PV LCA experts in North America, Europe, and Asia - for assumptions made on PV performance, decisions on process input and emissions allocation, methods of analysis, and reporting of the results. Guidance is given on PV-specific parameters used as inputs in LCA and on choices and assumptions in life cycle inventory (LCI) data analysis and on implementation of modeling approaches. A consistent approach towards system modeling, the functional unit, the system boundaries, water use modeling and the allocation aspects enhances the credibility of PV electricity LCA studies and enables balanced LCA-based comparisons of different electricity producing technologies. The document discusses metrics like greenhouse gas emissions (GHG), cumulative energy demand (CED), acidification potential (AP), ozone depletion potential (ODP), human toxicity, ecotoxicity and ionizing radiation. Guidance is given for the definition of the energy payback time (EPBT), the nonrenewable energy payback time (NREPBT), and the impact mitigation potentials (IMP). The indicator energy return on investment (EROI) is described in a separate International Energy Agency (IEA) PV Power Systems (PVPS) Task 12 report (Raugei et al. 2015). The guidelines on the reporting and communication of the results serve the need for

  14. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

    Science.gov (United States)

    Siering, Ulrich; Neugebauer, Edmund A. M.; Brockhaus, Anne Catharina; Lampert, Ulrike; Eikermann, Michaela

    2017-01-01

    Introduction The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments. Materials and methods A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: “yes”, “yes, with modifications”, “no”) was examined using a multinomial regression model. Results 118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 (“yes” vs. “no”) and Domains 3 and 5 (“yes, with modifications” vs. “no”). Conclusions The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis

  15. Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilnasheen Sheikh

    2017-06-01

    Full Text Available The objective of the study is to assess the medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. A prospective observational study was carried out for a period of 8 months from June 2015 to February 2016 at tertiary care hospital. At inpatient department regular chart review of patient case records was carried out to assess the medication errors. The observed medication errors were assessed for level of harm by using NCCMERP index. The outpatient prescriptions were screened for adherence to WHO prescription writing guidelines. Out of 200 patients, 40 patients developed medication errors. Most of the medication errors were observed in the age group above 61 years (40%. Majority of the medication errors were observed with drug class of antibiotics 9 (22.5% and bronchodilators 9 (22.5%. Most of the errors were under the NCCMERP index category C. Out of 545 outpatient prescriptions, 51 (9.37% prescriptions did not have prescriber’s name and all of the prescriptions lack prescriber’s personal contact number. Eighteen prescriptions did not have patient’s name and 426 (78.2% prescriptions did not have patient’s age. The prevalence of medication errors in this study was relatively low (20% without any fatal outcome. Omission error was the most frequently observed medication errors 31 (77.5%. In the present study, the patient’s age was missing in 78.2% of the prescriptions and none of the prescriptions had patient’s address and the drug names were not mentioned by their generic names.

  16. Guidelines for exposure assessment in health risk studies following a nuclear reactor accident.

    Science.gov (United States)

    Bouville, André; Linet, Martha S; Hatch, Maureen; Mabuchi, Kiyohiko; Simon, Steven L

    2014-01-01

    Worldwide concerns regarding health effects after the Chernobyl and Fukushima nuclear power plant accidents indicate a clear need to identify short- and long-term health impacts that might result from accidents in the future. Fundamental to addressing this problem are reliable and accurate radiation dose estimates for the affected populations. The available guidance for activities following nuclear accidents is limited with regard to strategies for dose assessment in health risk studies. Here we propose a comprehensive systematic approach to estimating radiation doses for the evaluation of health risks resulting from a nuclear power plant accident, reflected in a set of seven guidelines. Four major nuclear reactor accidents have occurred during the history of nuclear power production. The circumstances leading to these accidents were varied, as were the magnitude of the releases of radioactive materials, the pathways by which persons were exposed, the data collected afterward, and the lifestyle factors and dietary consumption that played an important role in the associated radiation exposure of the affected populations. Accidents involving nuclear reactors may occur in the future under a variety of conditions. The guidelines we recommend here are intended to facilitate obtaining reliable dose estimations for a range of different exposure conditions. We recognize that full implementation of the proposed approach may not always be feasible because of other priorities during the nuclear accident emergency and because of limited resources in manpower and equipment. The proposed approach can serve as a basis to optimize the value of radiation dose reconstruction following a nuclear reactor accident.

  17. Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines.

    Science.gov (United States)

    Guha, Kaushik; Allen, Christopher J; Chawla, Sumir; Pryse-Hawkins, Hayley; Fallon, Laura; Chambers, Vicki; Vazir, Ali; Lyon, Alex R; Cowie, Martin R; Sharma, Rakesh

    2016-10-01

    The National Institute for Health and Care Excellence (NICE) updated its guidelines for chronic heart failure (HF) in 2010. This re-audit assessed interim improvement as compared with an audit in 2011. Patients with HF (preserved and reduced ejection fraction) attending a tertiary cardiac centre over a 2-year period (January 2013-December 2014) were audited. The data collected included demographics, HF aetiology, medications, clinical parameters and cardiac rehabilitation. In total, 513 patients were audited. Compared with 2011, male preponderance (71%) and age (68±14 years, (Mean ± SD)) were similar. 73% of patients lived outside of London. HF aetiologies included ischaemic heart disease (37% versus 40% in 2011), dilated cardiomyopathy (26% versus 20%) primary valve disease (13% versus 12%). For patients with left ventricular systolic dysfunction (n=434, 85% of patients audited) 89% were taking beta-blockers (compared with 77% in 2011), 91% an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (86% in 2011) and 56% a mineralocorticoid receptor antagonist (44% in 2011); 6% were prescribed ivabradine. All patients were reviewed at least 6-monthly. Although 100% of patients were educated about exercise, only 21 (4%) enrolled in a supervised exercise programme. This audit demonstrated high rates of documentation, follow-up and compliance with guideline-based medical therapies. A consistent finding was poor access to cardiac rehabilitation. © Royal College of Physicians 2016. All rights reserved.

  18. Dose assessment by quantification of chromosome aberrations and micronuclei in peripheral blood lymphocytes from patients exposed to gamma radiation

    Energy Technology Data Exchange (ETDEWEB)

    Silva-Barbosa, Isvania; Pereira-MagnataI, Simey; Amaral, Ademir [Pernambuco Univ., Recife, PE (Brazil). Dept. de Energia Nuclear. Grupo de Estudos em Radioprotecao e Radioecologia - GERAR; Sotero, Graca [Fundacao de Hematologia e Hemoterapia, Recife, PE (Brazil); Melo, Homero Cavalcanti [Hospital do Cancer, Recife, PE (Brazil). Centro de Radioterapia de Pernambuco]. E-mail: isvania@uol.com.br

    2005-07-15

    Scoring of unstable chromosome aberrations (dicentrics, rings and fragments) and micronuclei in circulating lymphocytes are the most extensively studied biological means for estimating individual exposure to ionizing radiation (IR), which can be used as complementary methods to physical dosimetry or when the latter cannot be performed. In this work, the quantification of the frequencies of chromosome aberrations and micronuclei were carried out based on cytogenetic analyses of peripheral blood samples from 5 patients with cervical uterine cancer following radiotherapy in order to evaluate the absorbed dose as a result of partial-body exposure to 60Co source. Blood samples were collected from each patient in three phases of the treatment: before irradiation, 24 h after receiving 0.08 Gy and 1.8 Gy, respectively. The results presented in this report emphasize biological dosimetry, employing the quantification of chromosome aberrations and micronuclei in lymphocytes from peripheral blood, as an important methodology of dose assessment for either whole or partial-body exposure to IR.

  19. Effectiveness of peer assessment for implementing a dutch physical therapy low back pain guideline: cluster randomized controlled trial

    NARCIS (Netherlands)

    Dulmen, S.A. van; Maas, Marjo; Staal, J.B.; Rutten, G.; Kiers, H.; Nijhuis-Van der Sanden, M.W.G.; Wees, P. van der

    2014-01-01

    BACKGROUND: Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting. OBJECTIVE:

  20. Comparison of test specific sediment effect concentrations with marine sediment quality assessment guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Carr, R.S.; Biedenbach, J.M. [National Biological Service, Corpus Christi, TX (United States). Marine Ecotoxicology Research Station; Long, E.R. [NOAA, Seattle, WA (United States); MacDonald, D.D. [MacDonald Environmental Sciences Ltd., Ladysmith, British Columbia (Canada)

    1995-12-31

    As part of NOAA`s National Status and Trends (NS and T) Bioeffects Assessment program and studies conducted by the National Biological Service, numerous sediment quality assessment surveys have recently been conducted along the Atlantic and Gulf coasts of the US using the sea urchin (Arbacia punctulata) fertilization and embryological development tests with pore water. Additional toxicity tests were also conducted in conjunction with most of these studies. The areas that have been sampled include Boston harbor, Massachusetts; Charleston Harbor, Winyah Bay, and Savannah River, South Carolina; St. Simon Sound, Georgia; Biscayne Bay, Tampa Bay, Choctawhatchee Bay, Apalachicola Bay, St. Andrew Bay, and Pensacola Bay, Florida; Galveston Bay, Lavaca Bay, and Sabine Lake, Texas, and 200 stations in the vicinity of offshore oil and gas production platforms in the Gulf of Mexico. Sufficient data are now available from this series of surveys to calculate test specific sediment effect concentrations (SECs). Based on these recent studies, SECs were developed for the sea urchin porewater and amphipod tests and compared with existing marine sediment quality assessment guidelines.

  1. HAS Should Not Be NICE: Rejecting Imaginary Worlds in the French Technology Assessment Guidelines

    Directory of Open Access Journals (Sweden)

    Paul C Langley

    2017-01-01

    Full Text Available Pricing decisions and access to pharmaceuticals should be evidence based. Unfortunately, the French guidelines for technology assessment, in their adoption of the National Institute for Health and Clinical Excellence (NICE reference case modeling standard ensure that this is not the case. Rather than requiring the submission of claims that are credible, evaluable and replicable, the Haute Autorité de Sante (HAS mandates the creation of imaginary worlds to support comparative effectiveness and cost-outcome claims. The purpose of this commentary is to make the case that HAS should reconsider this commitment to standards for health technology assessment that are more appropriately seen as pseudoscience. The recommendation is that HAS should put to one side mandating lifetime cost-per-quality adjusted life year (QALY or life years saved claims in favor of short-term claims that can be evaluated and reported to health system decision makers as part of a provisional assessment of new products as well as supporting ongoing disease area and therapeutic class reviews.   Type: Commentary

  2. The development and validation of the guidelines for stalking assessment and management.

    Science.gov (United States)

    Kropp, P Randall; Hart, Stephen D; Lyon, David R; Storey, Jennifer E

    2011-01-01

    International research has established that stalking is a prevalent problem with serious and often life-threatening consequences for victims. Stalking is also a unique form of violence due to its nature and diversity, making it difficult for criminal justice and health professionals to establish which perpetrators and victims have the greatest need for services and protection. Risk assessment is one way to address these problems but few tools exist. This article describes the development of the Guidelines for Stalking Assessment and Management (SAM), the first risk assessment instrument designed specifically for the stalking situation. Preliminary data are presented, indicating that the SAM has promise for use by professionals working with stalkers and their victims. Results indicated that interrater reliabilities for the SAM risk factors and total scores range from fair to good, and the structural reliability of the SAM is sound. Moreover, the SAM showed good concurrent validity when compared with two other measures of violence propensity: the Psychopathy Checklist Screening Version (PCL:SV) and the Violence Risk Appraisal Guide (VRAG). Limitations of the study are discussed, especially those related to the difficulties inherent in file-based research, and suggestions for future research are offered. Copyright © 2011 John Wiley & Sons, Ltd.

  3. [Absolute risk for fracture and WHO guideline. Fracture risk assessments recommended by World Health Organization and Japanese guidelines for prevention and treatment of osteoporosis 2006].

    Science.gov (United States)

    Nakamura, Toshitaka

    2007-07-01

    Bone mineral density (BMD) is a strong predictor of osteoporotic fractures. However, the increase in fracture risk is not steep, rather gentle, for the decline in BMD values. Postmenopausal women with osteopenia (T scores between - 2.5 and - 1.0) may also be at risk. Case finding strategies such as the combination of BMD and appropriate clinical risk factors for fracture are shown to identify subjects at high fracture risk. World Health Organization developed a fracture risk assessment tool, recommending its exploitation in the case findings. Under these circumstances, Japan guideline 2006 provided new criteria for the pharmacological intervention to prevent fragility fracture, besides the conventional criteria for diagnosing osteoporosis.

  4. A multiple-scenario assessment of the effect of a continuous-care, guideline-based decision support system on clinicians' compliance to clinical guidelines.

    Science.gov (United States)

    Shalom, Erez; Shahar, Yuval; Parmet, Yisrael; Lunenfeld, Eitan

    2015-04-01

    To quantify the effect of a new continuous-care guideline (GL)-application engine, the Picard decision support system (DSS) engine, on the correctness and completeness of clinicians' decisions relative to an established clinical GL, and to assess the clinicians' attitudes towards a specific DSS. Thirty-six clinicians, including residents at different training levels and board-certified specialists at an academic OB/GYN department that handles around 15,000 deliveries annually, agreed to evaluate our continuous-care guideline-based DSS and to perform a cross-over assessment of the effects of using our guideline-based DSS. We generated electronic patient records that realistically simulated the longitudinal course of six different clinical scenarios of the preeclampsia/eclampsia/toxemia (PET) GL, encompassing 60 different decision points in total. Each clinician managed three scenarios manually without the Picard DSS engine (Non-DSS mode) and three scenarios when assisted by the Picard DSS engine (DSS mode). The main measures in both modes were correctness and completeness of actions relative to the PET GL. Correctness was further decomposed into necessary and redundant actions, relative to the guideline and the actual patient data. At the end of the assessment, a questionnaire was administered to the clinicians to assess their perceptions regarding use of the DSS. With respect to completeness, the clinicians applied approximately 41% of the GL's recommended actions in the non-DSS mode. Completeness increased to the performance of approximately 93% of the guideline's recommended actions, when using the DSS mode. With respect to correctness, approximately 94.5% of the clinicians' decisions in the non-DSS mode were correct. However, these included 68% of the actions that were correct but redundant, given the patient's data (e.g., repeating tests that had been performed), and 27% of the actions, which were necessary in the context of the GL and of the given scenario

  5. Comparison between visual grading and planimetric quantification of microvascular obstruction extent assessment in reperfused acute myocardial infarction.

    Science.gov (United States)

    Sirol, Marc; Gzara, Heger; Gayat, Etienne; Dautry, Raphael; Gellen, Barnabas; Logeart, Damien; Soyer, Philippe; Vicaut, Eric; Mercadier, Jean-Jacques

    2016-07-01

    Current methods for infarct size and microvascular obstruction (MVO) quantification by cardiac magnetic resonance (CMR) imaging rely on planimetry. This method is time-consuming. We sought to evaluate a direct assessment of MVO severity based on visual evaluation and to compare it to a reference method. CMR was performed in 112 consecutive patients after reperfused myocardial infarction. MVO was estimated by direct visual assessment based on a three-grade severity scale (MVO 1, mild; MVO 2, moderate; MVO 3, severe) on late gadolinium-enhancement (LGE). MVO was present in 69 patients (61.6 %). Quantitative MVO extent significantly increased accordingly to visual MVO grading (p < 0.01). Correlation between visual grading and quantitative assessment was excellent (r = 0.92, IQR 0.88-0.95, p < 0.001). CMR inter- and intraobserver variability for visual MVO evaluation was low (κ = 0.93 and κ = 0.96, respectively), whereas quantitative MVO assessment suffered from moderate agreement (interobserver, bias = -0.81 ± 1.8 g LV; intraobserver, -0.83 ± 2.1 g LV). Visual evaluation was significantly faster than reference method (0.65 ± 0.37 vs. 10.2 ± 2.9 min, p < 0.0001). MVO severity based on direct visual assessment on LGE images is feasible, rapid, reproducible and agrees very well with quantitative methods, with a very low inter- and intraobserver variability. Our approach could be used for routine evaluation in patients undergoing CMR after acute myocardial infarction. • Microvascular obstruction direct visual evaluation is feasible, rapid and highly reproducible. • Microvascular obstruction direct visual evaluation correlates well with quantification by planimetry. • Microvascular obstruction or no-reflow phenomenon is determined on late gadolinium-enhanced images. • Cardiac MRI is useful for myocardial damage assessment after myocardial infarction.

  6. DCE-MRI and DWI Integration for Breast Lesions Assessment and Heterogeneity Quantification

    Directory of Open Access Journals (Sweden)

    C. Andrés Méndez

    2012-01-01

    Full Text Available In order to better predict and follow treatment responses in cancer patients, there is growing interest in noninvasively characterizing tumor heterogeneity based on MR images possessing different contrast and quantitative information. This requires mechanisms for integrating such data and reducing the data dimensionality to levels amenable to interpretation by human readers. Here we propose a two-step pipeline for integrating diffusion and perfusion MRI that we demonstrate in the quantification of breast lesion heterogeneity. First, the images acquired with the two modalities are aligned using an intermodal registration. Dissimilarity-based clustering is then performed exploiting the information coming from both modalities. To this end an ad hoc distance metric is developed and tested for tuning the weighting for the two modalities. The distributions of the diffusion parameter values in subregions identified by the algorithm are extracted and compared through nonparametric testing for posterior evaluation of the tissue heterogeneity. Results show that the joint exploitation of the information brought by DCE and DWI leads to consistent results accounting for both perfusion and microstructural information yielding a greater refinement of the segmentation than the separate processing of the two modalities, consistent with that drawn manually by a radiologist with access to the same data.

  7. Reliable Assessment and Quantification of the Fluorescence-Labeled Antisense Oligonucleotides In Vivo

    Directory of Open Access Journals (Sweden)

    Maria Chiara Munisso

    2014-01-01

    Full Text Available The availability of fluorescent dyes and the advances in the optical systems for in vivo imaging have stimulated an increasing interest in developing new methodologies to study and quantify the biodistribution of labeled agents. However, despite these great achievements, we are facing significant challenges in determining if the observed fluorescence does correspond to the quantity of the dye in the tissues. In fact, although the far-red and near-infrared lights can propagate through several centimetres of tissue, they diffuse within a few millimetres as consequence of the elastic scattering of photons. In addition, when dye-labeled oligonucleotides form stable complex with cationic carriers, a large change in the fluorescence intensity of the dye is observed. Therefore, the measured fluorescence intensity is altered by the tissue heterogeneity and by the fluctuation of dye intensity. Hence, in this study a quantification strategy for fluorescence-labeled oligonucleotides was developed to solve these disadvantageous effects. Our results proved that upon efficient homogenization and dilution with chaotropic agents, such as guanidinium thiocyanate, it is possible to achieve a complete fluorescence intensity recovery. Furthermore, we demonstrated that this method has the advantage of good sensitivity and reproducibility, as well as easy handling of the tissue samples.

  8. Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease.

    Science.gov (United States)

    Wang, Liang; Xia, Peng; Lv, Ke; Han, Jie; Dai, Qing; Li, Xue-mei; Chen, Li-meng; Jiang, Yu-xin

    2014-07-01

    Chronic kidney disease (CKD), a progressive and irreversible pathological syndrome, is the major cause of renal failure. Renal fibrosis is the principal process underlying the progression of CKD. Acoustic radiation force impulse (ARFI) quantification is a promising noninvasive method for assessing tissue stiffness. We evaluated whether the technique could reveal renal tissue fibrosis in CKD patients. ARFI assessments were performed in 45 patients with CKD referred for renal biopsies to measure cortical shear wave velocity (SWV). During measurement, a standardized method was employed, which aimed to minimize the potential impact of variation of transducer force, sampling error of non-cortical tissue and structural anisotropy of the kidney. Then SWV was compared to patients' CKD stage and pathological fibrosis indicators. ARFI could not predict the different stages of CKD. Spearman correlation analysis showed that SWV did not correlate with any pathological indicators of fibrosis. ARFI assesses tissue stiffness of CKD kidneys by measuring cortical SWV. However, SWV did not show significant correlations with CKD stage and fibrosis indicators despite using standardized measurement methods. We therefore suggest that it would be necessary to evaluate the effect of pathological complexity and tissue perfusion of the kidney on stiffness assessment in future studies. • Acoustic radiation force impulse (ARFI) can quantify tissue elasticity of CKD kidney. • Despite standardized measurement, ARFI-estimated elasticity did not correlate with renal fibrosis. • Effects of pathological complexity and tissue perfusion on renal stiffness warrant further study.

  9. Guideline development and impact assessment for registration of medical, dental and veterinary x-ray apparatus

    Energy Technology Data Exchange (ETDEWEB)

    Colgan, P.; Harrison, D. [NSW Environment Protection Authority, Lidcombe, NSW, (Australia). Radiation Control Centre; Moore, W. [NSW Environmental Protection Authority, Chatswood, NSW, (Australia). Economics and Environmental Reporting Branch

    1996-10-01

    Under the NSW Radiation Control Act 1990, radiation apparatus used for diagnostic medical, dental and veterinary purposes will be required to become registered. The inspection required prior to registration will be conducted by a Consulting Radiation Expert who has been accredited by the Environment Protection Authority (EPA) as being competent in the field of quality assurance assessment of radiation apparatus used for diagnostic medical, dental and veterinary purposes. When regulating any activity in NSW, there is a requirement to undertake a regulatory impact statement of the proposed regulation. In addition, the introduction of any accompanying guideline requires a cost-benefit analysis. Costs may include enforcement, administrative and compliance activities. The calculation of benefit relies heavily on the improvement in apparatus performance (and hence dose reduction) that can be obtained with the introduction of a mandatory practice such as apparatus registration. This paper discusses the development of the registration guideline for NSW, including a summary of the public comments received. It further discusses the methodology and data used for the accompanying cost-benefit analysis. Information in this paper is presented in three parts: EPA field survey, cost analysis, and benefit analysis. For NSW it was estimated that the introduction of registration of these apparatus, over a two year period, would result in early replacement and repair costs (present values) to the medical industry of between $5.7 and $11.0 million, with an additional $2.5 million in EPA enforcement costs. The introduction of the proposed system of registration is expected to result in an estimated savings in quantifiable health detriment costs to NSW of between $11.8 and $17.7 million, and reduce the risk of radiation induced mortality. (authors). 4 refs., 11 tabs.

  10. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review.

    Science.gov (United States)

    Willson, Melina L; Vernooij, Robin W M; Gagliardi, Anna R

    2017-06-01

    This study described the number and characteristics of questionnaires used to assess barriers of guideline use among physicians. A scoping review was conducted. MEDLINE and EMBASE were searched from 2005 to June 2016. English-language studies that administered a questionnaire to assess barriers of guideline use among practicing physicians were eligible. Summary statistics were used to report study and questionnaire characteristics. Questionnaire content was assessed with a checklist of 57 known barriers. Each of the 178 included studies administered a unique questionnaire. The number of questionnaires increased yearly from 2005 to 2015. Few were pilot-tested (50, 28.1%) or tested for psychometric properties (3, 1.7%). Two were based on theory. None probed for the full range of known barriers. Ten included a free-text option. The majority assessed professional barriers (177, 99.4%) but few of the 14 factors within this domain. Questionnaire characteristics did not change over time. Organizations administered questionnaires that were not reliable or valid and did not comprehensively assess barriers and may have selected interventions unlikely to promote guideline use. Research is needed to construct a questionnaire that is practical, adaptable, and robust and leads to the selection of interventions that support guideline use. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Implementation of an Evidence Based Guideline for Assessment and Documentation of the Civil Commitment Process.

    Science.gov (United States)

    Perrigo, Tabitha L; Williams, Kimberly A

    2016-11-01

    The purpose of this quality improvement project was to implement an evidence-based practice guideline for assessment and documentation of the civil commitment process. Participants included six civil commitment examiners who conduct court ordered psychiatric evaluations at two crisis intervention centers in rural area of southeaster state. Data collection was conducted utilizing a chart audit tool both pre and post intervention of 100 civil commitment evaluations. The intervention included the development of an evidenced based form for documentation of civil commitment evaluations and a one on one educational training session was conducted for each participant. Descriptive statistics (t test) was utilized to analyze the data collected. The project demonstrated a significant increase as 25.5 % of evaluations contained the America Psychiatric Association's recommended 11 domains of assessment prior to implementation compared to 65.6 % (p value = 0.018) post implementation. Moreover, participants with family practice training showed an increase in commitment rates from 60 to 77.3 % (p value = 0.066). Whereas, psychiatric trained participants showed a decrease from 83.75 to 77.66 % (p value = 0.38). Demonstrating that court ordered evaluations guided by a standardized form based on evidence affected examiners recommendations for commitments.

  12. Summary guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Painuly, J.P.; Turkson, J.; Meyer, H.J.; Markandya, A.

    1999-09-01

    This document is a summary version of the methodological guidelines for climate change mitigation assessment developed as part of the Global Environment Facility (GEF) project Economics of Greenhouse Gas Limitations; Methodological Guidelines. The objectives of this project have been to develop a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change mitigation policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the Methodological Guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au) 13 refs.

  13. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

    Science.gov (United States)

    Peter, W F; Jansen, M J; Hurkmans, E J; Bloo, H; Dekker, J; Dilling, R G; Hilberdink, W; Kersten-Smit, C; de Rooij, M; Veenhof, C; Vermeulen, H M; de Vos, R J; Schoones, J W; Vliet Vlieland, T P

    2011-01-01

    An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 17 experts from different professional backgrounds. A second draft was field-tested by 45 physiotherapists. In total 11 topics were selected. For the initial assessment, three recommendations were formulated, pertaining to history taking, red flags, and formulating treatment goals. Concerning treatment, 7 recommendations were formulated; (supervised) exercise therapy, education and self management interventions, a combination of exercise and manual therapy, postoperative exercise therapy and taping of the patella were recommended. Balneotherapy and hydrotherapy in HKOA, and thermotherapy, TENS, and Continuous Passive Motion in knee OA were neither recommended nor discouraged. Massage therapy, ultrasound, electrotherapy, electromagnetic field, Low Level Laser Therapy, preoperative physiotherapy and education could not be recommended. For the evaluation of treatment goals the following measurement instruments were recommended: Lequesne index, Western Ontario and McMaster Universities osteoarthritis index, Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score, 6-minute walktest, Timed Up and Go test, Patient Specific Complaint list, Visual Analoge Scale for pain, Intermittent and Constant OsteoArthritis Pain Questionnaire, goniometry, Medical Research Council for strength, handheld

  14. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

    Energy Technology Data Exchange (ETDEWEB)

    Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

    2014-07-15

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

  15. Uncertainty quantification's role in modeling and simulation planning, and credibility assessment through the predictive capability maturity model

    Energy Technology Data Exchange (ETDEWEB)

    Rider, William J. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Witkowski, Walter R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mousseau, Vincent Andrew [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-04-13

    The importance of credible, trustworthy numerical simulations is obvious especially when using the results for making high-consequence decisions. Determining the credibility of such numerical predictions is much more difficult and requires a systematic approach to assessing predictive capability, associated uncertainties and overall confidence in the computational simulation process for the intended use of the model. This process begins with an evaluation of the computational modeling of the identified, important physics of the simulation for its intended use. This is commonly done through a Phenomena Identification Ranking Table (PIRT). Then an assessment of the evidence basis supporting the ability to computationally simulate these physics can be performed using various frameworks such as the Predictive Capability Maturity Model (PCMM). There were several critical activities that follow in the areas of code and solution verification, validation and uncertainty quantification, which will be described in detail in the following sections. Here, we introduce the subject matter for general applications but specifics are given for the failure prediction project. In addition, the first task that must be completed in the verification & validation procedure is to perform a credibility assessment to fully understand the requirements and limitations of the current computational simulation capability for the specific application intended use. The PIRT and PCMM are tools used at Sandia National Laboratories (SNL) to provide a consistent manner to perform such an assessment. Ideally, all stakeholders should be represented and contribute to perform an accurate credibility assessment. PIRTs and PCMMs are both described in brief detail below and the resulting assessments for an example project are given.

  16. 76 FR 44586 - Notice of Availability of the External Review Draft of the Microbial Risk Assessment Guideline...

    Science.gov (United States)

    2011-07-26

    ... genetically modified microorganisms with the potential for environmental exposure. USDA/FSIS is charged with...: Pathogenic Microorganisms With Focus on Food and in Water AGENCY: Environmental Protection Agency (EPA... Risk Assessment Guideline: Pathogenic Microorganisms with Focus on Food and in Water.'' EPA developed...

  17. Assessment of the Policy Guidelines for the Teaching and Learning of Geography at the Senior High School Level in Ghana

    Science.gov (United States)

    Ababio, Bethel T.; Dumba, Hillary

    2014-01-01

    This article empirically assessed the extent to which geography teachers adhered to the Ghana Education Service policy guidelines on the teaching of geography at the Senior High School Level in Ghana. Census survey was used to collect data from seven geography teachers because of the researchers' objective of gaining a quick insight into the…

  18. GPs' adherence to guidelines for structured assessments of stroke survivors in the community and care homes.

    Science.gov (United States)

    Gonçalves-Bradley, Daniela C; Boylan, Anne-Marie; Koshiaris, Constantinos; Vazquez Montes, Maria; Ford, Gary A; Lasserson, Daniel S

    2015-12-01

    Clinical practice guidelines recommend that stroke survivors' needs be assessed at regular intervals after stroke. The extent to which GPs comply with national guidance particularly for patients in care homes who have greatest clinical complexity is unknown. This study aimed to establish the current clinical practice in the UK of needs assessment by GPs for stroke survivors after hospital discharge for acute stroke. Cross-sectional online survey of current practice of GPs, using the national doctors.net network. The survey was completed by 300 GPs who had on average been working for 14 years. The structured assessment of stroke survivors' needs was not offered by 31% of GPs, with no significant difference for level of provision in community or care home settings. The outputs of reviews were added to patients' notes by 89% of GPs and used to change management by 57%. Only half the GPs reported integrating the information obtained into care plans and only a quarter of GPs had a protocol for follow-up of identified needs. Analysis of free-text comments indicated that patients in some care homes may receive more regular and structured reviews. This survey suggests that at least one-third of GPs provide no formal review of the needs of stroke patients and that in only a minority are identified needs addressed in a structured way. Standardization is required for what is included in reviews and how needs are being identified and met. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. ICF linked Dutch physiotherapy guidelines concerning initial assessment, treatment and evaluation in hip and knee osteoarthritis.

    NARCIS (Netherlands)

    Peter, W.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, E.M.; Vos, I. de; Schoones, J.W.; Vliet Vlieland, T.P.

    2011-01-01

    Purpose: In 2001 the Royal Dutch Society for Physical Therapy (KNGF) Guideline for hip and knee osteoarthritis (HKOA) was developed. Since then, many scientific papers on physical therapy interventions as well as national and international guidelines were published. Relevance: An update of the

  20. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines

    NARCIS (Netherlands)

    Kiriyama, Seiki; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Mayumi, Toshihiko; Pitt, Henry A.; Gouma, Dirk J.; Garden, O. James; Büchler, Markus W.; Yokoe, Masamichi; Kimura, Yasutoshi; Tsuyuguchi, Toshio; Itoi, Takao; Yoshida, Masahiro; Miura, Fumihiko; Yamashita, Yuichi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Higuchi, Ryota; Windsor, John A.; Bornman, Philippus C.; Fan, Sheung-Tat; Singh, Harijt; de Santibanes, Eduardo; Gomi, Harumi; Kusachi, Shinya; Murata, Atsuhiko; Chen, Xiao-Ping; Jagannath, Palepu; Lee, Sunggyu; Padbury, Robert; Chen, Miin-Fu

    2012-01-01

    Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis were published in 2007 (TG07) and have been widely cited in the world literature. Because of new information that has been published since 2007, we organized the Tokyo Guidelines Revision Committee to conduct a

  1. Quantification of urban metabolism through coupling with the life cycle assessment framework: concept development and case study

    Science.gov (United States)

    Goldstein, Benjamin; Birkved, Morten; Quitzau, Maj-Britt; Hauschild, Michael

    2013-09-01

    Cities now consume resources and produce waste in amounts that are incommensurate with the populations they contain. Quantifying and benchmarking the environmental impacts of cities is essential if urbanization of the world’s growing population is to occur sustainably. Urban metabolism (UM) is a promising assessment form in that it provides the annual sum material and energy inputs, and the resultant emissions of the emergent infrastructural needs of a city’s sociotechnical subsystems. By fusing UM and life cycle assessment (UM-LCA) this study advances the ability to quantify environmental impacts of cities by modeling pressures embedded in the flows upstream (entering) and downstream (leaving) of the actual urban systems studied, and by introducing an advanced suite of indicators. Applied to five global cities, the developed UM-LCA model provided enhanced quantification of mass and energy flows through cities over earlier UM methods. The hybrid model approach also enabled the dominant sources of a city’s different environmental footprints to be identified, making UM-LCA a novel and potentially powerful tool for policy makers in developing and monitoring urban development policies. Combining outputs with socioeconomic data hinted at how these forces influenced the footprints of the case cities, with wealthier ones more associated with personal consumption related impacts and poorer ones more affected by local burdens from archaic infrastructure.

  2. Multisite assessment of NIA-AA guidelines for the neuropathologic evaluation of Alzheimer's disease.

    Science.gov (United States)

    Montine, Thomas J; Monsell, Sarah E; Beach, Thomas G; Bigio, Eileen H; Bu, Yunqi; Cairns, Nigel J; Frosch, Matthew; Henriksen, Jonathan; Kofler, Julia; Kukull, Walter A; Lee, Edward B; Nelson, Peter T; Schantz, Aimee M; Schneider, Julie A; Sonnen, Joshua A; Trojanowski, John Q; Vinters, Harry V; Zhou, Xiao-Hua; Hyman, Bradley T

    2016-02-01

    Neuropathologic assessment is the current "gold standard" for evaluating the Alzheimer's disease (AD), but there is no consensus on the methods used. Fifteen unstained slides (8 brain regions) from each of the 14 cases were prepared and distributed to 10 different National Institute on Aging AD Centers for application of usual staining and evaluation following recently revised guidelines for AD neuropathologic change. Current practice used in the AD Centers Program achieved robustly excellent agreement for the severity score for AD neuropathologic change (average weighted κ = .88, 95% confidence interval: 0.77-0.95) and good-to-excellent agreement for the three supporting scores. Some improvement was observed with consensus evaluation but not with central staining of slides. Evaluation of glass slides and digitally prepared whole-slide images was comparable. AD neuropathologic evaluation as performed across AD Centers yields data that have high agreement with potential modifications for modest improvements. Copyright © 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  3. The opportunity of tracking food waste in school canteens: Guidelines for self-assessment.

    Science.gov (United States)

    Derqui, Belén; Fernandez, Vicenc

    2017-11-01

    Reducing food waste is one of the key challenges of the food system and addressing it in the institutional catering industry can be a quick win. In particular, school canteens are a significant source of food waste and therefore embody a great opportunity to address food waste. The goal of our research is the development of guidelines for audit and self-assessment in measuring and managing food waste produced at school canteens. The purpose of the tool is to standardise food waste audits to be executed either by scholars, school staff or by catering companies with the objective of measuring and reducing food waste at schools. We performed a research among public and private schools and catering companies from which we obtained the key performance indicators to be measured and then pilot-tested the resulting tool in four schools with over 2900 pupil participants, measuring plate waste from over 10,000 trays. This tool will help managers in their efforts towards more sustainable organisations at the same time as the standardisation of food waste audits will provide researchers with comparable data. The study suggests that although there is low awareness on the amount of food wasted at school canteens, managers and staff are highly interested in the topic and would be willing to implement audits and reduction measures. The case study also showed that our tool is easy to implement and not disruptive. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. A novel means of assessing institutional adherence to blood transfusion guidelines.

    Science.gov (United States)

    Hicks, Caitlin W; Frank, Steven M; Wasey, Jack O; Efron, Jonathan; Gearhart, Susan; Fang, Sandy; Safar, Bashar; Makary, Martin A; Wick, Elizabeth C

    2015-01-01

    Risk-adjusted institutional transfusion rates are not currently available on a national level. A surrogate means of benchmarking transfusion practices to use for internal quality improvement was studied. Blood utilization was prospectively studied among all colorectal surgery patients at the study institution (July 2010-November 2012), and these data were benchmarked with transfusion data from the National Surgical Quality Improvement Program (NSQIP) database by hospital type and size. Using NSQIP, the study institution's colorectal surgery transfusion rate was 16.3% (150/920 cases), which was slightly higher than the 14.3% national mean transfusion rate (12 191/85 507 cases; P = .08). When broken down by hospital type and size, the study hospital had a similar rate of blood transfusion compared with academic hospitals (P = .35) but a significantly higher rate than community hospitals, regardless of patient volume (P = .03). Benchmarking blood utilization compared with similar-type hospitals using NSQIP may be a surrogate method to assess adherence to evidence-based transfusion guidelines and identify areas for structured quality improvement initiatives. © The Author(s) 2014.

  5. Risk assessment of natural hazards : Data availability and applicability for loss quantification

    OpenAIRE

    Grahn, Tonje

    2017-01-01

    Quantitative risk assessments are a fundamental part of economic analysis and natural hazard risk management models. It increases the objectivity and the transparency of risk assessments and guides policymakers in making efficient decisions when spending public resources on risk reduction. Managing hazard risks calls for an understanding of the relationships between hazard exposure and vulnerability of humans and assets.   The purpose of this thesis is to identify and estimate causal relation...

  6. Guidelines for harmonized vulnerability and risk assessment for non-nuclear critical infrastructure: STREST Reference Report 3

    OpenAIRE

    Anastasiadis, Anastasios; Argyroudis, Sotiris; BABIČ Anže; Basco, Anna; CASOTTO Chiara; Crowley, Helen; Dolšek, Matjaž; FOTOPOULOU Stavroula; GALBUSERA LUCA; Giannopoulos, Georgios; Giardini, Domenico; KAKDERI Kalliopi; KARAFAGKA Stella; Matos, José Pedro; PITILAKIS Kyriazis

    2016-01-01

    Loss assessment of critical infrastructures (CIs) subject to natural hazards is fundamental to stress tests. The systemic approach that lifelines require for performance modelling is an open research topic, given their logical and physical complexity. The Work Package 4 (WP4) of STREST focused on the guidelines for the vulnerability assessment of critical infrastructures categorized as: A Individual, single-site infrastructures with high risk and potential for high local impact and regiona...

  7. [Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia].

    Science.gov (United States)

    Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Gil Lemus, Laura Marcela; Jaramillo, Luis Eduardo; García Valencia, Jenny; Bravo Narváez, Eliana; de la Hoz Bradford, Ana María; Palacio, Carlos

    2013-01-01

    Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  8. The external water footprint of the Netherlands: Quantification and impact assessment

    OpenAIRE

    van Oel, P.R.; Mekonnen, Mesfin; Hoekstra, Arjen Ysbert

    2008-01-01

    This study quantifies the external water footprint of the Netherlands by partner country and import product and assesses the impact of this footprint by contrasting the geographically explicit water footprint with water scarcity in the different parts of the world. Hotspots are identified as the places where the external water footprint of Dutch consumers is significant on the one hand and where water scarcity is serious on the other hand. The study shows that Dutch consumption implies the us...

  9. A comparative assessment of tools for ecosystem services quantification and valuation

    Science.gov (United States)

    Bagstad, Kenneth J.; Semmens, Darius; Waage, Sissel; Winthrop, Robert

    2013-01-01

    To enter widespread use, ecosystem service assessments need to be quantifiable, replicable, credible, flexible, and affordable. With recent growth in the field of ecosystem services, a variety of decision-support tools has emerged to support more systematic ecosystem services assessment. Despite the growing complexity of the tool landscape, thorough reviews of tools for identifying, assessing, modeling and in some cases monetarily valuing ecosystem services have generally been lacking. In this study, we describe 17 ecosystem services tools and rate their performance against eight evaluative criteria that gauge their readiness for widespread application in public- and private-sector decision making. We describe each of the tools′ intended uses, services modeled, analytical approaches, data requirements, and outputs, as well time requirements to run seven tools in a first comparative concurrent application of multiple tools to a common location – the San Pedro River watershed in southeast Arizona, USA, and northern Sonora, Mexico. Based on this work, we offer conclusions about these tools′ current ‘readiness’ for widespread application within both public- and private-sector decision making processes. Finally, we describe potential pathways forward to reduce the resource requirements for running ecosystem services models, which are essential to facilitate their more widespread use in environmental decision making.

  10. Suitability Assessment of Printed Dietary Guidelines for Pregnant Women and Parents of Infants and Toddlers From 7 European Countries.

    Science.gov (United States)

    Garnweidner-Holme, Lisa Maria; Dolvik, Stina; Frisvold, Cathrine; Mosdøl, Annhild

    2016-02-01

    To evaluate selected European printed dietary guidelines for pregnant women and parents of infants and toddlers using the suitability assessment of materials (SAM) method. A descriptive study to determine the suitability of 14 printed dietary guidelines from 7 European countries based on deductive quantitative analyses. Materials varied greatly in format and content: 35.7% of materials were rated superior and 64.3% were rated adequate according to the overall SAM score for patient education material. None of the materials were scored not suitable. Among the categories, the highest average scores were for layout and typography and the lowest average scores were for cultural appropriateness and learning stimulation and motivation. Interrater reliability ranged from Cohen's kappa of 0.37 to 0.62 (mean, 0.41), indicating fair to moderate agreement among the 3 investigators. Overall, the suitability of the assessed printed dietary guidelines was adequate. Based on the SAM methodology, printed dietary guidelines may increase in suitability by emphasizing aspects related to health literacy and accommodating the needs of different food cultures within a population. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  11. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain.

    Science.gov (United States)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P

    2018-03-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.

  12. Incorporating patient perspectives in health technology assessments and clinical practice guidelines.

    Science.gov (United States)

    Hämeen-Anttila, K; Komulainen, J; Enlund, H; Mäkelä, M; Mäkinen, E; Rannanheimo, P; Sipilä, R

    Ensuring patient involvement in health technology assessments (HTAs) and clinical practice guidelines (CPGs) is important. However, the goals and methods of such involvement are not always clear. The aim of this study was to 1) discover ways to involve patients in HTA and CPG processes, 2) describe challenges, and 3) find ways of informing patients about HTAs and CPGs in Finland. As part of a one-day seminar targeted at representatives of patient organizations (POs), 3, 1-h focus group discussions were held (n = 20, with 14 PO representatives). PO representatives included real patients and health care professionals working in the organizations. The discussions were tape-recorded, transcribed, and thematically analyzed. Focus group participants highlighted the importance of gathering patient views from a group of patients, rather than individuals. Surveys through POs were the most frequently mentioned means of gathering patients' views. PO representatives reported interest in cooperating in HTA and CPG processes. The most often mentioned challenges were finding appropriate representatives for the target group and conveying information about HTAs and CPGs to patients. Multichannel communication was seen as essential. Furthermore the information should be readable, comprehensible, tailored, reliable, reusable, complementary, and timely. Possible strategies to involve patients in HTA and CPG processes were incorporating patient representatives in the CPG and HTA groups, offering timely possibility to participate, and ensuring reporting with clear and unambiguous language. The main identified challenge was finding appropriate representatives of the target group. The role of POs was seen as important particularly when informing the patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Probabilistic safety assessment of WWER440 reactors prediction, quantification and management of the risk

    CERN Document Server

    Kovacs, Zoltan

    2014-01-01

    The aim of this book is to summarize probabilistic safety assessment (PSA) of nuclear power plants with WWER440 reactors and  demonstrate that the plants are safe enough for producing energy even in light of the Fukushima accident. The book examines level 1 and 2 full power, low power and shutdown PSA, and summarizes the author's experience gained during the last 35 years in this area. It provides useful examples taken from PSA training courses the author has lectured and organized by the International Atomic Energy Agency. Such training courses were organised in Argonne National Laboratory (

  14. Factors Influencing Quantification of in Vivo Bioluminescence Imaging: Application to Assessment of Pancreatic Islet Transplants

    Directory of Open Access Journals (Sweden)

    John Virostko

    2004-10-01

    Full Text Available The aim of this study is to determine and characterize factors influencing in vivo bioluminescence imaging (BLI and apply them to the specific application of imaging transplanted pancreatic islets. Noninvasive quantitative assessment of transplanted pancreatic islets poses a formidable challenge. Murine pancreatic islets expressing firefly luciferase were transplanted under the renal capsule or into the portal vein of nonobese diabetic–severe combined immunodeficiency mice and the bioluminescence was quantified with a cooled charge coupled device camera and digital photon image analysis. The important, but often neglected, effects of wound healing, mouse positioning, and transplantation site on bioluminescence measurements were investigated by imaging a constant emission, isotropic light-emitting bead (λ = 600 implanted at the renal or hepatic site. The renal beads emitted nearly four times more light than hepatic beads with a smaller spot size, indicating that light absorption and scatter are greatly influenced by the transplant site and must be accounted for in BLI measurements. Detected luminescence decreased with increasing angle between the mouse surface normal and optical axis. By defining imaging parameters such as postsurgical effects, animal positioning, and light attenuation as a function of transplant site, this study develops BLI as a useful imaging modality for quantitative assessment of islets post-transplantation.

  15. Thrombotic risk assessment in the antiphospholipid syndrome requires more than the quantification of lupus anticoagulants.

    Science.gov (United States)

    Devreese, Katrien; Peerlinck, Kathelijne; Hoylaerts, Marc F

    2010-01-28

    Lupus anticoagulants (LACs) are associated with thromboembolic complications (TECs). LACs can be detected by their anticoagulant properties in thrombin generation assays, by the peak height (PH) and lag time (LT). To assess the thrombotic risk in LAC-positive patients, we have expressed the LAC activity quantitatively by PH/LT calibration curves, constructed for mixtures of monoclonal antibodies against beta2-glycoprotein I (beta2GPI) and prothrombin, spiked in normal plasma. PH/LT was determined in LAC patients, with (n = 38) and without (n = 21) TECs and converted into arbitrary LAC units. LAC titers ranged from 0 to 200 AU/mL, with 5 of 59 patients being negative. In the positive LAC titer population (54 of 59), LAC and anti-beta2GPI immunoglobulin G (IgG) titers correlated with TECs, with odds ratios of 3.54 (95% CI, 1.0-1.7) and 10.0 (95% CI, 1.98-50.6), respectively. In patients with single or combined low titers, useful predictions on thrombosis could be made only after additional measurements of soluble P-selectin and factor VII. This layered strategy yielded positive and negative predictive values, sensitivity, and specificity values approximately 90% in this subgroup. Hence, LAC and anti-beta2GPI IgG titers, when combined with selected markers of the hypercoagulable state, allow a relevant thrombotic risk assessment in nearly all patients with LACs.

  16. Uncertainty quantification and reliability assessment in operational oil spill forecast modeling system.

    Science.gov (United States)

    Hou, Xianlong; Hodges, Ben R; Feng, Dongyu; Liu, Qixiao

    2017-03-15

    As oil transport increasing in the Texas bays, greater risks of ship collisions will become a challenge, yielding oil spill accidents as a consequence. To minimize the ecological damage and optimize rapid response, emergency managers need to be informed with how fast and where oil will spread as soon as possible after a spill. The state-of-the-art operational oil spill forecast modeling system improves the oil spill response into a new stage. However uncertainty due to predicted data inputs often elicits compromise on the reliability of the forecast result, leading to misdirection in contingency planning. Thus understanding the forecast uncertainty and reliability become significant. In this paper, Monte Carlo simulation is implemented to provide parameters to generate forecast probability maps. The oil spill forecast uncertainty is thus quantified by comparing the forecast probability map and the associated hindcast simulation. A HyosPy-based simple statistic model is developed to assess the reliability of an oil spill forecast in term of belief degree. The technologies developed in this study create a prototype for uncertainty and reliability analysis in numerical oil spill forecast modeling system, providing emergency managers to improve the capability of real time operational oil spill response and impact assessment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Quantification of Improvement in Environmental Quality for Old Residential Buildings Using Life Cycle Assessment

    Directory of Open Access Journals (Sweden)

    Jozef Mitterpach

    2016-12-01

    Full Text Available In Slovakia, 35% of buildings are older than 50 years but most newer buildings built before 1990 have greater energy consumption. Some other countries also have similar problems. The growing importance of energy saving in buildings can be, in the case of new and old residential buildings (RB, achieved by lowering thermal energy consumption most often by application of polystyrene insulation on the external walls and roof and the exchange of wood window frames for PVC (polyvinyl chloride windows. The novelty of the article for Slovakia and some other central European countries consists in using the life cycle assessment (LCA method for the objective assessment of the environmental benefits of the selected systems of wall insulation, as well as of energy savings in various time intervals of insulation functionality (up to 20 years. LCA software SimaPro (LE Amersfoort, The Netherlands was used with ReCiPe and IMPACT 2002+ assessment methods to quantify the total environmental impact at selected endpoints and midpoints (IMPACT 2002+ of basic structural materials of an RB and its energy demand—heat consumption (hot water heating, central heating before the application of insulation and thermal energy saving (TES after application of insulation to its external walls, roof, and the exchange of windows. The data we obtained confirmed that the environmental impact of the polystyrene insulation of external walls, roof, and exchange of windows of one residential building (RB in the first year after insulation is higher than the reduction caused by achieving a TES of 39%. When taking a lifespan of 20 years into consideration, the impact over the life cycle of the building materials is reduced by 25% (global warming: −4792 kg CO2 eq; production of carcinogens: −2479 kg C2H3Cl eq; acidification: −12,045 kg SO2 eq; and aquatic eutrophication: −257 kg PO4 P-lim. The verified LCA methodology will be used for comparative analysis of different variants

  18. How olfactory acuity affects the sensory assessment of boar fat: a proposal for quantification.

    Science.gov (United States)

    Trautmann, Johanna; Gertheiss, Jan; Wicke, Michael; Mörlein, Daniel

    2014-10-01

    Due to animal welfare concerns the production of entire male pigs is one viable alternative to surgical castration. Elevated levels of boar taint may, however, impair consumer acceptance. Due to the lack of technical methods, control of boar taint is currently done using sensory quality control. While the need for control measures with respect to boar taint has been clearly stated in EU legislation, no specific requirements for selecting assessors have yet been documented. This study proposes tests for the psychophysical evaluation of olfactory acuity to key volatiles contributing to boar taint. Odor detection thresholds for androstenone and skatole are assessed as well as the subject's ability to identify odorants at various levels through easy-to-use paper smell strips. Subsequently, fat samples are rated by the assessors, and the accuracy of boar taint evaluation is studied. Considerable variation of olfactory performance is observed demonstrating the need for objective criteria to select assessors. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Quantification of carbon footprint of urban roads via life cycle assessment

    DEFF Research Database (Denmark)

    Mao, Ruichang; Duan, Huabo; Dong, Dan

    2017-01-01

    studies attempted to examine the impacts from transport infrastructure, especially at a city or country level. This paper, taking Shenzhen in China (a fast developing megacity) as the case study, is specially designed to quantify the carbon footprint of the urban roads by using streamlined life cycle...... assessment method. For given years (ranged from 2004 to 2013), various activities of urban roads (e.g. newly planned road construction, maintenance of road in use, and road renovation and demolition) have been examined in this study. The results show that the total carbon footprint from urban roads...... in Shenzhen was 260 (±20) thousand tons CO2e in 2013. The major contributor was the materials use (embodied impact) from newly constructed roads, which accounts for 52.3% of the total carbon footprint, followed by the maintenance stage (24.3%). The eco-design process of road construction plays a vital role...

  20. Assessing the readiness of a school system to adopt food allergy management guidelines.

    Science.gov (United States)

    Eldredge, Christina; Patterson, Leslie; White, Brenda; Schellhase, Kenneth

    2014-08-01

    The prevalence of potentially fatal food allergies in school-aged children is rising. It is important for schools to have a food allergy management policy and an emergency action plan for each affected student. To examine the current status of food allergy guideline and/or policy implementation and adoption in a large school system in southeastern Wisconsin. A 24-item anonymous electronic survey was developed and completed by school principals and administrators in the Archdiocese of Milwaukee School System (approximately 125 schools) in southeastern Wisconsin. One in 4 responding schools reported no guidelines or policy. Schools that reported having students with special needs due to food allergy were more likely to have a local food allergy policy compared to schools that did not report having students with food allergy special needs (OR 6.3, 1.5-26, P = 0.01). Schools with food allergy guidelines/policies were 3.5 times more likely to require student individual action plans than schools with no guidelines or policies (OR 3.5, 1.00-12.2, P = 0.05). Gaps in evidence-based food allergy policy implementation were found in this school system. Schools with food-allergic children with special needs were more likely to have guidelines/policy, however, they were not more likely to require emergency action plans. The majority of schools (66, 90%) reported interest in receiving further information or training on food allergy management.

  1. A methodology for the quantification of doctrine and materiel approaches in a capability-based assessment

    Science.gov (United States)

    Tangen, Steven Anthony

    Due to the complexities of modern military operations and the technologies employed on today's military systems, acquisition costs and development times are becoming increasingly large. Meanwhile, the transformation of the global security environment is driving the U.S. military's own transformation. In order to meet the required capabilities of the next generation without buying prohibitively costly new systems, it is necessary for the military to evolve across the spectrum of doctrine, organization, training, materiel, leadership and education, personnel, and facilities (DOTMLPF). However, the methods for analyzing DOTMLPF approaches within the early acquisition phase of a capability-based assessment (CBA) are not as well established as the traditional technology design techniques. This makes it difficult for decision makers to decide if investments should be made in materiel or non-materiel solutions. This research develops an agent-based constructive simulation to quantitatively assess doctrine alongside materiel approaches. Additionally, life-cycle cost techniques are provided to enable a cost-effectiveness trade. These techniques are wrapped together in a decision-making environment that brings crucial information forward so informed and appropriate acquisition choices can be made. The methodology is tested on a future unmanned aerial vehicle design problem. Through the implementation of this quantitative methodology on the proof-of-concept study, it is shown that doctrinal changes including fleet composition, asset allocation, and patrol pattern were capable of dramatic improvements in system effectiveness at a much lower cost than the incorporation of candidate technologies. Additionally, this methodology was able to quantify the precise nature of strong doctrine-doctrine and doctrine-technology interactions which have been observed only qualitatively throughout military history. This dissertation outlines the methodology and demonstrates how potential

  2. Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

    Science.gov (United States)

    Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

    2017-09-01

    Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

  3. Quantification of metabolites for assessing human exposure to soapberry toxins hypoglycin A and methylenecyclopropylglycine.

    Science.gov (United States)

    Isenberg, Samantha L; Carter, Melissa D; Graham, Leigh Ann; Mathews, Thomas P; Johnson, Darryl; Thomas, Jerry D; Pirkle, James L; Johnson, Rudolph C

    2015-09-21

    Ingestion of soapberry fruit toxins hypoglycin A and methylenecyclopropylglycine has been linked to public health challenges worldwide. In 1976, over 100 years after Jamaican vomiting sickness (JVS) was first reported, the cause of JVS was linked to the ingestion of the toxin hypoglycin A produced by ackee fruit. A structural analogue of hypoglycin A, methylenecyclopropylglycine (MCPG), was implicated as the cause of an acute encephalitis syndrome (AES). Much of the evidence linking hypoglycin A and MCPG to these diseases has been largely circumstantial due to the lack of an analytical method for specific metabolites. This study presents an analytical approach to identify and quantify specific urine metabolites for exposure to hypoglycin A and MCPG. The metabolites are excreted in urine as glycine adducts methylenecyclopropylacetyl-glycine (MCPA-Gly) and methylenecyclopropylformyl-glycine (MCPF-Gly). These metabolites were processed by isotope dilution, separated by reverse-phase liquid chromatography, and monitored by electrospray ionization tandem mass spectrometry. The analytical response ratio was linearly proportional to the concentration of MCPF-Gly and MCPA-Gly in urine from 0.10 to 20 μg/mL with a correlation coefficient of r > 0.99. The assay demonstrated accuracy ≥80% and precision ≤20% RSD across the calibration range. This method has been applied to assess exposure to hypoglycin A and MCPG as part of a larger public health initiative and was used to provide the first reported identification of MCPF-Gly and MCPA-Gly in human urine.

  4. Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions - a taskforce report

    OpenAIRE

    Svensson, P; Ettlin, Dominik A.; Matsuka, Y

    2011-01-01

    Summary  The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development o...

  5. Guidelines for Establishing Monitoring Programs to Assess the Success of Riparian Restoration Efforts in Arid and Semi-Arid Landscapes

    Science.gov (United States)

    2006-08-01

    ERDC TN-EMRRP-SR-50 1 Guidelines for Establishing Monitoring Programs to Assess the Success of Riparian Restoration Efforts in Arid and Semi ...Management and Restoration Research Program (EMRRP) work unit titled “Techniques for Reestablishing Riparian Hardwoods in Arid and Semi - arid ...Regions.” The objectives of this work are to provide technology to improve capabilities of restoring riparian areas in arid and semi - arid regions. The

  6. Valvular heart disease: assessment of valve morphology and quantification using MR

    Energy Technology Data Exchange (ETDEWEB)

    Schwitter, J. [Div. of Cardiology and Cardiovascular, MR Center, Univ. Hospital Zurich (Switzerland)

    2000-06-01

    For clinical evaluation and decision-making in patients with valvular heart disease, the diagnostic armamentarium expands steadily. This evolution makes it difficult to choose the most appropriate approach for a specific valvular lesion. It may also reflect our uncertainty of what are the findings that best predict clinical outcome of patients, e. g. after surgery. Accordingly, for each type of valvular lesion, some pathophysiological considerations are stated in order to derive the most important measures that would allow optimal guidance of patients. Based on these considerations the value of an MR study is discussed for each valvular lesion. Newest advances in MR technology allow for highly accurate measurements of regurgitant volumes and hence, MR may be the method of choice for a quantitative evaluation of regurgitant valves. For assessment of stenosis severity, measurement of transvalvular pressure gradient is an appropriate measure and MR may not confer benefits over echocardiography, provided the ultrasound window is adequate (and stroke volume is in the normal range). With respect to surgical treatment, valvular morphology is of pivotal importance, particularly for the mitral valve, and echocardiography still appears to be the first line method. Little data relate lesion severity and/or morphology to clinical outcome. Conversely, the extent of cardiac adaptation to pressure- and/or volume-overload, i. e. ventricular remodeling, is a strong predictor of outcome, and is therefore most important for final judgement of the patient. For assessment of left and right ventricular remodeling, echocardiography typically provides all the necessary information. However, in special cases with discrepant findings, with inadequate ultrasound window, or in the preoperative work-up, MR may provide important information regarding cardiac adaptation to valvular lesion. (orig.) [German] Das diagnostische Repertoire zur Evaluation von Klappenvitien ist in den letzten Jahren

  7. Re-evaluation of the WHO (2010) formaldehyde indoor air quality guideline for cancer risk assessment.

    Science.gov (United States)

    Nielsen, Gunnar Damgård; Larsen, Søren Thor; Wolkoff, Peder

    2017-01-01

    In 2010, the World Health Organization (WHO) established an indoor air quality guideline for short- and long-term exposures to formaldehyde (FA) of 0.1 mg/m(3) (0.08 ppm) for all 30-min periods at lifelong exposure. This guideline was supported by studies from 2010 to 2013. Since 2013, new key studies have been published and key cancer cohorts have been updated, which we have evaluated and compared with the WHO guideline. FA is genotoxic, causing DNA adduct formation, and has a clastogenic effect; exposure-response relationships were nonlinear. Relevant genetic polymorphisms were not identified. Normal indoor air FA concentrations do not pass beyond the respiratory epithelium, and therefore FA's direct effects are limited to portal-of-entry effects. However, systemic effects have been observed in rats and mice, which may be due to secondary effects as airway inflammation and (sensory) irritation of eyes and the upper airways, which inter alia decreases respiratory ventilation. Both secondary effects are prevented at the guideline level. Nasopharyngeal cancer and leukaemia were observed inconsistently among studies; new updates of the US National Cancer Institute (NCI) cohort confirmed that the relative risk was not increased with mean FA exposures below 1 ppm and peak exposures below 4 ppm. Hodgkin's lymphoma, not observed in the other studies reviewed and not considered FA dependent, was increased in the NCI cohort at a mean concentration ≥0.6 mg/m(3) and at peak exposures ≥2.5 mg/m(3); both levels are above the WHO guideline. Overall, the credibility of the WHO guideline has not been challenged by new studies.

  8. Diet Assessment Methods in the Nurses' Health Studies and Contribution to Evidence-Based Nutritional Policies and Guidelines.

    Science.gov (United States)

    Hu, Frank B; Satija, Ambika; Rimm, Eric B; Spiegelman, Donna; Sampson, Laura; Rosner, Bernard; Camargo, Carlos A; Stampfer, Meir; Willett, Walter C

    2016-09-01

    To review the contribution of the Nurses' Health Studies (NHSs) to diet assessment methods and evidence-based nutritional policies and guidelines. We performed a narrative review of the publications of the NHS and NHS II between 1976 and 2016. Through periodic assessment of diet by validated dietary questionnaires over 40 years, the NHSs have identified dietary determinants of diseases such as breast and other cancers; obesity; type 2 diabetes; cardiovascular, respiratory, and eye diseases; and neurodegenerative and mental health disorders. Nutritional biomarkers were assessed using blood, urine, and toenail samples. Robust findings, from the NHSs, together with evidence from other large cohorts and randomized dietary intervention trials, have contributed to the evidence base for developing dietary guidelines and nutritional policies to reduce intakes of trans fat, saturated fat, sugar-sweetened beverages, red and processed meats, and refined carbohydrates while promoting higher intake of healthy fats and carbohydrates and overall healthful dietary patterns. The long-term, periodically collected dietary data in the NHSs, with documented reliability and validity, have contributed extensively to our understanding of the dietary determinants of various diseases, informing dietary guidelines and shaping nutritional policy.

  9. Theory and Practice: Examining PHAC's STI Assessment Guidelines Using Sexual Script Theory

    Directory of Open Access Journals (Sweden)

    JESSICA WATTS

    2010-10-01

    Full Text Available Across Canada, the rates of many sexually transmitted infections (STI, including HIV, continue to fluctuate, with the numbers of new infections increasing within many subpopulations. This warrants an evaluation of the Public Health Agency of Canada's clinical guidelines for STI management. To accomplish this, Gagnon and Simon's work on sexual scripts has been used to explore the structure of current STI clinical practice. This theoretical analysis reveals some of the shortcomings of PHAC's guidelines, and identifies how they reduce patients to vectors of illness and disease.

  10. Quantification of tsunami hazard on Canada's Pacific Coast; implications for risk assessment

    Science.gov (United States)

    Evans, Stephen G.; Delaney, Keith B.

    2015-04-01

    Our assessment of tsunami hazard on Canada's Pacific Coast (i.e., the coast of British Columbia) begins with a review of the 1964 tsunami generated by The Great Alaska Earthquake (M9.2) that resulted in significant damage to coastal communities and infrastructure. In particular, the tsunami waves swept up inlets on the west coast of Vancouver Island and damaged several communities; Port Alberni suffered upwards of 5M worth of damage. At Port Alberni, the maximum tsunami wave height was estimated at 8.2 m above mean sea level and was recorded on the stream gauge on the Somass River located at about 7 m a.s.l, 6 km upstream from its mouth. The highest wave (9.75 m above tidal datum) was reported from Shields Bay, Graham Island, Queen Charlotte Islands (Haida Gwaii). In addition, the 1964 tsunami was recorded on tide gauges at a number of locations on the BC coast. The 1964 signal and the magnitude and frequency of traces of other historical Pacific tsunamis (both far-field and local) are analysed in the Tofino tide gauge records and compared to tsunami traces in other tide gauges in the Pacific Basin (e.g., Miyako, Japan). Together with a review of the geological evidence for tsunami occurrence along Vancouver Island's west coast, we use this tide gauge data to develop a quantitative framework for tsunami hazard on Canada's Pacific coast. In larger time scales, tsunamis are a major component of the hazard from Cascadia megathrust events. From sedimentological evidence and seismological considerations, the recurrence interval of megathrust events on the Cascadia Subduction Zone has been estimated by others at roughly 500 years. We assume that the hazard associated with a high-magnitude destructive tsunami thus has an annual frequency of roughly 1/500. Compared to other major natural hazards in western Canada this represents a very high annual probability of potentially destructive hazard that, in some coastal communities, translates into high levels of local risk

  11. Capillarys 2 Flex Piercing: Analytical performance assessment according to CLSI protocols for HbA1c quantification.

    Science.gov (United States)

    Doggui, Radhouene; Abdelhafidh Sahli, Chaïma; Aissa, Wassef Lotfi; Hammami, Maroua; Ben Sedrine, Maha; Mahjoub, Rahma; Zouaoui, Khemais; Daboubi, Rim; Siala, Hajer; Messaoud, Taieb; Bibi, Amina

    2017-09-01

    HbA1c is used for monitoring diabetic balance. In this paper we report an assessment of the analytical performances of Capillarys 2 Flex Piercing (C2FP) for HbA1c measurement using CE (Capillary Electrophoresis). CLSI (Clinical and Laboratory Standard Institute) protocols are used for the evaluation of apparatus performances: precision, linearity, method comparison, trueness and common interferences. HbA1c CVs average in intra-assay was 1.6% between run imprecision CV ranged from 0.1 to 1.8%. The linearity was demonstrated between 4.7 and 15.0%. The comparison study revealed that Bland Altman plot mean difference was equal to -0.03 (CI 95% (-0.05 to -0.0003)) and Passing-Bablok regression intercept was -0.05, CI95%(-0.13 -  -0.05); slope: 1.00, CI95%[1.00-1.01]. A strong correlation (r > 0.99) was proved. No significant effects of hemoglobin variants were seen with CE on HbA1c measurement. No problem related to sample-to-sample carry over was noted. No interferences of LA1c and cHb were observed. CE allowed quantification of HbA1c even at low level of total hemoglobin (40 g/L) in contrast to HPLC. Furthermore, this analyzer offered the opportunity of quantifying the HbA2 simultaneously with HbA1c . This evaluation showed that C2FP is a convenient system for the control of diabetes and the detection of hemoglobinopathies. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  12. 76 FR 67439 - External Peer Review Meeting for Draft Microbial Risk Assessment Guideline: Pathogenic...

    Science.gov (United States)

    2011-11-01

    ... Microorganisms With Focus on Food and Water AGENCY: Environmental Protection Agency (EPA). ACTION: Notice...: Pathogenic Microorganisms with Focus on Food and Water. EPA previously announced the release of the draft... Guideline: Pathogenic Microorganisms with Focus on Food and Water will be held on Monday, November 7, 2011...

  13. Guidelines for Assessment of Sex Bias and Sex Fairness in Career Interest Inventories.

    Science.gov (United States)

    National Inst. of Education (DHEW), Washington, DC.

    The draft guidelines are the outcome of a broadly representative three-day workshop and represent a more specific definition than previously available of the many aspects of sex fairness in career interest inventories and related interpretive, technical, and promotional materials. The diverse concerns of inventory users, respondents, authors, and…

  14. Critical assessment of the European Association of Urology guideline indications for pelvic lymph node dissection at radical prostatectomy.

    Science.gov (United States)

    Abdollah, Firas; Sun, Maxine; Briganti, Alberto; Thuret, Rodolphe; Schmitges, Jan; Gallina, Andrea; Suardi, Nazareno; Capitanio, Umberto; Salonia, Andrea; Shariat, Shahrokh F; Perrotte, Paul; Rigatti, Patrizio; Montorsi, Francesco; Karakiewicz, Pierre I

    2011-12-01

    What's known on the subject? and What does the study add? Lymphadenectomy is the most accurate lymph node staging procedure in patients with prostate cancer. We presented the first formal validation of the 2010 European Association of Urology guidelines for lymphadenectomy in prostate cancer patients. • To assess the 2010 European Association of Urology (EAU) guidelines for prostate cancer, which recommend a pelvic lymph node dissection (PLND) at radical prostatectomy in all individuals with a nomogram-predicted lymph node invasion (LNI) risk of >7%. • We focused on 1520 patients treated with radical prostatectomy and PLND, between 2006 and 2010, at a single European institution. We examined the ability of the EAU proposed threshold to correctly predict histologically confirmed LNI. Moreover, we tested the ability of a range of nomogram thresholds between 1 and 14% to correctly predict histologically confirmed LNI. Finally, we externally validated the EAU PLND guideline nomogram. • Overall, 10.6% of patients had LNI. The use of the 7% limit would have allowed the avoidance of 49% of PLNDs, at the cost of missing 11% of patients with LNI. The use of thresholds of 6% and 8% would have allowed the avoidance of respectively 46% and 52% of PLNDs, at the cost of missing respectively 9% and 11% of patients with LNI. Overall, the accuracy of the EAU guideline nomogram according to the receiver operating characteristics derived area under curve was 81% • Our observations indicate that the EAU guideline nomogram is highly accurate. The recommended threshold of 7%, above which a PLND should be performed, is associated with a favourable compromise between avoidable PLNDs and potentially missed LNI cases. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  15. [Medico-economic assessment of two methods for implementing thyroid testing guidelines].

    Science.gov (United States)

    Saillour-Glénisson, F; Michel, P; Daucourt, V

    2005-09-01

    To compare independent and combined effectiveness and cost-effectiveness of two implementation interventions of guidelines for ordering thyroid function tests. The two implementation interventions were a Memorandum Pocket Card (MPC) and a Test Request Form (TRF). Intervention groups were wards. The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to pre-intervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting. The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR). The cost-effectiveness ratio was the cost difference between the tested intervention and the control intervention upon effectiveness difference between the tested intervention and the control intervention. Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (B=-0.70, p=0.21). Compared to simple information, TRF was effective in increasing GCR (OR=2.65, 95% Confidence Interval [CI]: 1.52-4.62), unlike MPC (OR=1.28, CI: 0.75-2.19). TRF was the less expensive and the most effective intervention. Using a robust design, our study shows a greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines. The development of clinical practice improvement projects through the second procedure of accreditation in France is a good opportunity to develop a guidelines implementation research project.

  16. Availability, content and quality of local guidelines for the assessment of suicide attempters in university and general hospitals in the Netherlands.

    NARCIS (Netherlands)

    Verwey, B.; Waarde, J.A. van; Rooij, I.A.L.M. van; Gerritsen, G.; Zitman, F.G.

    2006-01-01

    OBJECTIVE: This study was performed to investigate the availability, content and quality of local guidelines for the assessment of suicide attempters in the Netherlands. METHOD: All university and general hospitals in the Netherlands were asked to provide their local guidelines. Published national

  17. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke

    NARCIS (Netherlands)

    Meijer, Ronald; van Limbeek, Jacques; de Haan, Rob

    2006-01-01

    The purpose of this paper is to present the design of an evidence-based dataset of assessment instruments for the prognostic factors of the Stroke-unit Discharge Guideline (SDG), a consensus based guideline for the decision of the discharge destination from the hospital stroke unit. In our

  18. Best practice guidelines for the use of the assessment centre method in South Africa (5th edition

    Directory of Open Access Journals (Sweden)

    Deon Meiring

    2016-04-01

    Full Text Available Orientation: Assessment Centres (ACs have a long and successful track record in South Africa when used for selection and development purposes. The popularity of the approach is mainly attributable to the ACs’ numerous strengths, which include the perceived fairness, practical utility and strong associations with on-the-job performance. To maintain the integrity of the AC, it is important for practitioners and decision makers to apply the method in a consistent and standardised manner.Research purpose: The purpose of the report is to provide practitioners and decision makers with practical guidelines and concrete procedures when using ACs as part of the organisation’s human resource management strategy. Motivation for the study: The past decade has seen significant advances in the science and practice of ACs. Now in its fifth edition, the revised Guidelines seek to provide important information to practitioners and decision makers on a number of factors when used in conjunction with the AC method, namely, technology, validation, legislation, ethics and culture.Main findings: The Guidelines provide specific suggestions and recommendations for using technology as part of the manner of delivery. Issues of culture, diversity and representation are also discussed. New features of the Guidelines include more concrete guidance on how to conduct a validation study as well as unpacking several ethical dilemmas that practitioners may encounter. Of critical importance is a position statement on the use of ACs in relation to new legislation (Employment Equity Amendment Act, Section 8, clause d pertaining to psychometric testing.Practical/managerial implications: The Guidelines serve as a benchmark of best practice for practitioners and decision makers who intend on, or are currently, using ACs in their organisations.Contribution/value-add: In the absence of formal standards governing the use of ACs in South Africa, the Guidelines provide an important

  19. Analysis and overview of the guidelines for assessing fitness to drive for commercial and private vehicle drivers.

    Science.gov (United States)

    Beran, R G

    2005-06-01

    interpretation. Some sections, such as that on sleep and epilepsy, are effectively analysed, while illnesses such as dementia are considered superficially. The guidelines are an attempt to assess fitness to drive, but contain serious flaws and provide limited information upon which to base decisions. Ambiguous language complicates application of the guidelines and places the health care professional at risk, despite a disclaimer protecting its authors.

  20. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    Science.gov (United States)

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed. Copyright © 2015 International Society for Peritoneal Dialysis.

  1. Overview of the AVT-191 Project to Assess Sensitivity Analysis and Uncertainty Quantification Methods for Military Vehicle Design

    Science.gov (United States)

    Benek, John A.; Luckring, James M.

    2017-01-01

    A NATO symposium held in 2008 identified many promising sensitivity analysis and un-certainty quantification technologies, but the maturity and suitability of these methods for realistic applications was not known. The STO Task Group AVT-191 was established to evaluate the maturity and suitability of various sensitivity analysis and uncertainty quantification methods for application to realistic problems of interest to NATO. The program ran from 2011 to 2015, and the work was organized into four discipline-centric teams: external aerodynamics, internal aerodynamics, aeroelasticity, and hydrodynamics. This paper presents an overview of the AVT-191 program content.

  2. Summary Findings from the AVT-191 Project to Assess Sensitivity Analysis and Uncertainty Quantification Methods for Military Vehicle Design

    Science.gov (United States)

    Benek, John A.; Luckring, James M.

    2017-01-01

    A NATO symposium held in Greece in 2008 identified many promising sensitivity analysis and uncertainty quantification technologies, but the maturity and suitability of these methods for realistic applications was not clear. The NATO Science and Technology Organization, Task Group AVT-191 was established to evaluate the maturity and suitability of various sensitivity analysis and uncertainty quantification methods for application to realistic vehicle development problems. The program ran from 2011 to 2015, and the work was organized into four discipline-centric teams: external aerodynamics, internal aerodynamics, aeroelasticity, and hydrodynamics. This paper summarizes findings and lessons learned from the task group.

  3. [Guidelines for the fitness to drive assessment in people with obstructive sleep apnoea syndrome (OSAS) and narcolepsy].

    Science.gov (United States)

    Garbarino, S; Bonanni, E; Ingravallo, F; Mondini, S; Plazzi, G; Sanna, A

    2011-01-01

    Given the prevalence of sleep disorders and sleep deprivation in modern societies, and the correlation between sleepiness and work and driving accidents, the excessive daytime sleepiness is an important issue. Although many studies showed that patients with untreated Obstructive sleep apnoea syndrome (OSAS) and narcolepsy have an higher risk for driving accidents, neither the European Community regulation nor the Italian law of the driving licence mention restrictions for these disorders. In 2010 the scientific association COMLAS (Association of legal medicine professionals of the Italian National Health Service) published the Guidelines for the examination by the Local Medical Commissions. The author presented the guidelines to assess the fitness to drive of people with OSAS or narcolepsy. The proposed criteria, set up in collaboration with the Commission "Sleepiness, Safety and Transportation" of the Italian Association of Sleep Medicine (AIMS), can be considered among the most advanced internationally.

  4. Report from the ASCE task committee on chimney and stack examination and retrofit. Chimney and stack condition assessment guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Hertlein, B.H. [STS Consultants Ltd., Vernon Hills, IL (United States); Bochicchio, V. [ZBD Constructors Inc., Tampa, FL (United States)

    1999-11-01

    Industrial and Utility chimneys are typically exposed to severe environmental conditions, and sometimes subjected to changes in operating conditions. Extremes of weather and aggressive industrial atmospheres impose unavoidable stresses and can lead to rapid deterioration. Changes in fuel or the installation of flue gas scrubbers change the flue gas temperature and composition, and can create conditions unanticipated by the chimney designer. The purpose of the ASCE Task Committee for Chimney and Stack Examination and Retrofit was to develop a set of guidelines that would aid owners in understanding the issues involved in maintaining these structures, and at the same time ensure that owners, engineers, and contractors alike have a common frame of reference for the work involved. It is anticipated that, by using these guidelines, requests for chimney inspections or assessments can be answered with qualified responses that address the full scope of work required or expected by the owners.

  5. Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram-a comparative study

    DEFF Research Database (Denmark)

    Hänsel Petersson, Gunnel; Ericson, Ewa; Isberg, Per-Erik

    2012-01-01

    Abstract Objectives. To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. Materials and methods. All 19-year-old patients registered at eight public dental...... clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according...... to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. Results. The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk...

  6. Uncertainty Quantification Reveals the Importance of Data Variability and Experimental Design Considerations for in Silico Proarrhythmia Risk Assessment

    Directory of Open Access Journals (Sweden)

    Kelly C. Chang

    2017-11-01

    Full Text Available The Comprehensive in vitro Proarrhythmia Assay (CiPA is a global initiative intended to improve drug proarrhythmia risk assessment using a new paradigm of mechanistic assays. Under the CiPA paradigm, the relative risk of drug-induced Torsade de Pointes (TdP is assessed using an in silico model of the human ventricular action potential (AP that integrates in vitro pharmacology data from multiple ion channels. Thus, modeling predictions of cardiac risk liability will depend critically on the variability in pharmacology data, and uncertainty quantification (UQ must comprise an essential component of the in silico assay. This study explores UQ methods that may be incorporated into the CiPA framework. Recently, we proposed a promising in silico TdP risk metric (qNet, which is derived from AP simulations and allows separation of a set of CiPA training compounds into Low, Intermediate, and High TdP risk categories. The purpose of this study was to use UQ to evaluate the robustness of TdP risk separation by qNet. Uncertainty in the model parameters used to describe drug binding and ionic current block was estimated using the non-parametric bootstrap method and a Bayesian inference approach. Uncertainty was then propagated through AP simulations to quantify uncertainty in qNet for each drug. UQ revealed lower uncertainty and more accurate TdP risk stratification by qNet when simulations were run at concentrations below 5× the maximum therapeutic exposure (Cmax. However, when drug effects were extrapolated above 10× Cmax, UQ showed that qNet could no longer clearly separate drugs by TdP risk. This was because for most of the pharmacology data, the amount of current block measured was <60%, preventing reliable estimation of IC50-values. The results of this study demonstrate that the accuracy of TdP risk prediction depends both on the intrinsic variability in ion channel pharmacology data as well as on experimental design considerations that preclude an

  7. Uncertainty Quantification Reveals the Importance of Data Variability and Experimental Design Considerations for in Silico Proarrhythmia Risk Assessment.

    Science.gov (United States)

    Chang, Kelly C; Dutta, Sara; Mirams, Gary R; Beattie, Kylie A; Sheng, Jiansong; Tran, Phu N; Wu, Min; Wu, Wendy W; Colatsky, Thomas; Strauss, David G; Li, Zhihua

    2017-01-01

    The Comprehensive in vitro Proarrhythmia Assay (CiPA) is a global initiative intended to improve drug proarrhythmia risk assessment using a new paradigm of mechanistic assays. Under the CiPA paradigm, the relative risk of drug-induced Torsade de Pointes (TdP) is assessed using an in silico model of the human ventricular action potential (AP) that integrates in vitro pharmacology data from multiple ion channels. Thus, modeling predictions of cardiac risk liability will depend critically on the variability in pharmacology data, and uncertainty quantification (UQ) must comprise an essential component of the in silico assay. This study explores UQ methods that may be incorporated into the CiPA framework. Recently, we proposed a promising in silico TdP risk metric (qNet), which is derived from AP simulations and allows separation of a set of CiPA training compounds into Low, Intermediate, and High TdP risk categories. The purpose of this study was to use UQ to evaluate the robustness of TdP risk separation by qNet. Uncertainty in the model parameters used to describe drug binding and ionic current block was estimated using the non-parametric bootstrap method and a Bayesian inference approach. Uncertainty was then propagated through AP simulations to quantify uncertainty in qNet for each drug. UQ revealed lower uncertainty and more accurate TdP risk stratification by qNet when simulations were run at concentrations below 5× the maximum therapeutic exposure (Cmax). However, when drug effects were extrapolated above 10× Cmax, UQ showed that qNet could no longer clearly separate drugs by TdP risk. This was because for most of the pharmacology data, the amount of current block measured was design considerations that preclude an accurate determination of drug IC50-values in vitro. Thus, we demonstrate that UQ provides valuable information about in silico modeling predictions that can inform future proarrhythmic risk evaluation of drugs under the CiPA paradigm.

  8. Assessment of the Adherence of Cardiologists to Guidelines for the Treatment of Atrial Fibrillation

    Science.gov (United States)

    van der Sand, Cézar R.; Leiria, Tiago Luiz Luz; Kalil, Renato Abdala Karam

    2013-01-01

    Background No local studies evaluating the knowledge of cardiologists on the management of atrial fibrillation (AF) and their adherence to these guidelines are available. Objective To evaluate the knowledge of cardiologists on the guidelines and clinical practices for the treatment of AF, correlating it to the time since medical graduation. Methods Cross-sectional study randomly including cardiologists affiliated to the Society of Cardiology of the State of Rio Grande do Sul (Sociedade de Cardiologia do Estado do Rio Grande do Sul - SOCERGS). The physicians were divided into two groups, according to time since graduation: those graduated for more (G1) or less (G2) than 25 years. Results Of the 859 SOCERGS members, 150 were interviewed, and six refused to participate in the study. G1 comprised 71 physicians, and G2, 73. Differences were observed in regard to the following variables: use of betablockers as the first-choice drug for the control of AF response in 59.2% (G1) vs 91.8% (G2) (p<0.0001); use of digoxin as the preferred drug for the control of AF response in 19.7% (G1) vs 0% (G2) (p< 0.0001); warfarin as the preferred anticoagulant in 71.8% (G1) vs 93.2% (G2) (p=0.009); application of a risk score for anticoagulation in 73.2% (G1) vs 87.7% (G2) (p=0.02). In questions regarding the knowledge about the Brazilian Society of Cardiology's guideline for AF, the overall percentage of right answers was 82.3%. Conclusion Most of the clinical measures regarding the management of AF comply with the guidelines, and the clinical practice differs according with the time since graduation. PMID:23877745

  9. Best Practices and Provisional Guidelines for Integrating Mobile, Virtual, and Videogame-Based Training and Assessments

    Science.gov (United States)

    2014-01-01

    Personnel Psychology , 59, 665-702. Knowles, M. (1980). The modern practice of adult education : From pedagogy to andragogy: Wilton, CT: Association...Review Sources. A literature search of online databases ( Education Resources Information Center, PsycINFO, PsycARTICLES, PsycEXTRA, Psychology ...interviewing. Personnel Journal, 72(6), 66. APA Task Force on Psychology in Education (1993). Learner-centered psychological principles: Guidelines for

  10. A framework of the desirable features of guideline implementation tools (GItools): Delphi survey and assessment of GItools

    NARCIS (Netherlands)

    Gagliardi, A.R.; Brouwers, M.C.; Bhattacharyya, O.K.; Wees, P.J. van der

    2014-01-01

    BACKGROUND: Guidelines are the foundation for healthcare planning, delivery and quality improvement but are not consistently implemented. Few guidelines are accompanied by guideline implementation tools (GItools). Users have requested GItools, and developers have requested guidance on how to develop

  11. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.

    NARCIS (Netherlands)

    Peter, W.F.H.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, H.M.; Vos, R.J. de; Schoones, J.W.; Vliet Vlieland, T.P.M.

    2011-01-01

    BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial

  12. Assessment of heavy metals contamination in Mamut river sediments using sediment quality guidelines and geochemical indices.

    Science.gov (United States)

    Mohammad Ali, Bibi Noorarlijannah; Lin, Chin Yik; Cleophas, Fera; Abdullah, Mohd Harun; Musta, Baba

    2015-01-01

    This paper describes the concentration of selected heavy metals (Co, Cu, Ni, Pb, and Zn) in the Mamut river sediments and evaluate the degree of contamination of the river polluted by a disused copper mine. Based on the analytical results, copper showed the highest concentration in most of the river samples. A comparison with Interim Canadian Sediment Quality Guidelines (ICSQG) and Germany Sediment Quality Guidelines (GSQG) indicated that the sediment samples in all the sampling stations, except Mamut river control site (M1), exceeded the limit established for Cu, Ni, and Pb. On the contrary, Zn concentrations were reported well below the guidelines limit (ICSQG and GSQG). Mineralogical analysis indicated that the Mamut river sediments were primarily composed of quartz and accessory minerals such as chalcopyrite, pyrite, edenite, kaolinite, mica, and muscovite, reflected by the geological character of the study area. Enrichment factor (EF) and geoaccumulation index (Igeo) were calculated to evaluate the heavy metal pollution in river sediments. Igeo values indicated that all the sites were strongly polluted with the studied metals in most sampling stations, specifically those located along the Mamut main stream. The enrichment factor with value greater than 1.5 suggested that the source of heavy metals was mainly derived from anthropogenic activity such as mining. The degree of metal changes (δfold) revealed that Cu concentration in the river sediments has increased as much as 20 to 38 folds since the preliminary investigation conducted in year 2004.

  13. Impact of Sample Matrix on Accuracy of Peptide Quantification: Assessment of Calibrator and Internal Standard Selection and Method Validation.

    Science.gov (United States)

    Arnold, Samuel L; Stevison, Faith; Isoherranen, Nina

    2016-01-05

    Protein quantification based on peptides using LC-MS/MS has emerged as a promising method to measure biomarkers, protein drugs, and endogenous proteins. However, the best practices for selection, optimization, and validation of the quantification peptides are not well established, and the influence of different matrices on protein digestion, peptide stability, and MS detection has not been systematically addressed. The aim of this study was to determine how biological matrices affect digestion, detection, and stability of peptides. The microsomal retinol dehydrogenase (RDH11) and cytosolic soluble aldehyde dehydrogenases (ALDH1As) involved in the synthesis of retinoic acid (RA) were chosen as model proteins. Considerable differences in the digestion efficiency, sensitivity, and matrix effects between peptides were observed regardless of the target protein's subcellular localization. The precision and accuracy of the quantification of RDH11 and ALDH1A were affected by the choice of calibration and internal standards. The final method using recombinant protein calibrators and stable isotope labeled (SIL) peptide internal standards was validated for human liver. The results demonstrate that different sample matrices have peptide, time, and matrix specific effects on protein digestion and absolute quantification.

  14. Cancer evaluation in the assessment of solid organ transplant candidates: A systematic review of clinical practice guidelines.

    Science.gov (United States)

    Acuna, Sergio A; Lam, Winnie; Daly, Corinne; Kim, S Joseph; Baxter, Nancy N

    2018-01-01

    Active malignancies are a contraindication to transplantation, as immunosuppression can lead to worse cancer outcomes; therefore, ensuring transplant candidates are free of malignancy before transplantation is essential. This systematic review assesses the availability, quality, and consistency of recommended cancer evaluation prior to transplantation in Clinical Practice Guidelines (CPGs) for the selection of solid organ transplant candidates. We systematically searched for CPGs for the assessment of transplant candidates. The characteristics of included CPGs, strength of recommendations and supporting evidence were extracted. A quality assessment of the CPGs was conducted using the AGREE II tool. We identified 52 CPG for the selection of solid organ transplant candidates. Only 13 (25%) included recommendations for cancer evaluation as part of the assessment of transplant candidates. Most recommended age and sex appropriate cancer screening as per the general population guidelines. Recommendations to evaluate for other malignancies and for high-risk candidates were variable. Most recommendations were based on expert opinion and only two CPGs provided an explicit link between the recommendations and supporting evidence. There is a lack of clear and consistent recommendations for pretransplant cancer evaluation in existing CPGs. Although there is some consensus regarding the indication to screen for cancer as per the recommendations for the general population, these recommendations are not an appropriate risk reduction strategy for transplant candidates. Standardized protocols to ensure transplant candidates are cancer free prior to transplantation are needed. Copyright © 2017. Published by Elsevier Inc.

  15. Comparison between modified Dixon MRI techniques, MR spectroscopic relaxometry, and different histologic quantification methods in the assessment of hepatic steatosis

    Energy Technology Data Exchange (ETDEWEB)

    Kukuk, Guido M.; Block, Wolfgang; Willinek, Winfried A.; Schild, Hans H.; Traeber, Frank [University of Bonn, Department of Radiology, Bonn (Germany); Hittatiya, Kanishka; Fischer, Hans-Peter [University of Bonn, Department of Pathology, Bonn (Germany); Sprinkart, Alois M. [University of Bonn, Department of Radiology, Bonn (Germany); Ruhr-University, Institute of Medical Engineering, Bochum (Germany); Eggers, Holger [Philips Research Europe, Hamburg (Germany); Gieseke, Juergen [University of Bonn, Department of Radiology, Bonn (Germany); Philips Healthcare, Best (Netherlands); Moeller, Philipp; Spengler, Ulrich; Trebicka, Jonel [University of Bonn, Department of Internal Medicine I, Bonn (Germany)

    2015-10-15

    To compare systematically quantitative MRI, MR spectroscopy (MRS), and different histological methods for liver fat quantification in order to identify possible incongruities. Fifty-nine consecutive patients with liver disorders were examined on a 3 T MRI system. Quantitative MRI was performed using a dual- and a six-echo variant of the modified Dixon (mDixon) sequence, calculating proton density fat fraction (PDFF) maps, in addition to single-voxel MRS. Histological fat quantification included estimation of the percentage of hepatocytes containing fat vesicles as well as semi-automatic quantification (qHisto) using tissue quantification software. In 33 of 59 patients, the hepatic fat fraction was >5 % as determined by MRS (maximum 45 %, mean 17 %). Dual-echo mDixon yielded systematically lower PDFF values than six-echo mDixon (mean difference 1.0 %; P < 0.001). Six-echo mDixon correlated excellently with MRS, qHisto, and the estimated percentage of hepatocytes containing fat vesicles (R = 0.984, 0.967, 0.941, respectively, all P < 0.001). Mean values obtained by the estimated percentage of hepatocytes containing fat were higher by a factor of 2.5 in comparison to qHisto. Six-echo mDixon and MRS showed the best agreement with values obtained by qHisto. Six-echo mDixon, MRS, and qHisto provide the most robust and congruent results and are therefore most appropriate for reliable quantification of liver fat. (orig.)

  16. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice.

    Science.gov (United States)

    Bernert, Rebecca A; Hom, Melanie A; Roberts, Laura Weiss

    2014-10-01

    The current paper aims to: (1) examine clinical practice guidelines in suicide prevention across fields, organizations, and clinical specialties and (2) inform emerging standards in clinical practice, research, and training. The authors conducted a systematic literature review to identify clinical practice guidelines and resource documents in suicide prevention and risk management. The authors used PubMed, Google Scholar, and Google Search, and keywords included: clinical practice guideline, practice guideline, practice parameters, suicide, suicidality, suicidal behaviors, assessment, and management. To assess for commonalities, the authors reviewed guidelines and resource documents across 13 key content categories and assessed whether each document suggested validated assessment measures. The search generated 101 source documents, which included N = 10 clinical practice guidelines and N = 12 additional resource documents (e.g., non-formalized guidelines, tool-kits). All guidelines (100 %) provided detailed recommendations for the use of evidence-based risk factors and protective factors, 80 % provided brief (but not detailed) recommendations for the assessment of suicidal intent, and 70 % recommended risk management strategies. By comparison, only 30 % discussed standardization of risk-level categorizations and other content areas considered central to best practices in suicide prevention (e.g., restricting access to means, ethical considerations, confidentiality/legal issues, training, and postvention practices). Resource documents were largely consistent with these findings. Current guidelines address similar aspects of suicide risk assessment and management, but significant discrepancies exist. A lack of consensus was evident in recommendations across core competencies, which may be improved by increased standardization in practice and training. Additional resources appear useful for supplemental use.

  17. Fluorescent quantification of melanin

    OpenAIRE

    Fernandes, Bruno Pacheco; Matamá, Maria Teresa; Guimarães, Diana Isabel Pereira; Gomes, Andreia; Cavaco-Paulo, Artur

    2016-01-01

    Melanin quantification is reportedly performed by absorption spectroscopy, commonly at 405 nm. Here, we propose the implementation of fluorescence spectroscopy for melanin assessment. In a typical in vitro assay to assess melanin production in response to an external stimulus, absorption spectroscopy clearly overvalues melanin content. This method is also incapable of distinguishing non-melanotic/amelanotic control cells from those that are actually capable of performing melanogenesis. Theref...

  18. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

    Science.gov (United States)

    Eichenfield, Lawrence F; Tom, Wynnis L; Chamlin, Sarah L; Feldman, Steven R; Hanifin, Jon M; Simpson, Eric L; Berger, Timothy G; Bergman, James N; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Krol, Alfons; Margolis, David J; Paller, Amy S; Schwarzenberger, Kathryn; Silverman, Robert A; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

    2014-02-01

    Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  19. Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Miles, K.A. [University of Sussex, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer (United Kingdom); Lee, T.Y. [Robarts Research Institute, Imaging Research Laboratories, London, Ontario (Canada); Goh, V. [St Thomas' Hospital, Division of Imaging Sciences and Biomedical Engineering, King' s College London, London (United Kingdom); Klotz, E. [Computed Tomography H IM CT PLM-E PA, Siemens Healthcare Sector, Forchheim (Germany); Cuenod, C. [INSERM U970 PARCC, Hopital Europeen Georges Pompidou (HEGP), Paris (France); Bisdas, S. [Eberhard Karls University, Department of Neuroradiology, Tuebingen (Germany); Groves, A.M. [University College London, University College Hospital, Institute of Nuclear Medicine, London (United Kingdom); Hayball, M.P. [Cambridge Computed Imaging Ltd, Cambridge (United Kingdom); Alonzi, R. [Mount Vernon Cancer Centre, Northwood (United Kingdom); Brunner, T. [Gray Institute for Radiation, Oncology and Biology, Oxford (United Kingdom)

    2012-07-15

    Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity. (orig.)

  20. Assessing the diagnostic accuracy of the identification of hyperkinetic disorders following the introduction of government guidelines in England

    Directory of Open Access Journals (Sweden)

    Ford Tamsin

    2008-11-01

    Full Text Available Abstract Background Previous studies have suggested that both underdiagnosis and overdiagnosis routinely occur in ADHD and hyperkinesis (hyperkinetic disorders. England has introduced governmental guidelines for these disorders' detection and treatment, but there has been no study on clinical diagnostic accuracy under such a regime. Methods All open cases in three Child and Adolescent Mental Health Services (CAMHS in the South East of England were assessed for accuracy in the detection of hyperkinetic disorders, using a two-stage process employing the Strengths and Difficulties Questionnaire (SDQ for screening, with the cut-off between "unlikely" and "possible" as the threshold for identification, and the Development And Well-Being Assessment (DAWBA as a valid and reliable standard. Results 502 cases were collected. Their mean age 11 years (std dev 3 y; 59% were clinically diagnosed as having a hyperkinetic disorder including ADHD. Clinicians had missed two diagnoses of hyperkinesis and six of ADHD. The only 'false positive' case was one that had become asymptomatic on appropriate treatment. Conclusion The identification of children with hyperkinetic disorders by three ordinary English CAMHS teams appears now to be generally consistent with that of a validated, standardised assessment. It seems likely that this reflects the impact of Governmental guidelines, which could therefore be an appropriate tool to ensure consistent accurate diagnosis internationally.

  1. A Retrospective Performance Assessment of the Developmental Neurotoxicity Study in Support of OECD Test Guideline 426

    DEFF Research Database (Denmark)

    Makris, Susan L.; Raffaele, Kathleen; Allen, Sandra

    2009-01-01

    OBJECTIVE: We conducted a review of the history and performance of developmental neurotoxicity mic (DNT) testing in support of the finalization and implementation of Organisation of Economic Co-operation and Development (OECD) DNT test guideline 426 (TG 426). INFORMATION SOURCES AND ANALYSIS......: In this review we summarize extensive scientific efforts that form the foundation for this testing paradigm, including basic neurotoxicology research, interlaboratory collaborative studies, expert workshops, and validation studies, and we address the relevance, applicability, and use of the DNT study in risk...

  2. Guidelines for youth sports clubs to develop, implement, and assess health promotion within its activities.

    Science.gov (United States)

    Kokko, Sami

    2014-05-01

    The settings approach to health promotion is a world-known concept concerning settings like city, hospital, school, and workplace. The concept has also been used in some regionally specific settings, such as island, prison, or university. However, there are still many, often noninstitutional, settings that have a lot of potential but have not yet been recognized. One of the newcomers is the youth sports club, which has the potential to reach a lot of children and adolescents and is effective, via its casual educational nature based on voluntary participation. According to research, health is an important aim for most youth sports clubs, but it has not been converted into practical actions. Indeed, the clubs often recognize the importance of healthy lifestyles, but there is a lack of understanding of what to do to reinforce it within one's activities. That is why, on the basis of the results of the Health Promoting Sports Club survey in Finland, guidelines for clubs to enhance health promotion as a part of their activities were created. The aim of this article is to present the guidelines, theirs rationale, and practical examples.

  3. Levels and Patterns of Objectively Assessed Physical Activity and Compliance with Different Public Health Guidelines in University Students.

    Directory of Open Access Journals (Sweden)

    Natalia María Arias-Palencia

    Full Text Available Physical activity (PA is associated with health enhancement. The aim of this study was to assess: 1 levels and patterns of PA in university students by using accelerometers; and 2 the percentage of fulfilment of PA recommendations for adults, according to different public health guidelines.Observational cross-sectional study (Cuenca's Adults Study involving 296 (206 women healthy Spanish university students aged 18-25 years old. Participants wore the ActiGraph GT1M accelerometer for seven consecutive days. Total PA, steps and time spent in sedentary time, light, moderate, vigorous, and moderate to vigorous PA (MVPA was assessed, and the prevalence of sufficient PA was calculated according to various public health guidelines.No sex differences in total PA were found. University students were more sedentary during weekend days than weekdays (p<0.05. Only 30.3% of participants accumulated 30 min/day at least five days a week of MVPA. A total of 5.4% of students met the recommendation of 150 min/week of MVPA or 75 min/week of vigorous PA, in PA bouts of at least 10 min. using the same definition, but on five or more days a week, only 0.5% students were found to meet the recommendation. In addition, only 0.5% of students met the recommendation of 30 min/day of MVPA, at least five days a week and in bouts of at least 10 min. Finally, 28.1% of the students met the recommendation of 10,000 steps/day.Our study shows a high incidence of sedentary time in university students. The number of students meeting PA recommendations significantly differed depending on the recommendation proposed. Specific strategies to promote PA in this population are necessary as well as an agreement as to which PA guidelines should be used.

  4. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.

    Science.gov (United States)

    Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

    2014-09-01

    Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

  5. Assessment of food safety using a new real-time PCR assay for detection and quantification of virulence factors of enterococci in food samples.

    Science.gov (United States)

    Abouelnaga, M; Lamas, A; Guarddon, M; Osman, M; Miranda, J M; Cepeda, A; Franco, C M

    2016-12-01

    Development of Taqman MGB real-time PCR (q-PCR) assays for the quantitative detection of virulence factor genes in pure culture and food samples with regard to food safety assessment. New Taqman primers and probes were designed for the ace, esp and gelE genes based on the determinants of virulence profiles of enterococcal strains from GenBank. The high specificity and accuracy of the Taqman probe assay was confirmed. The limit of detection for the different virulence genes was 102  CFU ml-1 or CFU g-1 for pure culture and meat samples, and 103  CFU g-1 for cheese samples. This method provides the specific and rapid detection and quantification of ace, esp and gelE genes compared to conventional PCR assays, thus allowing the rapid and direct safety assessment of Enterococcus genus in food samples. This study presents efficient methods that can be used directly on food products for the rapid quantification and tracing of virulence genes, regarding food safety assessment. Moreover, this is the first study to quantify these virulence factors using a specific Taqman q-PCR assay in food samples. © 2016 The Society for Applied Microbiology.

  6. Assessment of CPR-D skills of nursing students in two institutions: reality versus recommendations in the guidelines.

    Science.gov (United States)

    Mäkinen, Marja; Axelsson, Asa; Castrén, Maaret; Nurmi, Jouni; Lankinen, Iira; Niemi-Murola, Leila

    2010-08-01

    Significant differences in basic life support skills including cardiopulmonary resuscitation and defibrillation (CPR-D) were detected when nurses working in one Finnish and one Swedish hospital were tested using an Objective Structured Clinical Examination (OSCE). The purpose of this study was to use OSCE test in assessing guideline based CPR-D skills of newly qualified nurses. The CPR-D skills of newly qualified registered nurses studying in Halmstad University (n = 30), Sweden, Helsinki Metropolia University of Applied Sciences (n = 30), and Finland were assessed using an OSCE which was built up with a case of cardiac arrest with ventricular fibrillation as the initial rhythm. The Angoff average, 32.47, was calculated as cutoff point to pass the test. Forty-seven percent of the students in the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed the OSCE (Pskills correlated with high grading of the clinical skills. In conclusion, CPR-D skills of the newly qualified nurses in both the institutes were clearly under par and were not adequate according to the resuscitation guidelines. Current style of teaching is unlikely to result in students being able to perform adequate CPR-D. Standardized testing would help in controlling the quality of learning.

  7. Evaluation of Chemical Warfare Agent Percutaneous Vapor Toxicity: Derivation of Toxicity Guidelines for Assessing Chemical Protective Ensembles.

    Energy Technology Data Exchange (ETDEWEB)

    Watson, A.P.

    2003-07-24

    Percutaneous vapor toxicity guidelines are provided for assessment and selection of chemical protective ensembles (CPEs) to be used by civilian and military first responders operating in a chemical warfare agent vapor environment. The agents evaluated include the G-series and VX nerve agents, the vesicant sulfur mustard (agent HD) and, to a lesser extent, the vesicant Lewisite (agent L). The focus of this evaluation is percutaneous vapor permeation of CPEs and the resulting skin absorption, as inhalation and ocular exposures are assumed to be largely eliminated through use of SCBA and full-face protective masks. Selection of appropriately protective CPE designs and materials incorporates a variety of test parameters to ensure operability, practicality, and adequacy. One aspect of adequacy assessment should be based on systems tests, which focus on effective protection of the most vulnerable body regions (e.g., the groin area), as identified in this analysis. The toxicity range of agent-specific cumulative exposures (Cts) derived in this analysis can be used as decision guidelines for CPE acceptance, in conjunction with weighting consideration towards more susceptible body regions. This toxicity range is bounded by the percutaneous vapor estimated minimal effect (EME{sub pv}) Ct (as the lower end) and the 1% population threshold effect (ECt{sub 01}) estimate. Assumptions of exposure duration used in CPE certification should consider that each agent-specific percutaneous vapor cumulative exposure Ct for a given endpoint is a constant for exposure durations between 30 min and 2 hours.

  8. International guidelines for the in vivo assessment of skin properties in non-clinical settings

    DEFF Research Database (Denmark)

    Stefaniak, Aleksandr B; Plessis, Johan du; John, Swen M

    2013-01-01

    position, skin health, time of day), exogenous (hand washing, barrier creams, soaps and detergents, occlusion), environmental (seasonality), and measurement (atmospheric conditions) factors; (ii) report pH measurements results as a difference or percent change (not absolute values) using a measure......BACKGROUND: Skin surface pH is known to influence the dissolution and partitioning of chemicals and may influence exposures that lead to skin diseases. Non-clinical environments (e.g. workplaces) are highly variable, thereby presenting unique measurement challenges that are not typically...... encountered in clinical settings. Hence, guidelines are needed for consistent measurement of skin surface pH in environments that are difficult to control. METHODS: An expert workshop was convened at the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals to review...

  9. Buckling-driven delamination growth in composite laminates: Guidelines for assessing the threat posed by interlaminar matrix delamination

    DEFF Research Database (Denmark)

    Bhushan, Karihaloo; Stang, Henrik

    2008-01-01

    This paper is concerned with development of a simple procedure to assess the threat posed by interlaminar matrix delaminations to the integrity of composite laminates when they are situated in a compressive stress field. Depending upon the size of the delamination, its location below the surface...... and on the level of the applied stress, it may or may not buckle away from the rest of the laminate. If it buckles, the post-buckling response will depend upon the applied compressive stress level, the thickness of the delaminated ply and the interlaminar critical energy release rate of the composite material...... for the mode mixity present at the delamination front. The pre- and post-buckling response is examined in its simplest form and guidelines provided for assessing whether or not a delamination detected during quality control or inspection poses a threat to the safe operation of the composite laminate....

  10. ECOHEATCOOL Work Package 4. Guidelines for assessing the efficiency of district heating and district cooling system

    Energy Technology Data Exchange (ETDEWEB)

    Werner, Sven [Chalmers Univ. of Technology, Goeteborg (Sweden)] (and others)

    2006-07-01

    The main purpose with this report have been to present an overall quantification of the benefits of expanded use of district heating in Europe. This quantification is based on the definition and description of the European heat market during 2003 presented in the preceding report from Work Package 1. The target area covers 32 countries, including the EU25 member states, four accession countries (Bulgaria, Croatia, Romania, and Turkey), and three EFTA countries (Iceland, Norway, and Switzerland). The main source for statistical information was the IEA Energy Balances and 2003 was chosen as the reference year for the analyses. The quantification of the overall benefits with district heating is introductory supported by descriptions of: The fuel and heat supply to district heating systems during 2003; The five major strategic heat source options for district heating; Institutional and market barriers for district heating; Projections for future district heat sales; and The fuel and heat supply to district heating systems are dominated by the use of heat from CHP plants, corresponding to 68 % of all district heat generated. The renewable part in the district heat supply (14 %) is also higher than the corresponding fraction (7%) in the overall primary energy supply. Hereby, the European district heating systems have together succeeded to fulfil the EU ambition of a 12 % renewable share in 2010. The total share of renewables and heat retrieved from other activities amounted to 78 % for all heat generated, proving that the European district heating systems are in general successful in avoiding direct heat only generation with fossil fuels. The five major strategic heat source options were identified as combined heat and power (CHP), waste incineration, industrial surplus heat, geothermal heat, and combustible renewables such as biomass. The total available potential for these resources are about 200 times higher than the current district heat deliveries and about 20 times

  11. Methodological guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Callaway, J.M.; Meyer, H.J.

    1999-04-01

    The guideline document establishes a general overview of the main components of climate change mitigation assessment. This includes an outline of key economic concepts, scenario structure, common assumptions, modelling tools and country study assumptions. The guidelines are supported by Handbook Reports that contain more detailed specifications of calculation standards, input assumptions and available tools. The major objectives of the project have been provided a methodology, an implementing framework and a reporting system which countries can follow in meeting their future reporting obligations under the FCCC and for GEF enabling activities. The project builds upon the methodology development and application in the UNEP National Abatement Coasting Studies (UNEP, 1994a). The various elements provide countries with a road map for conducting climate change mitigation studies and submitting national reports as required by the FCCC. (au) 121 refs.

  12. PET optimization for improved assessment and accurate quantification of {sup 90}Y-microsphere biodistribution after radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Martí-Climent, Josep M., E-mail: jmmartic@unav.es; Prieto, Elena; Elosúa, César; Rodríguez-Fraile, Macarena; Domínguez-Prado, Inés; Vigil, Carmen; García-Velloso, María J.; Arbizu, Javier; Peñuelas, Iván; Richter, José A. [Nuclear Medicine Department, Clínica Universidad de Navarra, 36, Pío XII Avenue, 31008 Pamplona (Spain)

    2014-09-15

    Purpose: {sup 90}Y-microspheres are widely used for the radioembolization of metastatic liver cancer or hepatocellular carcinoma and there is a growing interest for imaging {sup 90}Y-microspheres with PET. The aim of this study is to evaluate the performance of a current generation PET/CT scanner for {sup 90}Y imaging and to optimize the PET protocol to improve the assessment and the quantification of {sup 90}Y-microsphere biodistribution after radioembolization. Methods: Data were acquired on a Biograph mCT-TrueV scanner with time of flight (TOF) and point spread function (PSF) modeling. Spatial resolution was measured with a{sup 90}Y point source. Sensitivity was evaluated using the NEMA 70 cm line source filled with {sup 90}Y. To evaluate the count rate performance, {sup 90}Y vials with activity ranging from 3.64 to 0.035 GBq were measured in the center of the field of view (CFOV). The energy spectrum was evaluated. Image quality with different reconstructions was studied using the Jaszczak phantom containing six hollow spheres (diameters: 31.3, 28.1, 21.8, 16.1, 13.3, and 10.5 mm), filled with a 207 kBq/ml {sup 90}Y concentration and a 5:1 sphere-to-background ratio. Acquisition time was adjusted to simulate the quality of a realistic clinical PET acquisition of a patient treated with SIR-Spheres{sup ®}. The developed methodology was applied to ten patients after SIR-Spheres{sup ®} treatment acquiring a 10 min per bed PET. Results: The energy spectrum showed the{sup 90}Y bremsstrahlung radiation. The {sup 90}Y transverse resolution, with filtered backprojection reconstruction, was 4.5 mm in the CFOV and degraded to 5.0 mm at 10 cm off-axis. {sup 90}Y absolute sensitivity was 0.40 kcps/MBq in the center of the field of view. Tendency of true and random rates as a function of the {sup 90}Y activity could be accurately described using linear and quadratic models, respectively. Phantom studies demonstrated that, due to low count statistics in {sup 90}Y PET

  13. School-Based Mental Health Professionals' Bullying Assessment Practices: A Call for Evidence-Based Bullying Assessment Guidelines

    Science.gov (United States)

    Blake, Jamilia; Banks, Courtney S.; Patience, Brenda A.; Lund, Emily M.

    2014-01-01

    A sample of 483 school-based mental health professionals completed a survey about the training they have received related to conducting bullying assessments in schools, competence in conducting an assessment of bullying, and the bullying assessment methods they used. Results indicate that school counselors were usually informed about incidents of…

  14. Assessment of Coronary Artery Calcium Scoring for Statin Treatment Strategy according to ACC/AHA Guidelines in Asymptomatic Korean Adults.

    Science.gov (United States)

    Han, Donghee; Ó Hartaigh, Bríain; Lee, Ji Hyun; Rizvi, Asim; Park, Hyo Eun; Choi, Su Yeon; Sung, Jidong; Chang, Hyuk Jae

    2017-01-01

    The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines advocate the use of statin treatment for prevention of cardiovascular disease. We aimed to assess the usefulness of coronary artery calcium (CAC) for stratifying potential candidates of statin use among asymptomatic Korean individuals. A total of 31375 subjects who underwent CAC scoring as part of a general health examination were enrolled in the current study. Statin eligibility was categorized as statin recommended (SR), considered (SC), and not recommended (SN) according to ACC/AHA guidelines. Cox regression analysis was employed to estimate hazard ratios (HR) with 95% confidential intervals (CI) after stratifying the subjects according to CAC scores of 0, 1-100, and >100. Number needed to treat (NNT) to prevent one mortality event during study follow up was calculated for each group. Mean age was 54.4±7.5 years, and 76.3% were male. During a 5-year median follow-up (interquartile range; 3-7), there were 251 (0.8%) deaths from all-causes. A CAC >100 was independently associated with mortality across each statin group after adjusting for cardiac risk factors (e.g., SR: HR, 1.60; 95% CI, 1.07-2.38; SC: HR, 2.98; 95% CI, 1.09-8.13, and SN: HR, 3.14; 95% CI, 1.08-9.17). Notably, patients with CAC >100 displayed a lower NNT in comparison to the absence of CAC or CAC 1-100 in SC and SN groups. In Korean asymptomatic individuals, CAC scoring might prove useful for reclassifying patient eligibility for receiving statin therapy based on updated 2013 ACC/AHA guidelines.

  15. International guidelines for the in vivo assessment of skin properties in non-clinical settings

    DEFF Research Database (Denmark)

    du Plessis, Johan; Stefaniak, Aleksandr; Eloff, Fritz

    2013-01-01

    There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, repre...

  16. 75 FR 15485 - Pipeline Safety: Workshop on Guidelines for Integrity Assessment of Cased Pipe

    Science.gov (United States)

    2010-03-29

    ... will be for the public, pipeline operators, trade associations, and others to address ideas and concerns with using External Corrosion Direct Assessment integrity evaluation methods and use of other... they were encountering technical challenges in conducting External Corrosion Direct Assessment (ECDA...

  17. EPA`s program for risk assessment guidelines: Cancer classification issues

    Energy Technology Data Exchange (ETDEWEB)

    Wiltse, J. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    Issues presented are related to classification of weight of evidence in cancer risk assessments. The focus in this paper is on lines of evidence used in constructing a conclusion about potential human carcinogenicity. The paper also discusses issues that are mistakenly addressed as classification issues but are really part of the risk assessment process. 2 figs.

  18. School-Based Assessment of ADHD: Purpose, Alignment with Best Practice Guidelines, and Training

    Science.gov (United States)

    Ogg, Julia; Fefer, Sarah; Sundman-Wheat, Ashley; McMahan, Melanie; Stewart, Tiffany; Chappel, Ashley; Bateman, Lisa

    2013-01-01

    Youth exhibiting symptoms of attention deficit hyperactivity disorder are frequently referred to school psychologists because of academic, social, and behavioral difficulties that they face. To address these difficulties, evidence-based assessment methods have been outlined for multiple purposes of assessment. The goals of this study were to…

  19. Assessment of in-vitro efficacy of 1% Virkon against bacteria, fungi, viruses and spores by means of AFNOR guidelines.

    Science.gov (United States)

    Herńndez, A; Martró, E; Matas, L; Martín, M; Ausina, V

    2000-11-01

    Peroxygenic acid, under the brand name Virkon, has unleashed great debate following contradictory reports of its efficacy and spectrum of activity. The aim of this study was to test the biocidal activity of the compound against 10 different micro-organisms, following standard in-vitro test procedures. Bactericidal, fungicidal and sporicidal activities were determined using quantitative suspension and germ carrier tests and virucidal activity was assessed using a simple dilution suspension test, following the Association Française de Normalisation (AFNOR) guidelines. One percent Virkon demonstrated bactericidal activity against Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Enterococcus hirae and Mycobacterium smegmatis in the suspension test and against P. aeruginosa, E. coli, S. aureus and E. hirae in the carrier test. One percent Virkon showed virucidal activity against poliovirus in the suspension test. However, this concentration did not comply with sporicidal and fungicidal activity guidelines. In conclusion, 1% Virkon is effective only against vegetative bacteria, yeasts and viruses, and should therefore be considered a low-level disinfectant. Copyright 2000 The Hospital Infection Society.

  20. Deliverable 4.3 Decision support guideline based on LCA and cost/efficiency assessment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Hansen, Peter Augusto; Boyer-Souchet, Florence

    2010-01-01

    The environmental sustainability assessments described in this report is based on life cycle assessments (LCA) of selected waste water treatment technology (WWTT) cases included in NEPTUNE. The basic approach in these assessments (avoided against induced impacts) is described in Deliverable 4...... into four clusters related to the main purpose of the treatment, e.g. nutrient removal or micropollutant removal. All are assessed within the cluster by comparing with the reference or by looking at induced versus avoided environmental impacts potentials originated from the various emissions and flows...... inventory of cluster 1 on micropollutant removal, tracks 22 organic micropollutants (pharmaceuticals) that have been sampled in different WWTTs by NEPTUNE partners. The resulting inventory is then modelled according to the EDIP97 methodology on the GaBi LCA modelling software, i.e. GaBi 4 (PE 2008...

  1. The state of school-based bilingual assessment: actual practice versus recommended guidelines.

    Science.gov (United States)

    Caesar, Lena G; Kohler, Paula D

    2007-07-01

    This study was designed to investigate the frequency with which school-based speech-language pathologists (SLPs) used recommended practices when assessing the language skills of bilingual students. The study also investigated the frequency with which SLPs used formal, standardized tests versus informal, alternative procedures with this population. A total of 596 surveys were mailed out to school-based SLPs in the state of Michigan who were members of the Michigan Speech, Language, and Hearing Association (MSHA) during the 2003-2004 academic year. Of the 409 usable surveys that were returned, 130 respondents indicated being involved in assessing bilingual children and comprised the sample used in this study. Results indicated that SLPs used formal, standardized English tests more frequently than informal assessment procedures when assessing bilingual students. Further in-depth analyses of SLPs' responses indicated that neither factors related to their years of experience or factors related to their academic preparation were significantly related to their use of recommended assessment practices. However, significant differences in use were noted based on respondents' employment settings. This study underscores the need for academic training programs and professional organizations to intentionally disseminate information regarding the expediency of alternative testing procedures. Implications for the adequate nonbiased assessment of bilingual children are discussed.

  2. Neuropathological assessment and validation of mouse models for Alzheimer's disease: applying NIA-AA guidelines

    Directory of Open Access Journals (Sweden)

    C. Dirk Keene

    2016-06-01

    Full Text Available Dozens of transgenic mouse models, generally based on mutations associated with familial Alzheimer's disease (AD, have been developed, in part, for preclinical testing of candidate AD therapies. However, none of these models has successfully predicted the clinical efficacy of drugs for treating AD patients. Therefore, development of more translationally relevant AD mouse models remains a critical unmet need in the field. A concept not previously implemented in AD preclinical drug testing is the use of mouse lines that have been validated for neuropathological features of human AD. Current thinking suggests that amyloid plaque and neurofibrillary tangle deposition is an essential component for accurate modeling of AD. Therefore, the AD translational paradigm would require pathologic Aβ and tau deposition, a disease-relevant distribution of plaques and tangles, and a pattern of disease progression of Aβ and tau isoforms similar to the neuropathological features found in the brains of AD patients. Additional parameters useful to evaluate parallels between AD and animal models would include 1 cerebrospinal fluid (CSF AD biomarker changes with reduced Aβ and increased phospho-tau/tau; 2 structural and functional neuroimaging patterns including MRI hippocampal atrophy, fluorodeoxyglucose (FDG, and amyloid/tau PET alterations in activity and/or patterns of pathologic peptide deposition and distribution; and 3 cognitive impairment with emphasis on spatial learning and memory to distinguish presymptomatic and symptomatic mice at specific ages. A validated AD mouse model for drug testing would likely show tau-related neurofibrillary degeneration following Aβ deposition and demonstrate changes in pathology, CSF analysis, and neuroimaging that mirror human AD. Development of the ideal model would revolutionize the ability to establish the translational value of AD mouse models and serve as a platform for discussions about national phenotyping guidelines

  3. Neuropathological assessment and validation of mouse models for Alzheimer's disease: applying NIA-AA guidelines.

    Science.gov (United States)

    Keene, C Dirk; Darvas, Martin; Kraemer, Brian; Liggitt, Denny; Sigurdson, Christina; Ladiges, Warren

    2016-01-01

    Dozens of transgenic mouse models, generally based on mutations associated with familial Alzheimer's disease (AD), have been developed, in part, for preclinical testing of candidate AD therapies. However, none of these models has successfully predicted the clinical efficacy of drugs for treating AD patients. Therefore, development of more translationally relevant AD mouse models remains a critical unmet need in the field. A concept not previously implemented in AD preclinical drug testing is the use of mouse lines that have been validated for neuropathological features of human AD. Current thinking suggests that amyloid plaque and neurofibrillary tangle deposition is an essential component for accurate modeling of AD. Therefore, the AD translational paradigm would require pathologic Aβ and tau deposition, a disease-relevant distribution of plaques and tangles, and a pattern of disease progression of Aβ and tau isoforms similar to the neuropathological features found in the brains of AD patients. Additional parameters useful to evaluate parallels between AD and animal models would include 1) cerebrospinal fluid (CSF) AD biomarker changes with reduced Aβ and increased phospho-tau/tau; 2) structural and functional neuroimaging patterns including MRI hippocampal atrophy, fluorodeoxyglucose (FDG), and amyloid/tau PET alterations in activity and/or patterns of pathologic peptide deposition and distribution; and 3) cognitive impairment with emphasis on spatial learning and memory to distinguish presymptomatic and symptomatic mice at specific ages. A validated AD mouse model for drug testing would likely show tau-related neurofibrillary degeneration following Aβ deposition and demonstrate changes in pathology, CSF analysis, and neuroimaging that mirror human AD. Development of the ideal model would revolutionize the ability to establish the translational value of AD mouse models and serve as a platform for discussions about national phenotyping guidelines and standards

  4. GUIDELINES FOR THE DESIGN OF INSTRUMENTS OF COMPETENCE ASSESSMENT FROM MEASURABLE LEARNING STANDARDS

    Directory of Open Access Journals (Sweden)

    Ignacio Polo Martínez

    2015-06-01

    Full Text Available The evaluation is not enough to improve education necessary but. There are no magic to educational problems through assessment solutions. However, the evaluation, in partnership with the methodology, should be treated as determinants of the quality and improving education. Surely, many teachers agree that it is not easy to design assessment tools that are consistent with the teaching-learning competence and, in turn, with rigorous curriculum standards and assessment of the Autonomous Community. However, this difficulty should not be considered as an impossibility. Through this article aims to contribute to building an improvement plan associated with the design of the evaluation instruments from different areas or subjects. Such a design should be based on at least the following: I want to evaluate (referring to assessment criteria and standards of assessable learning included in the instrument and I will evaluate (referencing jurisdictional situations linked to next and known student context, HOW I WILL QUALIFY (preserving the right of students to an objective evaluation and what consequences they will have the results for the different agents that make up the educational community.

  5. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  6. The quantity and quality of complementary and alternative medicine clinical practice guidelines on herbal medicines, acupuncture and spinal manipulation: systematic review and assessment using AGREE II.

    Science.gov (United States)

    Ng, Jeremy Y; Liang, Laurel; Gagliardi, Anna R

    2016-10-29

    Complementary and alternative medicine (CAM) use is often not disclosed by patients, and can be unfamiliar to health care professionals. This may lead to underuse of beneficial CAM therapies, and overuse of other CAM therapies with little proven benefit or known contraindications. No prior research has thoroughly evaluated the credibility of knowledge-based resources. The purpose of this research was to assess the quantity and quality of CAM guidelines. A systematic review was conducted to identify CAM guidelines. MEDLINE, EMBASE and CINAHL were searched in January 2016 from 2003 to 2015. The National Guideline Clearinghouse, National Center for Complementary and Integrative Health web site, and two CAM journals were also searched. Eligible guidelines published in English language by non-profit agencies on herbal medicine, acupuncture, or spinal manipulation for adults with any condition were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. From 3,126 unique search results, 17 guidelines (two herbal medicine, three acupuncture, four spinal manipulation, eight mixed CAM therapies) published in 2003 or later and relevant to several clinical conditions were eligible. Scaled domain percentages from highest to lowest were clarity of presentation (85.3 %), scope and purpose (83.3 %), rigour of development (61.2 %), editorial independence (60.1 %), stakeholder involvement (52.0 %) and applicability (20.7 %). Quality varied within and across guidelines. None of the 17 guidelines were recommended by both appraisers; 14 were recommended as Yes or Yes with modifications. Guidelines that scored well could be used by patients and health care professionals as the basis for discussion about the use of these CAM therapies. In future updates, guidelines that achieved variable or lower scores could be improved according to specifications in the AGREE II instrument, and with insight from a large number of resources that are available

  7. 76 FR 57992 - Assessment Rate Adjustment Guidelines for Large and Highly Complex Institutions

    Science.gov (United States)

    2011-09-19

    ... total score will be made only if the comprehensive analysis of an institution's risk generally based on... bank methodology under the Amended Assessment Regulations and determine the relative risk ranking of... methodology regarding higher risk concentrations should include consideration of an institution's historical...

  8. Quantification of urban metabolism through coupling with the life cycle assessment framework: concept development and case study

    DEFF Research Database (Denmark)

    Goldstein, Benjamin Paul; Birkved, Morten; Quitzau, Maj-Britt

    2013-01-01

    Cities now consume resources and produce waste in amounts that are incommensurate with the populations they contain. Quantifying and benchmarking the environmental impacts of cities is essential if urbanization of the world’s growing population is to occur sustainably. Urban metabolism (UM...... of cities by modeling pressures embedded in the flows upstream (entering) and downstream (leaving) of the actual urban systems studied, and by introducing an advanced suite of indicators. Applied to five global cities, the developed UM–LCA model provided enhanced quantification of mass and energy flows...... through cities over earlier UM methods. The hybrid model approach also enabled the dominant sources of a city’s different environmental footprints to be identified, making UM–LCA a novel and potentially powerful tool for policy makers in developing and monitoring urban development policies. Combining...

  9. A study on current risk assessments and guidelines on the use of food animal products derived from cloned animals.

    Science.gov (United States)

    Hur, Sun Jin

    2017-10-01

    The author widely surveyed and analyzed the food safety issues, ethical issues, permits, and approval of animal products from animals cloned by somatic cell nuclear transfer worldwide. As a result of a 2-year survey, the author found that there is no evidence that meat and milk derived from cloned animals or their progeny pose a risk to food safety in terms of genotoxicity, adverse reproductive effects, or allergic reactions. Most countries have not approved meat and milk derived from cloned animals, and their progeny are entering the food supply. To establish the guidelines, the author suggests four principles of safety assessment for meat and milk derived from cloned animals. The four main principles for safety assessment are similarities of chemical composition, adverse reproductive effects, genotoxicity, and allergic reactions under the influence of meat and milk from cloned animals and noncloned counterparts. This principle means that meat and milk derived from a cloned animal are safe if there are no differences in the four safety assessments of meat and milk between cloned animal's progeny and noncloned counterparts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Superposition Quantification

    Science.gov (United States)

    Chang, Li-Na; Luo, Shun-Long; Sun, Yuan

    2017-11-01

    The principle of superposition is universal and lies at the heart of quantum theory. Although ever since the inception of quantum mechanics a century ago, superposition has occupied a central and pivotal place, rigorous and systematic studies of the quantification issue have attracted significant interests only in recent years, and many related problems remain to be investigated. In this work we introduce a figure of merit which quantifies superposition from an intuitive and direct perspective, investigate its fundamental properties, connect it to some coherence measures, illustrate it through several examples, and apply it to analyze wave-particle duality. Supported by Science Challenge Project under Grant No. TZ2016002, Laboratory of Computational Physics, Institute of Applied Physics and Computational Mathematics, Beijing, Key Laboratory of Random Complex Structures and Data Science, Chinese Academy of Sciences, Grant under No. 2008DP173182

  11. Personalized, assessment-based, and tiered medical education curriculum integrating treatment guidelines for atrial fibrillation.

    Science.gov (United States)

    Lee, Brian C; Ruiz-Cordell, Karyn D; Haimowitz, Steven M; Williams, Cara; Stambler, Bruce S; Mandarakas, Anthia

    2017-07-01

    This continuing medical education (CME) curriculum utilizes the Learner Assessment Platform (LAP), providing learners with personalized educational pathways related to atrial fibrillation treatment. There are improvements in knowledge among physician learners after CME, especially among LAP learners. In this LAP-based curriculum, an evaluation of learner deficits on designated learning objectives was conducted in tier 1 and used to direct learners to individualized tier 2 activities. Performance was assessed across learner tracks from baseline to learners' final intervention. Retention data were measured by the postcurriculum assessment, completed 8 weeks after the learners last intervention. Additionally, each activity included a unique matched set of pretest and post-test questions assessing the 4 learner domains: knowledge, competence, confidence, and practice patterns. Significant learner improvement was measured across the curriculum over all 4 learner-domains: 48% (P < 0.0005), 78% (P < 0.0005), 21% (P < 0.0005), and 20% (P < 0.0005) improvements for knowledge, competence, confidence, and practice, respectively. Significant gains in participant performance scores (28% increase, P < 0.0005) by the final activity was observed. Learners who participated in the LAP (N = 989) demonstrated greater improvement in performance from baseline compared to non-LAP learners (41% increase for LAP vs 23% and 26% increase for non-LAP learners who completed 1 (N = 1899) or ≥2 (N = 533) activities, respectively, P = 0.003). The participant population (N = 3421) achieved statistically significant improvement across the curriculum, with LAP learners showing greater performance gains compared to non-LAP learners. These findings support the value of the LAP methodology in providing a cumulative and individualized CME experience. © 2017 Wiley Periodicals, Inc.

  12. Guidelines for Exposure Assessment in Health Risk Studies Following a Nuclear Reactor Accident

    OpenAIRE

    Bouville, André; Linet, Martha S.; Hatch, Maureen; Mabuchi, Kiyohiko; Simon, Steven L.

    2013-01-01

    Background: Worldwide concerns regarding health effects after the Chernobyl and Fukushima nuclear power plant accidents indicate a clear need to identify short- and long-term health impacts that might result from accidents in the future. Fundamental to addressing this problem are reliable and accurate radiation dose estimates for the affected populations. The available guidance for activities following nuclear accidents is limited with regard to strategies for dose assessment in health risk s...

  13. Tri-Service Procedural Guidelines for Ecological Risk Assessments. Volume 1.

    Science.gov (United States)

    1996-05-01

    Acheta domesticus to acridine. Environ. Entomol. 9:18-20. B-93 Technique Name: Terrestrial Arthropods (non-insect) and isopods...US EPA 1982). Crickets and harvester ants have been used on a limited basis within an ecological effects assessment. Adult house crickets ( Acheta ... domesticus ) were exposed to acridine via the diet, and following 18-day exposures lethality and sublethal effects were determined. House crickets and

  14. Ethically sound technology? Guidelines for interactive ethical assessment of personal health monitoring.

    Science.gov (United States)

    Palm, Elin; Nordgren, Anders; Verweij, Marcel; Collste, Göran

    2013-01-01

    Novel care-technologies possess a transformational potential. Future care and support may be provided via monitoring technologies such as smart devices, sensors, actors (robots) and Information and Communication Technologies. Such technologies enable care provision outside traditional care institutions, for instance in the homes of patients. Health monitoring may become "personalized" i.e. tailored to the needs of individual care recipients' but may also alter relations between care providers and care recipents, shape and form the care environment and influence values central to health-care. Starting out from a social constructivist theory of technology, an interactive ethical assessment-model is offered. The suggested model supplements a traditional analysis based on normative ethical theory (top-down approach) with interviews including relevant stakeholders (a bottom-up approach). This method has been piloted by small-scale interviews encircling stakeholder perspectives on three emerging technologies: (1) Careousel, a smart medicine-management device, (2) Robot Giraff, an interactive and mobile communication-device and (3) I-Care, a care-software that combines alarm and register system. By incorporating stakeholder perspectives into the analysis, the interactive ethical assessment model provides a richer understanding of the impact of PHM-technologies on ethical values than a traditional top-down model. If the assessment is conducted before the technology has reached the market - preferably in close interaction with developers and users - ethically sound technologies may be obtained.

  15. Guidelines for Composing and Assessing a Paper on Treatment of Pain.

    Science.gov (United States)

    Bogduk, Nikolai; Kennedy, David J; Vorobeychik, Yakov; Engel, Andrew

    2017-11-01

    Authors, readers, and editors share a common focus. Authors want to publish their work. Readers want to see high-quality, new information. Referees and editors serve to ensure that authors provide valid conclusions based on the quality of information that readers want.Common to each of these roles are instructions to authors. However, these are typically written in an uninspiring, legalistic style, as if they are a set of rules that authors must obey if they expect to get published. This renders the instructions boring and oppressive, if not forbidding. Yet they need not be so, if they are set in context.Instructions to authors can be cast in a way as to reflect common purpose. They can remind authors what perceptive readers want to see in a paper and, thereby, prompt authors to include all necessary information. If cast in this way, instructions to authors are not a set of rules by which to satisfy publishers; they become guidelines for the etiquette of communication between authors and their readers.Against this background, the present article has been composed to serve several purposes. Foremost, it amplifies instructions to authors beyond the conventional technicalities such as headings, layout, font size, and line spacing. It prescribes the type of information that should be communicated and explains the reasons for those recommendations. Doing so not only informs authors about what to write, but also informs readers and referees about what to look for in a good paper. Secondarily, the article publicizes examples of errors and deficiencies of manuscripts submitted to the Journal in the past that have delayed their acceptance and publication, which could have been avoided had the forthcoming recommendations been followed. The recommendations also reprise the elements taught in courses conducted by the Spine Intervention Society in their extended program on evidence-based medicine. Doing so underscores that instructions for authors are not a procedural

  16. Can life-cycle assessment produce reliable policy guidelines in the building sector?

    Science.gov (United States)

    Säynäjoki, Antti; Heinonen, Jukka; Junnila, Seppo; Horvath, Arpad

    2017-01-01

    Life-cycle assessment (LCA) is an established methodology that can provide decision-makers with comprehensive data on the environmental impacts of products and processes during the entire life cycle. However, the literature on building LCAs consists of highly varying results between the studies, even when the assessed buildings are very similar. This makes it doubtful if LCA can actually produce reliable data for supporting policy-making in the building sector. However, no prior reviews looking into this issue in the building sector exist. This study includes an extensive literature review of LCA studies on the pre-use phase of buildings. The purpose of this study is to analyze the variation between the results of different studies and find out whether the differences can be explained by the contextual differences or if it is actually the methodological choices that cause the extremely high variation. We present 116 cases from 47 scientific articles and reports that used process LCA, input-output (IO) LCA or hybrid LCA to study the construction-phase GHG emissions of buildings. The results of the reviewed studies vary between 0.03 and 2.00 tons of GHG emissions per gross area. The lowest was assessed with process LCA and highest with IO LCA, and in general the lower end was found to be dominated by process LCA studies and the higher end by IO LCA studies, hybrid LCAs being placed in between. In general, it is the methodological issues and subjective choices of the LCA practitioner that cause the vast majority of the huge variance in the results. It thus seems that currently the published building LCAs do not offer solid background information for policy-making without deep understanding of the premises of a certain study and good methodological knowledge.

  17. Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency.

    Directory of Open Access Journals (Sweden)

    Caroline de Godoi Rezende Costa Molino

    Full Text Available Annually, non-communicable diseases (NCDs kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs.We conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II."Scope and purpose" and "clarity and presentation" domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all. After 2009, 2 domain scores ("rigor of development" and "clarity and presentation" increased (61% and 73%, respectively. However, "rigor of development" was still rated < 30%.Brazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients' preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors' conflict of

  18. Assessing the economic impact of Rx-to-OTC switches: systematic review and guidelines for future development.

    Science.gov (United States)

    Cohen, J; Millier, A; Karray, S; Toumi, M

    2013-01-01

    Switching drugs from prescription to non-prescription status (Rx-to-OTC) presents a unique set of challenges and opportunities to policy-makers and the industry in terms of managing health outcomes, pharmaceutical spending, and steering of consumer choices of therapy. Decision-analytic models are used to address uncertainty and produce reasonable estimates of the economic impact of switches for payers. This article presents a critical literature review of existing models which assess the economic impact of Rx-to-OTC switches, and provides guidelines in which future economic evaluations of Rx-to-OTC switches could be improved. A comprehensive search strategy was implemented in Medline and Embase, to retrieve published economic evaluations on Rx-to-OTC switches from 1995-2010. The research digest of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) was reviewed for potentially relevant abstracts for the past 3 years. Each model used was critically evaluated in terms of structure, relevance of inputs, methodology used, and robustness of results. Worldwide, the economic impact of Rx-to-OTC switches has only been evaluated in a total of 12 peer-reviewed publications. Ten out of 12 studies were US-based, and two European-based. The models covered various disease categories, including allergy, hypercholesterolemia, gastroenterology, contraception, pulmonology, and virology. Seventy-five per cent of the models predicted cost savings for payers and patients. Limitations of the models mainly included use of strong assumptions and non-inclusion of specific populations due to lack of data. Guidelines were developed to help future model development. They cover structural issues on decision context, health states, and clinical outcomes, and other considerations for model specifications. Although reviewed studies lacked quality, this review of economic evidence of Rx-to-OTC switches suggests that switches may produce cost savings to public and private

  19. Parasites as biological tags to assess host population structure: Guidelines, recent genetic advances and comments on a holistic approach☆

    Science.gov (United States)

    Catalano, Sarah R.; Whittington, Ian D.; Donnellan, Stephen C.; Gillanders, Bronwyn M.

    2013-01-01

    We review the use of parasites as biological tags of marine fishes and cephalopods in host population structure studies. The majority of the work published has focused on marine fish and either single parasite species or more recently, whole parasite assemblages, as biological tags. There is representation of host organisms and parasites from a diverse range of taxonomic groups, although focus has primarily been on host species of commercial importance. In contrast, few studies have used parasites as tags to assess cephalopod population structure, even though records of parasites infecting cephalopods are well-documented. Squid species are the only cephalopod hosts for which parasites as biological tags have been applied, with anisakid nematode larvae and metacestodes being the parasite taxa most frequently used. Following a brief insight into the importance of accurate parasite identification, the population studies that have used parasites as biological tags for marine fishes and cephalopods are reviewed, including comments on the dicyemid mesozoans. The advancement of molecular genetic techniques is discussed in regards to the new ways parasite genetic data can be incorporated into population structure studies, alongside host population genetic analyses, followed by an update on the guidelines for selecting a parasite species as a reliable tag candidate. As multiple techniques and methods can be used to assess the population structure of marine organisms (e.g. artificial tags, phenotypic characters, biometrics, life history, genetics, otolith microchemistry and parasitological data), we conclude by commenting on a holistic approach to allow for a deeper insight into population structuring. PMID:25197624

  20. Novel phase-based noise reduction strategy for quantification of left ventricular function and mass assessment by cardiac CT: comparison with cardiac magnetic resonance.

    Science.gov (United States)

    Wai, Bryan; Thai, Wai-Ee; Brown, Heather; Truong, Quynh A

    2013-08-01

    Tube current modulation in retrospective ECG gated cardiac computed tomography (CT) results in increased image noise and may reduce the accuracy of left ventricular (LV) ejection fraction (EF) and mass assessment. To examine the effects of a novel CT phase-based noise reduction (NR) algorithm on LV EF and mass quantification as compared to cardiac magnetic resonance (CMR). In 40 subjects, we compared the LV EF and mass between CT and CMR. In a subset of 24 subjects with tube current modulated CT, the effect of phase-based noise reduction strategies on contrast-to-noise ratio (CNR) and the assessment of LV EF and mass was compared to CMR. There was excellent correlation between CT and CMR for EF (r=0.94) and mass (r=0.97). As compared to CMR, the limits of agreement improved with increasing strength of NR strategy. There was a systematic underestimation of LV mass by CT compared to CMR with no NR (-10.3±10.1g) and low NR (-10.3±12.5g), but was attenuated with high NR (-0.5±8.3g). Studies without NR had lower CNR compared to low and high NR at both the ES phase and ED phase (all pstrategy on tube current modulated functional cardiac CT improves correlation of EF compared to CMR and reduces variability of EF and mass evaluation by increasing the CNR. In an effort to reduce radiation dose with tube current modulation, this strategy provides better image quality when LV function and mass quantification is needed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Diagnosis and assessment of dilated cardiomyopathy: a guideline protocol from the British Society of Echocardiography

    Directory of Open Access Journals (Sweden)

    Thomas Mathew

    2017-06-01

    Full Text Available Heart failure (HF is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approach to diagnosis and assessment of dilated cardiomyopathy that is aimed at the practising sonographer.

  2. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design

    NARCIS (Netherlands)

    Maas, M.J.M.; Dulmen, S.A. van; Sagasser, M.H.; Heerkens, Y.F.; Vleuten, C.P.M. van der; Nijhuis, M.W.; Wees, P.J. van der

    2015-01-01

    BACKGROUND: Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously

  3. The Crisis of Qualified Manpower for Criminal Justice: An Analytic Assessment with Guidelines for New Policy. Volume 1, Probation/Parole.

    Science.gov (United States)

    Piven, Herman; Alcabes, Abraham

    This study analyzed data on manpower problems and solutions in criminal justice with special reference to probation and parole. It provides guidelines for the development of a national policy regarding probation and parole manpower and training, which were established through systematic assessment of manpower shortages and standards, and of…

  4. A Review of School Readiness Practices in the States: Early Learning Guidelines and Assessments. Early Childhood Highlights. Volume 1, Issue 3

    Science.gov (United States)

    Daily, Sarah; Burkhauser, Mary; Halle, Tamara

    2010-01-01

    Research on the importance of the early childhood years has compelled states to support children's school readiness. This brief provides an overview of states' Early Learning Guidelines (ELGs) and school readiness assessments and outlines the following considerations: (1) School Readiness is more than Academics; (2) Align standards in appropriate…

  5. Quality Control Assessment of Human Immunodeficiency Virus Type 2 (HIV-2) Viral Load Quantification Assays: Results from an International Collaboration on HIV-2 Infection in 2006▿

    Science.gov (United States)

    Damond, Florence; Benard, Antoine; Ruelle, Jean; Alabi, Abraham; Kupfer, Bernd; Gomes, Perpetua; Rodes, Berta; Albert, Jan; Böni, Jürg; Garson, Jeremy; Ferns, Bridget; Matheron, Sophie; Chene, Geneviève; Brun-Vezinet, Françoise

    2008-01-01

    Human immunodeficiency virus type 2 (HIV-2) RNA quantification assays used in nine laboratories of the ACHIEV2E (A Collaboration on HIV-2 Infection) study group were evaluated. In a blinded experimental design, laboratories quantified three series of aliquots of an HIV-2 subtype A strain, each at a different theoretical viral load. Quantification varied between laboratories, and international standardization of quantification assays is strongly needed. PMID:18434556

  6. Proposal for a method aiming at the quantification of the impact of wood extraction in life cycle assessment

    NARCIS (Netherlands)

    Esser, P.M.; Voet, E. van der

    1998-01-01

    Life Cycle Assessment has been accepted as an instrument for the assessment of the environmental impact of products. Characterisation factors for impact assessment of emissions from products have been established. To date no characterisation factor exists for the extraction of biotic resources, for

  7. Validation of the MEDFICTS dietary questionnaire: A clinical tool to assess adherence to American Heart Association dietary fat intake guidelines

    Directory of Open Access Journals (Sweden)

    Bindeman Jody

    2003-06-01

    Full Text Available Abstract Background Dietary assessment tools are often too long, difficult to quantify, expensive to process, and largely used for research purposes. A rapid and accurate assessment of dietary fat intake is critically important in clinical decision-making regarding dietary advice for coronary risk reduction. We assessed the validity of the MEDFICTS (MF questionnaire, a brief instrument developed to assess fat intake according to the American Heart Association (AHA dietary "steps". Methods We surveyed 164 active-duty US Army personnel without known coronary artery disease at their intake interview for a primary prevention cardiac intervention trial using the Block food frequency (FFQ and MF questionnaires. Both surveys were completed on the same intake visit and independently scored. Correlations between each tools' assessment of fat intake, the agreement in AHA step categorization of dietary quality with each tool, and the test characteristics of the MF using the FFQ as the gold standard were assessed. Results Subjects consumed a mean of 36.0 ± 13.0% of their total calories as fat, which included saturated fat consumption of 13.0 ± 0.4%. The majority of subjects (125/164; 76.2% had a high fat (worse than AHA Step 1 diet. There were significant correlations between the MF and the FFQ for the intake of total fat (r = 0.52, P 70 [high fat diet] was negligible (kappa statistic = 0.036. The MF was accurate at the extremes of fat intake, but could not reliably identify the 3 AHA dietary classifications. Alternative MF cutpoints of 50 (high fat diet were highly sensitive (96%, but had low specificity (46% for a high fat diet. ROC curve analysis identified that a MF score cutoff of 38 provided optimal sensitivity 75% and specificity 72%, and had modest agreement (kappa = 0.39, P Conclusions The MEDFICTS questionnaire is most suitable as a tool to identify high fat diets, rather than discriminate AHA Step 1 and Step 2 diets. Currently recommended

  8. Assessment of possible allergenicity of hypothetical ORFs in common food crops using current bioinformatic guidelines and its implications for the safety assessment of GM crops.

    Science.gov (United States)

    Young, Gregory J; Zhang, Shiping; Mirsky, Henry P; Cressman, Robert F; Cong, Bin; Ladics, Gregory S; Zhong, Cathy X

    2012-10-01

    Before a genetically modified (GM) crop can be commercialized it must pass through a rigorous regulatory process to verify that it is safe for human and animal consumption, and to the environment. One particular area of focus is the potential introduction of a known or cross-reactive allergen not previously present within the crop. The assessment of possible allergenicity uses the guidelines outlined by the Food and Agriculture Organization (FAO) and World Health Organization's (WHO) Codex Alimentarius Commission (Codex) to evaluate all newly expressed proteins. Some regulatory authorities have broadened the scope of the assessment to include all DNA reading frames between stop codons across the insert and spanning the insert/genomic DNA junctions. To investigate the utility of this bioinformatic assessment, all naturally occurring stop-to-stop frames in the non-transgenic genomes of maize, rice, and soybean, as well as the human genome, were compared against the AllergenOnline (www.allergenonline.org) database using the Codex criteria. We discovered thousands of frames that exceeded the Codex defined threshold for potential cross-reactivity suggesting that evaluating hypothetical ORFs (stop-to-stop frames) has questionable value for making decisions on the safety of GM crops. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Effectiveness of automated quantification of pulmonary perfused blood volume using dual-energy CTPA for the severity assessment of acute pulmonary embolism.

    Science.gov (United States)

    Meinel, Felix G; Graef, Anita; Bamberg, Fabian; Thieme, Sven F; Schwarz, Florian; Sommer, Wieland H; Neurohr, Claus; Kupatt, Christian; Reiser, Maximilian F; Johnson, Thorsten R C

    2013-08-01

    The purpose of this study was to determine whether automated quantification of pulmonary perfused blood volume (PBV) in dual-energy computed tomography pulmonary angiography is of diagnostic value in assessing the severity of acute pulmonary embolism (PE). Ethical approval and informed consent were waived by the responsible institutional review board for this retrospective study. Of 224 consecutive patients with dual-energy computed tomography pulmonary angiographic findings positive for acute PE, we excluded 153 patients because of thoracic comorbidities (n = 130), missing data (n = 11), severe artifacts (n = 11), or inadequate enhancement (n = 1). Automated quantification of PBV was performed in the remaining 71 patients (mean [SD] age, 62 [16] years) with acute PE and no cardiopulmonary comorbidities. Perfused blood volume values adjusted for age and sex were correlated with the Qanadli obstruction score, morphological computed tomographic signs of right heart dysfunction, serum levels of troponin, and the necessity for intensive care unit (ICU) admission. Dual-energy computed tomography pulmonary angiography-derived PBV values inversely correlated with the Qanadli score (r = -0.46; P global PBV values lower than 60% were significantly more likely to require admission to an ICU than did the patients with global pulmonary PBV of 60% or higher (47% vs 11%; P = 0.003; positive predictive value, 47%; negative predictive value, 89%). On the univariate analysis, a significant negative correlation was found between the global PBV values and the Qanadli obstruction score (r = -0.46; P reader-independent estimation of global pulmonary PBV in acute PE, which inversely correlates with thrombus load, laboratory parameters of PE severity, and the necessity for ICU admission.

  10. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

    Directory of Open Access Journals (Sweden)

    Smith Patricia M

    2012-04-01

    Full Text Available Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269 via mail to the researchers. Results Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent Conclusions The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

  11. French good practice guidelines for management of the risk of low back pain among workers exposed to manual material handling: Hierarchical strategy of risk assessment of work situations.

    Science.gov (United States)

    Petit, Audrey; Mairiaux, Philippe; Desarmenien, Arnaud; Meyer, Jean-Pierre; Roquelaure, Yves

    2016-02-15

    Manual material handling remains a major cause of occupational accidents and diseases in various sectors and occupations. This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for the risk assessment for back disorders in workers exposed to manual handling of loads. The guidelines were written by a multidisciplinary working group of 24 experts, according to the Clinical Practice Guidelines method proposed by French National Health Authority, and reviewed by a multidisciplinary peer review committee of 50 experts. Recommendations were based on a large systematic review of the international literature carried out from 1990 to March 2012 and classified (Grade A, B, C or expert consensus) according to their level of evidence. The main recommendations are a three-level hierarchical method of risk assessment based on participatory ergonomics and suggested assessment tools that can be used routinely by professionals of occupational health, workers themselves and their supervisors. These French guidelines are intended for professionals of occupational health in charge of the prevention of low back disorders. The recommended methods are applicable to other countries than France.

  12. Unexplained developmental delay/learning disability: guidelines for best practice protocol for first line assessment and genetic/metabolic/radiological investigations.

    Science.gov (United States)

    O'Byrne, J J; Lynch, S A; Treacy, E P; King, M D; Betts, D R; Mayne, P D; Sharif, F

    2016-02-01

    Investigation of patients, particularly children, with unexplained global developmental delay (GDD)/learning disability (LD) has been challenging due to a lack of clear guidance from specialised centres. Limited knowledge of rare diseases and a poor understanding of the purpose or limitations of appropriate investigations have been some of the principal reasons for this difficulty. A guideline development group was formed to recommend on appropriate, first line metabolic, genetic and radiological investigations for children and adults with unexplained GDD/ID. A comprehensive literature search was conducted, evaluated and reviewed by the guideline committee and a best practice protocol for first line assessment and genetic, metabolic and radiological investigations was decided upon after considering diagnostic yield, practicality, treatability and costs. It is hoped that these recommendations will become national guidelines for the first line metabolic, genetic and radiological investigation of patients presenting with unexplained GDD/ID.

  13. Advancing agricultural greenhouse gas quantification*

    Science.gov (United States)

    Olander, Lydia; Wollenberg, Eva; Tubiello, Francesco; Herold, Martin

    2013-03-01

    , multiple development goals can be reinforced by specific climate funding granted on the basis of multiple benefits and synergies, for instance through currently negotiated mechanisms such as Nationally Appropriate Mitigation Actions (NAMAs) (REDD+, Kissinger et al 2012). 3. Challenges to quantifying GHG information for the agricultural sector The quantification of GHG emissions from agriculture is fundamental to identifying mitigation solutions that are consistent with the goals of achieving greater resilience in production systems, food security, and rural welfare. GHG emissions data are already needed for such varied purposes as guiding national planning for low-emissions development, generating and trading carbon credits, certifying sustainable agriculture practices, informing consumers' choices with regard to reducing their carbon footprints, assessing product supply chains, and supporting farmers in adopting less carbon-intensive farming practices. Demonstrating the robustness, feasibility, and cost effectiveness of agricultural GHG inventories and monitoring is a necessary technical foundation for including agriculture in the international negotiations under the United Nations Framework Convention on Climate Change (UNFCCC), and is needed to provide robust data and methodology platforms for global corporate supply-chain initiatives (e.g., SAFA, FAO 2012). Given such varied drivers for GHG reductions, there are a number of uses for agricultural GHG information, including (1) reporting and accounting at the national or company level, (2) land-use planning and management to achieve specific objectives, (3) monitoring and evaluating impact of management, (4) developing a credible and thus tradable offset credit, and (5) research and capacity development. The information needs for these uses is likely to differ in the required level of certainty, scale of analysis, and need for comparability across systems or repeatability over time, and they may depend on whether

  14. Native T1-mapping for non-contrast assessment of myocardial fibrosis in patients with hypertrophic cardiomyopathy--comparison with late enhancement quantification.

    Science.gov (United States)

    Małek, Łukasz A; Werys, Konrad; Kłopotowski, Mariusz; Śpiewak, Mateusz; Miłosz-Wieczorek, Barbara; Mazurkiewicz, Łukasz; Petryka-Mazurkiewicz, Joanna; Marczak, Magdalena; Witkowski, Adam

    2015-07-01

    Myocardial fibrosis was shown to influence prognosis in hypertrophic cardiomyopathy (HCM). It is typically assessed by late gadolinium enhancement (LGE) on cardiac magnetic resonance. Native T1-mapping has been proposed, as a contrast-free method of fibrosis assessment. The aim of the study was to define a cut-off value for native T1 relaxation time that best reflects LGE quantification of myocardial fibrosis. In 25 patients with HCM and 20 controls we performed T1-mapping pre-contrast using ShMOLLI technique. This was followed by LGE assessment in the studied group 10 minutes after gadolinium contrast injection. Relative myocardial fibrosis size was calculated for varying T1 time thresholds (940-1100 ms) and compared with 6 standard deviations (6SD) method for LGE. Median fibrosis size calculated with T1-mapping was insignificantly different from LGE only for native T1 time threshold of 1060 ms (p = 0.62). Using this threshold, Bland-Altman plots demonstrated very good agreement between fibrosis sizes from the two methods (slightly better only for 1080 ms threshold). For threshold of 1060 ms we also observed good correlation (rho = 0.73) with LGE 6SD method (insignificantly better for lower thresholds, best for threshold of 980 ms-rho = 0.88). In control group with no diagnosis of HCM, fibrosis size T1-mapping can be used for non-contrast assessment of myocardial fibrosis in HCM. The 1060 ms threshold of the native T1 relaxation time is characterized by the best balance between agreement and correlation with fibrosis assessed by LGE 6SD method. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. [Guidelines for the sociomedical assessment of performance in patients suffering from chronic non-malignant diseases of the liver and the bile ducts--for the Medical Assessment Services of the German Pension Fund].

    Science.gov (United States)

    Horn, S; Irle, H; Knorr, I; Pottins, I; Rohwetter, M; Schuhknecht, P; Timner, K; Becker, E

    2009-06-01

    The following guidelines were developed for the medical assessment services of the German pension fund. Starting from day-to-day practice, criteria and attributes to guide decisions for a systematisation of the sociomedical assessment of performance in diseases of the liver and the bile ducts were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent, e. g., for the assessment of applications for decreased earning capacity benefits. The guidelines summarise the typical manifestations of diseases of the liver and the bile ducts and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions, the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual. The guidelines followed from an extended procedure to attain a wide consensus in the setting of the German Pension Fund and an upgraded evidence base.

  16. Assessment of Adaptive Reuse of Heritage Shop Houses for Sleep Lodging in Malaysia: Fulfilment of Conservation Guidelines

    National Research Council Canada - National Science Library

    Othuman Mydin, M.A; Keling, N.A; Sani, N. Md; Abas, N.F

    2014-01-01

    This study focuses on the compliance of adaptive reuse of historic shop houses for sleep lodging with reference to the Guidelines for Conservation Areas and Heritage Buildings by Majlis Perbandaran Pulau Pinang (MPPP...

  17. Performance of a Condensed Protocol That Reduces Effort and Cost of NIA-AA Guidelines for Neuropathologic Assessment of Alzheimer Disease.

    Science.gov (United States)

    Flanagan, Margaret E; Marshall, Desiree A; Shofer, Jane B; Montine, Kathleen S; Nelson, Peter T; Montine, Thomas J; Keene, C Dirk

    2017-01-01

    Concerns regarding resource expenditures have been expressed about the 2012 NIA-AA Sponsored Guidelines for neuropathologic assessment of Alzheimer disease (AD) and related dementias. Here, we investigated a cost-reducing Condensed Protocol and its effectiveness in maintaining the diagnostic performance of Guidelines in assessing AD, Lewy body disease (LBD), microvascular brain injury, hippocampal sclerosis (HS), and congophilic amyloid angiopathy (CAA). The Condensed Protocol consolidates the same 20 regions into 5 tissue cassettes at ∼75% lower cost. A 28 autopsy brain-retrospective cohort was selected for varying levels of neuropathologic features in the Guidelines (Original Protocol), as well as an 18 consecutive autopsy brain prospective cohort. Three neuropathologists at 2 sites performed blinded evaluations of these cases. Lesion specificity was similar between Original and Condensed Protocols. Sensitivities for AD neuropathologic change, LBD, HS, and CAA were not substantially impacted by the Condensed Protocol, whereas sensitivity for microvascular lesions (MVLs) was decreased. Specificity for CAA was decreased using the Condensed Protocol when compared with the Original Protocol. Our results show that the Condensed Protocol is a viable alternative to the NIA-AA guidelines for AD neuropathologic change, LBD, and HS, but not MVLs or CAA, and may be a practical alternative in some practice settings. © 2017 American Association of Neuropathologists, Inc. All rights reserved.

  18. Dissolution test of herbal medicines containing Paullinia cupana: validation of methods for quantification and assessment of dissolution

    Directory of Open Access Journals (Sweden)

    Sandra Alves de Sousa

    2011-06-01

    Full Text Available "Guaraná" (Paullinia cupana is used as a physical activity enhancer and stimulator due to its methylxanthines and condensed tannins. The aim of this work was to evaluate the dissolution behavior of five herbal medicines in the form of capsules and tablets containing guaraná. Assay and dissolution methods were validated and results obtained allowed simultaneous marker quantification with precision, accuracy, selectivity and robustness. Findings showed that 100% of the herbal medicinal products analyzed did not provide satisfactory results concerning the presence of four markers, 60% had three markers (caffeine, catechin and epicatechin, while 40% had only caffeine at tested dosage forms. In addition, after 30 minutes, only capsule A showed at least 80% of the dissolved markers. In other capsules, marker dissolution did not exceed 60% whereas 60% of the samples had some characteristic pharmacotechnical problems. These results evidence the need for rigorous quality control to help ensure the therapeutic action of these drugs. To this end, dissolution studies are an essential tool for quality assurance of herbal medicines.Guaraná (Paullinia cupana é utilizado como revigorante e estimulante devido à presença de metilxantinas e taninos condensados. Este trabalho visou avaliar o comportamento de dissolução de cinco fitoterápicos, na forma de cápsulas e comprimidos, contendo guaraná. O método de quantificação e de dissolução foram validados e os resultados obtidos permitiram a quantificação dos marcadores simultaneamente, com precisão, exatidão, seletividade e robustez. Foi verificado que 100% dos fitoterápicos analisados encontravam em desacordo quanto à presença dos quatro marcadores, sendo que 60% apresentaram três marcadores (cafeína, catequina e epicatequina e 40% apresentaram somente a cafeína. Além disso, após o tempo de 30 minutos de ensaio foi possível observar que somente a cápsula A apresentou pelo menos 80% dos

  19. The effect of volume of interest definition on quantification of lymph node immune response to a monkeypox virus infection assessed by (18)F-FDG-PET.

    Science.gov (United States)

    Chefer, Svetlana; Reba, Richard C; Leyson, Christopher Z; Seidel, Jurgen; Johnson, Reed F; Blaney, Joseph E; Jahrling, Peter B; Dyall, Julie

    2014-12-01

    2-deoxy-2-[(18)F]fluoro-D-glucose-positron emission tomography ((18)F-FDG-PET) is applied in the clinic for infection assessment and is under consideration for investigating the inflammatory/immune response in lymphoid tissue in animal models of viral infection. Assessing changes in (18)F-FDG uptake of lymph nodes (LNs), primary lymphoid tissues targeted during viral infection, requires suitable methods for image analysis. Similar to tumor evaluation, reliable quantitation of the LN function via multiple (18)F-FDG-PET sessions will depend how the volume of interest is defined. Volume of interest definition has a direct effect on statistical outcome. The current study objective is to compare for the first time agreement between conventional and modified VOI metrics to determine which method(s) provide(s) reproducible standardized uptake values (SUVs) for (18)F-FDG uptake in the LN of rhesus macaques. Multiple (18)F-FDG-PET images of LNs in macaques were acquired prior to and after monkeypox virus intravenous inoculation. We compared five image analysis approaches, SUVmax, SUVmean, SUVthreshold, modified SUVthreshold, and SUVfixed volume, to investigate the impact of these approaches on quantification of the changes in LN metabolic activity denoting the immune response during viral infection progression. The lowest data repeatability was observed with SUVmax. The best correspondence was between SUVfixed volume and conventional and modified SUVthreshold. A statistically significant difference in the LN (18)F-FDG uptake between surviving and moribund animals was shown using modified SUVthreshold and SUVfixed volume (adjusted p = 0.0037 and p = 0.0001, respectively). Quantification of the LN (18)F-FDG uptake is highly sensitive to the method applied for PET image analysis. SUVfixed volume and modified SUVthreshold demonstrate better reproducibility for SUV estimates than SUVmax, SUVmean, and SUVthreshold. SUVfixed volume and modified SUVthreshold are capable of

  20. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment.

    Science.gov (United States)

    Smith, Patricia M; Sellick, Scott M; Spadoni, Michelle M

    2012-04-30

    This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269) via mail to the researchers. Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent benefits and motivation) encouraged nurses to intervene and work-related factors discouraged them (time and workloads). There were significant rural-urban differences--more rural nurses perceived intervening as part of their role, reported having more systems in place to support cessation, reported higher confidence for intervening, and more frequently assisted patients with quitting and arranged follow-up. The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

  1. Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Baade Peter

    2009-05-01

    Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

  2. Asthma control assessment in a pediatric population: comparison between GINA/NAEPP guidelines, Childhood Asthma Control Test (C-ACT), and physician's rating.

    Science.gov (United States)

    Deschildre, A; Pin, I; El Abd, K; Belmin-Larrar, S; El Mourad, S; Thumerelle, C; Le Roux, P; Langlois, C; de Blic, J

    2014-06-01

    Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P 21 were controlled and 85% of patients with a C-ACT < 17 not controlled. We observed discrepancies between the different tools applied to assess asthma control in children, and the impact of age and exacerbations. Cutoff point of 19 of C-ACT was not associated with the best performance compared to PA. Assessment of control should take into account symptoms and lung function as suggested by the latest GINA guidelines as well as exacerbation over a long period. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines.

    Science.gov (United States)

    Silva, Abigail; Rauscher, Garth H; Hoskins, Kent; Rao, Ruta; Ferrans, Carol Estwing

    2013-12-01

    Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.

  4. Assessment of groundwater contamination risk using hazard quantification, a modified DRASTIC model and groundwater value, Beijing Plain, China.

    Science.gov (United States)

    Wang, Junjie; He, Jiangtao; Chen, Honghan

    2012-08-15

    Groundwater contamination risk assessment is an effective tool for groundwater management. Most existing risk assessment methods only consider the basic contamination process based upon evaluations of hazards and aquifer vulnerability. In view of groundwater exploitation potentiality, including the value of contamination-threatened groundwater could provide relatively objective and targeted results to aid in decision making. This study describes a groundwater contamination risk assessment method that integrates hazards, intrinsic vulnerability and groundwater value. The hazard harmfulness was evaluated by quantifying contaminant properties and infiltrating contaminant load, the intrinsic aquifer vulnerability was evaluated using a modified DRASTIC model and the groundwater value was evaluated based on groundwater quality and aquifer storage. Two groundwater contamination risk maps were produced by combining the above factors: a basic risk map and a value-weighted risk map. The basic risk map was produced by overlaying the hazard map and the intrinsic vulnerability map. The value-weighted risk map was produced by overlaying the basic risk map and the groundwater value map. Relevant validation was completed by contaminant distributions and site investigation. Using Beijing Plain, China, as an example, thematic maps of the three factors and the two risks were generated. The thematic maps suggested that landfills, gas stations and oil depots, and industrial areas were the most harmful potential contamination sources. The western and northern parts of the plain were the most vulnerable areas and had the highest groundwater value. Additionally, both the basic and value-weighted risk classes in the western and northern parts of the plain were the highest, indicating that these regions should deserve the priority of concern. Thematic maps should be updated regularly because of the dynamic characteristics of hazards. Subjectivity and validation means in assessing the

  5. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines.

    Science.gov (United States)

    Rissanen, A; Lean, M; Rössner, S; Segal, K R; Sjöström, L

    2003-01-01

    To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss >/=2.5 kg during a 4 week dietary lead-in period, and weight losses of >/=5% after 12 weeks and >/=10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design. Twenty-nine centres throughout Europe. Two hundred and twenty men and women (BMI 28-43 kg/m(2)) who completed 2 years of treatment. After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two. Weight loss and obesity-related risk factor changes. Weight loss >/=5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of >/=2.5 kg during the 4 week lead-in and >/=10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost >/=5% of their weight at 12 weeks (n=104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P=0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved >/=5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose >/=10% body weight at 6 months compared with those who did not achieve >/=10% weight loss by month 6. Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of >/=5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2 years, while other suggested criteria are less useful.

  6. Evaluation and Quantification of Uncertainty in the Modeling of Contaminant Transport and Exposure Assessment at a Radioactive Waste Disposal Site

    Science.gov (United States)

    Tauxe, J.; Black, P.; Carilli, J.; Catlett, K.; Crowe, B.; Hooten, M.; Rawlinson, S.; Schuh, A.; Stockton, T.; Yucel, V.

    2002-12-01

    The disposal of low-level radioactive waste (LLW) in the United States (U.S.) is a highly regulated undertaking. The U.S. Department of Energy (DOE), itself a large generator of such wastes, requires a substantial amount of analysis and assessment before permitting disposal of LLW at its facilities. One of the requirements that must be met in assessing the performance of a disposal site and technology is that a Performance Assessment (PA) demonstrate "reasonable expectation" that certain performance objectives, such as dose to a hypothetical future receptor, not be exceeded. The phrase "reasonable expectation" implies recognition of uncertainty in the assessment process. In order for this uncertainty to be quantified and communicated to decision makers, the PA computer model must accept probabilistic (uncertain) input (parameter values) and produce results which reflect that uncertainty as it is propagated through the model calculations. The GoldSim modeling software was selected for the task due to its unique facility with both probabilistic analysis and radioactive contaminant transport. Probabilistic model parameters range from water content and other physical properties of alluvium to the activity of radionuclides disposed to the amount of time a future resident might be expected to spend tending a garden. Although these parameters govern processes which are defined in isolation as rather simple differential equations, the complex interaction of couple processes makes for a highly nonlinear system with often unanticipated results. The decision maker has the difficult job of evaluating the uncertainty of modeling results in the context of granting permission for LLW disposal. This job also involves the evaluation of alternatives, such as the selection of disposal technologies. Various scenarios can be evaluated in the model, so that the effects of, for example, using a thicker soil cap over the waste cell can be assessed. This ability to evaluate mitigation

  7. Rapid quantification of viable Campylobacter bacteria on chicken carcasses, using real-time PCR and propidium monoazide treatment, as a tool for quantitative risk assessment.

    Science.gov (United States)

    Josefsen, M H; Löfström, C; Hansen, T B; Christensen, L S; Olsen, J E; Hoorfar, J

    2010-08-01

    A number of intervention strategies against Campylobacter-contaminated poultry focus on postslaughter reduction of the number of cells, emphasizing the need for rapid and reliable quantitative detection of only viable Campylobacter bacteria. We present a new and rapid quantitative approach to the enumeration of food-borne Campylobacter bacteria that combines real-time quantitative PCR (Q-PCR) with simple propidium monoazide (PMA) sample treatment. In less than 3 h, this method generates a signal from only viable and viable but nonculturable (VBNC) Campylobacter bacteria with an intact membrane. The method's performance was evaluated by assessing the contributions to variability by individual chicken carcass rinse matrices, species of Campylobacter, and differences in efficiency of DNA extraction with differing cell inputs. The method was compared with culture-based enumeration on 50 naturally infected chickens. The cell contents correlated with cycle threshold (C(T)) values (R(2) = 0.993), with a quantification range of 1 x 10(2) to 1 x 10(7) CFU/ml. The correlation between the Campylobacter counts obtained by PMA-PCR and culture on naturally contaminated chickens was high (R(2) = 0.844). The amplification efficiency of the Q-PCR method was not affected by the chicken rinse matrix or by the species of Campylobacter. No Q-PCR signals were obtained from artificially inoculated chicken rinse when PMA sample treatment was applied. In conclusion, this study presents a rapid tool for producing reliable quantitative data on viable Campylobacter bacteria in chicken carcass rinse. The proposed method does not detect DNA from dead Campylobacter bacteria but recognizes the infectious potential of the VBNC state and is thereby able to assess the effect of control strategies and provide trustworthy data for risk assessment.

  8. Assessing the impact of the U.S. Endangered Species Act recovery planning guidelines on managing threats for listed species.

    Science.gov (United States)

    Troyer, Caitlin M; Gerber, Leah R

    2015-10-01

    The Endangered Species Act (ESA) of the United States was enacted in 1973 to prevent the extinction of species. Recovery plans, required by 1988 amendments to the ESA, play an important role in organizing these efforts to protect and recover species. To improve the use of science in the recovery planning process, the Society for Conservation Biology (SCB) commissioned an independent review of endangered species recovery planning in 1999. From these findings, the SCB made key recommendations for how management agencies could improve the recovery planning process, after which the U.S. Fish and Wildlife Service and the National Marine Fisheries Service redrafted their recovery planning guidelines. One important recommendation called for recovery plans to make threats a primary focus, including organizing and prioritizing recovery tasks for threat abatement. We sought to determine the extent to which results from the SCB study were incorporated into these new guidelines and whether the SCB recommendations regarding threats manifested in recovery plans written under the new guidelines. Recovery planning guidelines generally incorporated the SCB recommendations, including those for managing threats. However, although recent recovery plans have improved in their treatment of threats, many fail to adequately incorporate threat monitoring. This failure suggests that developing clear guidelines for monitoring should be an important priority in improving ESA recovery planning. © 2015 Society for Conservation Biology.

  9. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review.

    Science.gov (United States)

    Zeng, Xiantao; Zhang, Yonggang; Kwong, Joey S W; Zhang, Chao; Li, Sheng; Sun, Feng; Niu, Yuming; Du, Liang

    2015-02-01

    To systematically review the methodological assessment tools for pre-clinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline. We searched PubMed, the Cochrane Handbook for Systematic Reviews of Interventions, Joanna Briggs Institute (JBI) Reviewers Manual, Centre for Reviews and Dissemination, Critical Appraisal Skills Programme (CASP), Scottish Intercollegiate Guidelines Network (SIGN), and the National Institute for Clinical Excellence (NICE) up to May 20th, 2014. Two authors selected studies and extracted data; quantitative analysis was performed to summarize the characteristics of included tools. We included a total of 21 assessment tools for analysis. A number of tools were developed by academic organizations, and some were developed by only a small group of researchers. The JBI developed the highest number of methodological assessment tools, with CASP coming second. Tools for assessing the methodological quality of randomized controlled studies were most abundant. The Cochrane Collaboration's tool for assessing risk of bias is the best available tool for assessing RCTs. For cohort and case-control studies, we recommend the use of the Newcastle-Ottawa Scale. The Methodological Index for Non-Randomized Studies (MINORS) is an excellent tool for assessing non-randomized interventional studies, and the Agency for Healthcare Research and Quality (ARHQ) methodology checklist is applicable for cross-sectional studies. For diagnostic accuracy test studies, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool is recommended; the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk of bias tool is available for assessing animal studies; Assessment of Multiple Systematic Reviews (AMSTAR) is a measurement tool for systematic reviews/meta-analyses; an 18-item tool has been developed for appraising case series studies, and the Appraisal of Guidelines, Research and Evaluation (AGREE

  10. Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response

    Energy Technology Data Exchange (ETDEWEB)

    Baxa, Jan; Vondrakova, Alena; Matouskova, Tana; Ferda, Jiri [Charles University Teaching Hospital Plzen, Department of Imaging Methods, Plzen (Czech Republic); Ruzickova, Olga [Charles University Teaching Hospital Plzen, Department of Pulmonary Diseases, Plzen (Czech Republic); Schmidt, Bernhard; Flohr, Thomas; Sedlmair, Martin [Siemens Healthcare, CT Physics and Applications Development, Forchheim (Germany)

    2014-08-15

    To investigate the potential contribution of iodine uptake calculation from dual-phase dual-energy CT (DE-CT) for lymph node staging and therapy response monitoring in lung cancer patients. Retrospective analysis of 27 patients with non-small cell lung carcinoma (NSCLC), who underwent dual-phase DE-CT before and after chemotherapy, was performed. Iodine uptake (mg/mL) and total iodine uptake (mg) were calculated using prototype software in the early (arterial) and late (venous) post-contrast circulatory phase in 110 mediastinal lymph nodes. The arterial enhancement fraction (AEF) was calculated and compared with lymph node size and response to chemotherapy. A significant difference of AEF was observed between enlarged (90.4 %; 32.3-238.5 %) and non-enlarged (72.7 %; -37.5-237.5 %) lymph nodes (p = 0.044) before treatment onset. A significantly different change of AEF in responding (decrease of 26.3 %; p = 0.022) and non-responding (increase of 43.0 %; p = 0.031) lymph nodes was demonstrated. A higher value of AEF before treatment was observed in lymph nodes with subsequent favourable response (88.6 % vs. 77.7 %; p = 0.122), but this difference did not reach statistical significance. The dual-phase DE-CT examination with quantification of ratio of early and late post-contrast iodine uptake is a feasible and promising method for the functional evaluation of mediastinal lymph nodes including therapy response assessment. (orig.)

  11. The fish sexual development test: an OECD test guideline proposal with possible relevance for environmental risk assessment. Results from the validation programme

    DEFF Research Database (Denmark)

    Holbech, Henrik; Brande-Lavridsen, Nanna; Kinnberg, Karin Lund

    2010-01-01

    The Fish Sexual Development Test (FSDT) has gone through two validations as an OECD test guideline for the detection of endocrine active chemicals with different modes of action. The validation has been finalized on four species: Zebrafish (Danio rerio), Japanese medaka (Oryzias latipes), three...... as a population relevant endpoint and the results of the two validation rounds will be discussed in relation to environmental risk assessment and species selection....

  12. ASVCP quality assurance guidelines: external quality assessment and comparative testing for reference and in-clinic laboratories.

    Science.gov (United States)

    Camus, Melinda S; Flatland, Bente; Freeman, Kathleen P; Cruz Cardona, Janice A

    2015-12-01

    The purpose of this document is to educate providers of veterinary laboratory diagnostic testing in any setting about comparative testing. These guidelines will define, explain, and illustrate the importance of a multi-faceted laboratory quality management program which includes comparative testing. The guidelines will provide suggestions for implementation of such testing, including which samples should be tested, frequency of testing, and recommendations for result interpretation. Examples and a list of vendors and manufacturers supplying control materials and services to veterinary laboratories are also included. © 2015 American Society for Veterinary Clinical Pathology.

  13. The "bioeffect assessment index" (BAI). A concept for the quantification of effects of marine pollution by an integrated biomarker approach.

    Science.gov (United States)

    Broeg, K; Westernhagen, H V; Zander, S; Körting, W; Koehler, A

    2005-05-01

    The "bioeffect assessment index" (BAI) is based on the integration of several pathological endpoints measured in the liver of European flounder (Platichthys flesus (L.)) during a long term study of biological effects of pollution in the German Bight. The BAI represents a modification of the "health assessment index" since it includes solely validated biomarkers reflecting toxically induced alterations at different levels of biological organisation in order to quantify the effects of environmental pollution. The concept of the BAI is based on the observation of progressive deleterious effects from early responses to late effects. Specific "key events" were detected, representing progressive stages of functional deterioration. The biomarkers selected from a whole battery of cellular markers for the BAI calculation reflect deleterious effects of various classes of contaminants such as heavy metals, organochlorines, pesticides, PAHs, and therefore reflect general toxicity in an integrative manner. Selected biomarkers were: lysosomal perturbations (reduced membrane stability), storage disorders (lipid accumulation) as early markers for toxic effects of liver cells, and the size of macrophage aggregates and their acid phosphatase activity. The latter two markers are indicative for the modulation of non-specific immune response which represents longer time scale responses after chronic exposure.

  14. Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation.

    Directory of Open Access Journals (Sweden)

    Antonino Di Franco

    Full Text Available Ischemic mitral regurgitation (iMR predisposes to right ventricular (RV pressure and volume overload, providing a nidus for RV dysfunction (RVDYS and non-ischemic fibrosis (NIF. Echocardiography (echo is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown.iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S', fractional area change [FAC], and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS] and parasternal long axis orientation (transverse strain. CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI and septal NIF.73 iMR patients were studied; 36% had RVDYS (EF<50% on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05. CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73 and lowest for RV-S' (r = 0.43; all p<0.001. RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001. Whereas all RV indices were lower among NIF-affected patients (all p≤0.006, percent change was largest for transverse strain (48.3%. CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001 and transverse strain (r = 0.38, p = 0.002 (R = 0.78, p<0.001. Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87-0.99]|0.91[0.84-0.99], both p<0.001, and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively.Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR.

  15. A Systematic Review of Ebola Treatment Trials to Assess the Extent to Which They Adhere to Ethical Guidelines.

    Science.gov (United States)

    Richardson, Thomas; Johnston, Andrew McDonald; Draper, Heather

    2017-01-01

    base for its effectiveness against Ebola is speculative. Some limited and appropriate deviation from standard research expectations in disaster situations is increasingly accepted. However, this is not an excuse for poor ethics oversight and international regulations are in place which should not be ignored. New guidelines are needed that better define the boundaries between using medicines for compassionate use and conducting a clinical trial. Greater support should be offered for local research ethics committees in affected areas so that they can provide robust ethical review. Further systematic reviews should be carried out in epidemics of any novel infectious diseases to assess if comparable findings arise.

  16. A Systematic Review of Ebola Treatment Trials to Assess the Extent to Which They Adhere to Ethical Guidelines.

    Directory of Open Access Journals (Sweden)

    Thomas Richardson

    pre-trial evidence base for its effectiveness against Ebola is speculative.Some limited and appropriate deviation from standard research expectations in disaster situations is increasingly accepted. However, this is not an excuse for poor ethics oversight and international regulations are in place which should not be ignored. New guidelines are needed that better define the boundaries between using medicines for compassionate use and conducting a clinical trial. Greater support should be offered for local research ethics committees in affected areas so that they can provide robust ethical review. Further systematic reviews should be carried out in epidemics of any novel infectious diseases to assess if comparable findings arise.

  17. On-line quantification and human health risk assessment of organic by-products from the removal of toluene in air using non-thermal plasma.

    Science.gov (United States)

    Guo, Teng; Li, Xueshuang; Li, Jianquan; Peng, Zhen; Xu, Li; Dong, Junguo; Cheng, Ping; Zhou, Zhen

    2018-03-01

    Harmful organic by-products, produced during the removal of volatile organic compounds (VOCs) from the air by treatment with non-thermal plasma (NTP), hinder the practical applications of NTP. An on-line quantification and risk assessment method for the organic by-products produced by the NTP removal of toluene from the air has been developed. Formaldehyde, methanol, ketene, acetaldehyde, formic acid, acetone, acetic acid, benzene, benzaldehyde, and benzoic acid were determined to be the main organic by-products by proton transfer reaction mass spectrometry (PTR-MS), a powerful technique for real-time and on-line measurements of trace levels of VOCs, and a health-related index (HRI) was introduced to assess the health risk of these organic by-products. The discharge power (P) is a key factor affecting the formation of the organic by-products and their HRI values. Higher P leads to a higher removal efficiency (η) and lower HRI. However, higher P also means higher cost and greater production of discharge by-products, such as NO x and O 3 , which are also very dangerous to the environment and human health. In practical applications P, HRI, and η must be balanced, and sometimes the risks posed by the organic by-products are even greater than those of the removed compounds. Our mechanistic study reveals that acetone is a crucial intermediate for the removal of toluene by NTP, and we found that toluene molecules first fragment into acetone molecules, followed by other by-products. These observations will guide the study of the mechanism of aromatic molecule dissociation in plasma. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders

    Directory of Open Access Journals (Sweden)

    Mairead C. Cardamone-Breen

    2017-09-01

    Full Text Available Background Despite substantial evidence demonstrating numerous parental risk and protective factors for the development of adolescent depression and anxiety disorders, there is currently no single measure that assesses these parenting factors. To address this gap, we developed the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS as a criterion-referenced measure of parental concordance with a set of evidence-based parenting guidelines for the prevention of adolescent depression and anxiety disorders. In this paper, we used a sample of Australian parents of adolescents to: (1 validate the PRADAS as a criterion-referenced measure; (2 examine parental concordance with the guidelines in the sample; and (3 examine correlates of parental concordance with the guidelines. Methods Seven hundred eleven parents completed the PRADAS, as well as two established parenting measures, and parent-report measures of adolescent depression and anxiety symptoms. Six hundred sixty adolescent participants (aged 12–15 also completed the symptom measures. Concordance with the guidelines was assessed via nine subscale scores and a total score. Reliability of the scores was assessed with an estimate of the agreement coefficient, as well as 1-month test-retest reliability. Convergent validity was examined via correlations between the scale and two established parenting measures. Results One proposed subscale was removed from the final version of the scale, resulting in a total of eight subscales. Reliability was high for the total score, and acceptable to high for seven of the eight subscales. One-month test-retest reliability was acceptable to high for the total score. Convergent validity was supported by moderate to high correlations with two established measures of parenting. Overall, rates of parental concordance with the guidelines were low in our sample. Higher scores were associated with being female and higher levels of parental education

  19. The Parenting to Reduce Adolescent Depression and Anxiety Scale: Assessing parental concordance with parenting guidelines for the prevention of adolescent depression and anxiety disorders.

    Science.gov (United States)

    Cardamone-Breen, Mairead C; Jorm, Anthony F; Lawrence, Katherine A; Mackinnon, Andrew J; Yap, Marie B H

    2017-01-01

    Despite substantial evidence demonstrating numerous parental risk and protective factors for the development of adolescent depression and anxiety disorders, there is currently no single measure that assesses these parenting factors. To address this gap, we developed the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS) as a criterion-referenced measure of parental concordance with a set of evidence-based parenting guidelines for the prevention of adolescent depression and anxiety disorders. In this paper, we used a sample of Australian parents of adolescents to: (1) validate the PRADAS as a criterion-referenced measure; (2) examine parental concordance with the guidelines in the sample; and (3) examine correlates of parental concordance with the guidelines. Seven hundred eleven parents completed the PRADAS, as well as two established parenting measures, and parent-report measures of adolescent depression and anxiety symptoms. Six hundred sixty adolescent participants (aged 12-15) also completed the symptom measures. Concordance with the guidelines was assessed via nine subscale scores and a total score. Reliability of the scores was assessed with an estimate of the agreement coefficient, as well as 1-month test-retest reliability. Convergent validity was examined via correlations between the scale and two established parenting measures. One proposed subscale was removed from the final version of the scale, resulting in a total of eight subscales. Reliability was high for the total score, and acceptable to high for seven of the eight subscales. One-month test-retest reliability was acceptable to high for the total score. Convergent validity was supported by moderate to high correlations with two established measures of parenting. Overall, rates of parental concordance with the guidelines were low in our sample. Higher scores were associated with being female and higher levels of parental education. Greater parental concordance with the guidelines

  20. International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 1. pH

    Science.gov (United States)

    Stefaniak, Aleksandr B; du Plessis, Johan; John, Swen M; Eloff, Fritz; Agner, Tove; Chou, Tzu-Chieh; Nixon, Rosemary; Steiner, Markus F C; Kudla, Irena; Holness, D Linn

    2013-01-01

    Background Skin surface pH is known to influence the dissolution and partitioning of chemicals and may influence exposures that lead to skin diseases. Non-clinical environments (e.g. workplaces) are highly variable, thereby presenting unique measurement challenges that are not typically encountered in clinical settings. Hence, guidelines are needed for consistent measurement of skin surface pH in environments that are difficult to control. Methods An expert workshop was convened at the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals to review available data on factors that could influence the determination of skin surface pH in non-clinical settings with emphasis on the workplace as a worst case scenario. Results The key elements of the guidelines are: (i) minimize, to the extent feasible, the influences of relevant endogenous (anatomical position, skin health, time of day), exogenous (hand washing, barrier creams, soaps and detergents, occlusion), environmental (seasonality), and measurement (atmospheric conditions) factors; (ii) report pH measurements results as a difference or percent change (not absolute values) using a measure of central tendency and variability; and (iii) report notable deviations from these guidelines and other relevant factors that may influence measurements. Conclusion Guidelines on the measurement and reporting of skin surface pH in non-clinical settings should promote consistency in data reporting, facilitate inter-comparison of study results, and aid in understanding and preventing occupational skin diseases. PMID:23279097

  1. Developing search strategies for clinical practice guidelines in SUMSearch and Google Scholar and assessing their retrieval performance

    Directory of Open Access Journals (Sweden)

    Kirchner Hanna

    2007-06-01

    Full Text Available Abstract Background Information overload, increasing time constraints, and inappropriate search strategies complicate the detection of clinical practice guidelines (CPGs. The aim of this study was to provide clinicians with recommendations for search strategies to efficiently identify relevant CPGs in SUMSearch and Google Scholar. Methods We compared the retrieval efficiency (retrieval performance of search strategies to identify CPGs in SUMSearch and Google Scholar. For this purpose, a two-term GLAD (GuideLine And Disease strategy was developed, combining a defined CPG term with a specific disease term (MeSH term. We used three different CPG terms and nine MeSH terms for nine selected diseases to identify the most efficient GLAD strategy for each search engine. The retrievals for the nine diseases were pooled. To compare GLAD strategies, we used a manual review of all retrievals as a reference standard. The CPGs detected had to fulfil predefined criteria, e.g., the inclusion of therapeutic recommendations. Retrieval performance was evaluated by calculating so-called diagnostic parameters (sensitivity, specificity, and "Number Needed to Read" [NNR] for search strategies. Results The search yielded a total of 2830 retrievals; 987 (34.9% in Google Scholar and 1843 (65.1% in SUMSearch. Altogether, we found 119 unique and relevant guidelines for nine diseases (reference standard. Overall, the GLAD strategies showed a better retrieval performance in SUMSearch than in Google Scholar. The performance pattern between search engines was similar: search strategies including the term "guideline" yielded the highest sensitivity (SUMSearch: 81.5%; Google Scholar: 31.9%, and search strategies including the term "practice guideline" yielded the highest specificity (SUMSearch: 89.5%; Google Scholar: 95.7%, and the lowest NNR (SUMSearch: 7.0; Google Scholar: 9.3. Conclusion SUMSearch is a useful tool to swiftly gain an overview of available CPGs. Its retrieval

  2. Quality assessment of raw and processed Arctium lappa L. through multicomponent quantification, chromatographic fingerprint, and related chemometric analysis.

    Science.gov (United States)

    Qin, Kunming; Wang, Bin; Li, Weidong; Cai, Hao; Chen, Danni; Liu, Xiao; Yin, Fangzhou; Cai, Baochang

    2015-05-01

    In traditional Chinese medicine, raw and processed herbs are used to treat different diseases. Suitable quality assessment methods are crucial for the discrimination between raw and processed herbs. The dried fruit of Arctium lappa L. and their processed products are widely used in traditional Chinese medicine, yet their therapeutic effects are different. In this study, a novel strategy using high-performance liquid chromatography and diode array detection coupled with multivariate statistical analysis to rapidly explore raw and processed Arctium lappa L. was proposed and validated. Four main components in a total of 30 batches of raw and processed Fructus Arctii samples were analyzed, and ten characteristic peaks were identified in the fingerprint common pattern. Furthermore, similarity evaluation, principal component analysis, and hierachical cluster analysis were applied to demonstrate the distinction. The results suggested that the relative amounts of the chemical components of raw and processed Fructus Arctii samples are different. This new method has been successfully applied to detect the raw and processed Fructus Arctii in marketed herbal medicinal products. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Early Results in Flow Diverter Sizing by Computational Simulation: Quantification of Size Change and Simulation Error Assessment.

    Science.gov (United States)

    Narata, Ana Paula; Blasco, Jordi; Roman, Luis San; Macho, Juan Miguel; Fernandez, Hector; Moyano, Raquel Kale; Winzenrieth, Renaud; Larrabide, Ignacio

    2018-01-17

    Sizing of flow diverters (FDs) stent in the treatment of intracranial aneurysms is a challenging task due to the change of stent length after implantation. To quantify the size change and assess the error in length prediction in 82 simulated FD deployments. Eighty-two consecutive patients treated with FDs were retrospectively analyzed. Implanted FD length was measured from angiographic images and compared to the nominal sizes of the implanted device. Length change was obtained by subtracting the nominal length from the real length and dividing by the nominal length. Implanted devices were simulated on 3-dimensional models of each patient. Simulation error was obtained by subtracting real length from simulated length and dividing by the real length of the FD. Subanalysis was done using ANOVA. Statistical significance was set to P simulation results showed a lower error of 3.52% in average with a maximum of 30%. Paired t-test showed nonsignificant differences between measured and real length (P = .07, with the mean of differences at 0.45 mm, 95% confidence interval [-0.950 0.038]). Nominal length is not an accurate sizing metric when choosing the size of an FD irrespective of the brand and manufacturer. Good estimation of the final length of the stent after deployment as expressed by an error of 3.5% in average.

  4. Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance.

    Science.gov (United States)

    Gweon, Hye Mi; Youk, Ji Hyun; Son, Eun Ju; Kim, Jeong-Ah

    2013-03-01

    To determine whether colour overlay features can be quantified by the standard deviation (SD) of the elasticity measured in shear-wave elastography (SWE) and to evaluate the diagnostic performance for breast masses. One hundred thirty-three breast lesions in 119 consecutive women who underwent SWE before US-guided core needle biopsy or surgical excision were analysed. SWE colour overlay features were assessed using two different colour overlay pattern classifications. Quantitative SD of the elasticity value was measured with the region of interest including the whole breast lesion. For the four-colour overlay pattern, the area under the ROC curve (Az) was 0.947; with a cutoff point between pattern 2 and 3, sensitivity and specificity were 94.4 % and 81.4 %. According to the homogeneity of the elasticity, the Az was 0.887; with a cutoff point between reasonably homogeneous and heterogeneous, sensitivity and specificity were 86.1 % and 82.5 %. For the SD of the elasticity, the Az was 0.944; with a cutoff point of 12.1, sensitivity and specificity were 88.9 % and 89.7 %. The colour overlay features showed significant correlations with the quantitative SD of the elasticity (P colour overlay features and the SD of the elasticity in SWE showed excellent diagnostic performance and showed good correlations between them.

  5. A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

    Science.gov (United States)

    Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

    2017-02-01

    The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision

  6. Disease quantification in dermatology

    DEFF Research Database (Denmark)

    Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B E

    2013-01-01

    Accurate documentation of disease severity is a prerequisite for clinical research and the practice of evidence-based medicine. The quantification of skin diseases such as psoriasis currently relies heavily on clinical scores. Although these clinical scoring methods are well established and very...... useful in quantifying disease severity, they require an extensive clinical experience and carry a risk of subjectivity. We explore the opportunity to use in vivo near-infrared (NIR) spectra as an objective and noninvasive method for local disease severity assessment in 31 psoriasis patients in whom...... selected plaques were scored clinically. A partial least squares (PLS) regression model was used to analyze and predict the severity scores on the NIR spectra of psoriatic and uninvolved skin. The correlation between predicted and clinically assigned scores was R=0.94 (RMSE=0.96), suggesting that in vivo...

  7. Clinical validation and assessment of a modular fluorescent imaging system and algorithm for rapid detection and quantification of dental plaque.

    Science.gov (United States)

    Angelino, Keith; Shah, Pratik; Edlund, David A; Mohit, Mrinal; Yauney, Gregory

    2017-12-28

    Significant numbers of adults and children have untreated plaque due to poor oral hygiene and consequently suffer from associate dental and systemic diseases. A handheld device equipped with 405 nm light-emitting diodes was constructed to examine the prevalence of red fluorescence signatures associated with dental plaque. This device was used for in vivo imaging of all four incisors and all four canines of twenty-eight consenting human subjects. The same areas were further imaged under white light illumination with a commercial image-processing based plaque-imaging device, and evaluated by a hygienist and dentist. A custom computer vision algorithm using pixel information was developed to calculate plaque coverage ratios ranging from 0 (no plaque) to 1 (complete plaque coverage) for images captured by both devices. The algorithm calculated red fluorescence-based plaque coverage ratios ranging from 0.011 to 0.211 for the subjects imaged. Clinical assessment and statistical analyses of associated plaque ratios of the 405 nm device images indicated high sensitivity and specificity in detecting dental plaque by the experimental device compared to the commercial reference device. The low-cost and open source 405 nm device and the associated computer vision algorithm successfully captured red fluorescence signatures associated with dental plaque and demonstrated comparable performance to a commercially available device. Therefore, a proof of concept validation was provided for the construction and application of a sensitive cost-effective plaque-detecting device. A miniaturized mobile adaptable version of the device was also provided, together with and a step-by-step guide for device assembly and webhost the associated software, to facilitate open-source access to a cost-effective at-home, in-clinic oral care technology. ClinicalTrials.gov NCT03379337, December 19 2017. Retrospectively registered.

  8. [Real-time 3D echocardiography for estimation of severity in valvular heart disease : Impact on current guidelines].

    Science.gov (United States)

    Buck, T; Bösche, L; Plicht, B

    2017-05-01

    Besides providing spatial anatomic information on heart valves, real-time three-dimensional echocardiography (3DE) combined with color Doppler has the potential to overcome the limitations of flow quantification inherent to conventional 2D color Doppler methods. Recent studies validated the application of color Doppler 3DE (cD-3DE) for the quantification of regurgitation flow based on the vena contracta area (VCA) and the proximal isovelocity surface area (PISA) methods. Particularly the assessment of VCA by cD-3DE led to a change of paradigm by understanding of the VCA as being strongly asymmetric in the majority of patients and etiologies. This review provides a comprehensive description of the different concepts of cD-3DE-based flow quantification in the setting of different valvular heart diseases and their presentation in recent guidelines.

  9. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

    OpenAIRE

    Smith Patricia M; Sellick Scott M; Spadoni Michelle M

    2012-01-01

    Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by n...

  10. Guideline of guidelines: kidney stones.

    Science.gov (United States)

    Ziemba, Justin B; Matlaga, Brian R

    2015-08-01

    Several professional organizations have developed evidence-based guidelines for the initial evaluation, diagnostic imaging selection, symptomatic management, surgical treatment, medical therapy, and prevention of recurrence for both ureteric and renal stones. The purpose of this article is to summarize these guidelines with reference to the strength of evidence. All guidelines endorse an initial evaluation to exclude concomitant infection, imaging with a non-contrast computed tomography scan, and consideration of medical expulsive therapy or surgical intervention depending on stone size and location. Recommends for metabolic evaluation vary by guideline, but all endorse increasing fluid intake to reduce the risk of recurrence. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  11. Assessment of Practice Patterns Following Publication of the SSO–ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer

    Science.gov (United States)

    DeSnyder, Sarah M.; Hunt, Kelly K.; Smith, Benjamin D.; Moran, Meena S.; Klimberg, Suzanne; Lucci, Anthony

    2015-01-01

    Background The recently published SSO–ASTRO consensus guideline on margins concluded “no ink on tumor” is the standard for an adequate margin. This study was conducted to determine how this guideline is aligned with current clinical practice. Methods A survey was sent to 3057 members of the American Society of Breast Surgeons. Questions assessed respondents’ clinical practice type and duration, familiarity with the guideline, and preferences for margin re-excision. Results Of those surveyed, 777 (25 %) responded. Most (92 %) indicated familiarity with the guideline. Of these respondents, the majority (n = 678, or 94.7 %) would re-excise all or most of the time when tumor extended to the inked margin. Very few (n = 9, or 1.3 %) would re-excise all or most of the time when tumor was within 2 mm of the margin. Over 12 % (n = 90) would re-excise all or most of the time for a triple-negative tumor within 1 mm of the margin, whereas 353 (49.6 %) would re-excise all or most of the time when imaging and pathology were discordant, and tumor was within 1 mm of multiple margins. Finally, 330 (45.8 %) would re-excise all or most of the time when multiple foci of ductal carcinoma in situ extended to within 1 mm of multiple inked margins. Conclusions Surgeons are in agreement to re-excise margins when tumor touches ink and generally not to perform re-excisions when tumor is close to (but not touching) the inked margin. For more complex scenarios, surgeons are utilizing their individual clinical judgment to determine the need for re-excision. PMID:26202554

  12. Assessment of Practice Patterns Following Publication of the SSO-ASTRO Consensus Guideline on Margins for Breast-Conserving Therapy in Stage I and II Invasive Breast Cancer.

    Science.gov (United States)

    DeSnyder, Sarah M; Hunt, Kelly K; Smith, Benjamin D; Moran, Meena S; Klimberg, Suzanne; Lucci, Anthony

    2015-10-01

    The recently published SSO-ASTRO consensus guideline on margins concluded "no ink on tumor" is the standard for an adequate margin. This study was conducted to determine how this guideline is aligned with current clinical practice. A survey was sent to 3057 members of the American Society of Breast Surgeons. Questions assessed respondents' clinical practice type and duration, familiarity with the guideline, and preferences for margin re-excision. Of those surveyed, 777 (25%) responded. Most (92%) indicated familiarity with the guideline. Of these respondents, the majority (n = 678, or 94.7%) would re-excise all or most of the time when tumor extended to the inked margin. Very few (n = 9, or 1.3%) would re-excise all or most of the time when tumor was within 2 mm of the margin. Over 12 % (n = 90) would re-excise all or most of the time for a triple-negative tumor within 1 mm of the margin, whereas 353 (49.6%) would re-excise all or most of the time when imaging and pathology were discordant, and tumor was within 1 mm of multiple margins. Finally, 330 (45.8%) would re-excise all or most of the time when multiple foci of ductal carcinoma in situ extended to within 1 mm of multiple inked margins. Surgeons are in agreement to re-excise margins when tumor touches ink and generally not to perform re-excisions when tumor is close to (but not touching) the inked margin. For more complex scenarios, surgeons are utilizing their individual clinical judgment to determine the need for re-excision.

  13. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design.

    Science.gov (United States)

    Maas, Marjo J M; van Dulmen, Simone A; Sagasser, Margaretha H; Heerkens, Yvonne F; van der Vleuten, Cees P M; Nijhuis-van der Sanden, Maria W G; van der Wees, Philip J

    2015-11-12

    Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in

  14. Application of sediment quality guidelines in the assessment and management of contaminated surficial sediments in Port Jackson (Sydney Harbour), Australia.

    Science.gov (United States)

    Birch, Gavin F; Taylor, Stuart E

    2002-06-01

    Sediments in the Port Jackson estuary are polluted by a wide range of toxicants and concentrations are among the highest reported for any major harbor in the world. Sediment quality guidelines (SQGs), developed by the National Oceanographic and Atmospheric Administration (NOAA) in the United States are used to estimate possible adverse biological effects of sedimentary contaminants in Port Jackson to benthic animals. The NOAA guidelines indicate that Pb, Zn, DDD, and DDE are the most likely contaminants to cause adverse biological effects in Port Jackson. On an individual chemical basis, the detrimental effects due to these toxicants may occur over extensive areas of the harbor, i.e., about 40%, 30%, 15% and 50%, respectively. The NOAA SQGs can also be used to estimate the probability of sediment toxicity for contaminant mixtures by determining the number of contaminants exceeding an upper guideline value (effects range medium, or ERM), which predicts probable adverse biological effects. The exceedence approach is used in the current study to estimate the probability of sediment toxicity and to prioritize the harbour in terms of possible adverse effects on sediment-dwelling animals. Approximately 1% of the harbor is mantled with sediment containing more than ten contaminants exceeding their respective ERM concentrations and, based on NOAA data, these sediments have an 80% probability of being toxic. Sediment with six to ten contaminants exceeding their respective ERM guidelines extend over approximately 4% of the harbor and have a 57% probability of toxicity. These areas are located in the landward reaches of embayments in the upper and central harbor in proximity to the most industrialised and urbanized part of the catchment. Sediment in a further 17% of the harbor has between one and five exceedences and has a 32% probability of being toxic. The application of SQGs developed by NOAA has not been tested outside North America, and the validity of using them in Port

  15. Practice implications for peristomal skin assessment and care from the 2014 world council of enterostomal therapists international ostomy guideline.

    Science.gov (United States)

    Stelton, Susan; Zulkowski, Karen; Ayello, Elizabeth A

    2015-06-01

    All persons with an ostomy are at risk for development of peristomal skin problems. This is true regardless of the person's nation of residence, type of stoma, or supplies available for stoma care. There are measures that can be taken to lessen the potential for peristomal skin problems. These measures include preoperative stoma site marking, preoperative education, appropriate pouch/barrier fitting, and pouch maintenance. The 2014 World Council of Enterostomal Therapists International Ostomy Guideline includes recommendations that can be implemented to prevent situations that may lead to peristomal skin complications.

  16. Dietary guidelines

    DEFF Research Database (Denmark)

    Jelsøe, Erling

    2015-01-01

    Dietary guidelines are issued regularly in most developed countries. In almost all cases they are concerned solely with the nutritional aspects of food and eating and are based on an understanding of food exclusively as a source of nutrients. In recent years, however, a growing number of proposals...... in a number of countries have addressed the issue of making dietary guidelines that integrate health and sustainability, but in all cases they have been met with different kinds of resistance. This article reviews the development towards an integrated understanding of health and sustainability in relation...... to food and eating and the emergence of proposals for integrated guidelines. It explores the conflicts and controversies that have arisen in the wake of the various proposals and identifies a number of different types of conflicts. These relate to conflicts of interests between the various actors involved...

  17. Assessment of Iranian Nurses and Emergency Medical Personnel in Terms of Cardiopulmonary Resuscitation Knowledge Based on the 2010 Guideline.

    Science.gov (United States)

    Kalhori, Reza Pourmirza; Jalali, Amir; Naderipour, Arsalan; Almasi, Afshin; Khavasi, Mohammad; Rezaei, Masoud; Abbasi, Mohammad

    2017-01-01

    The aim of this study was to compare the cardiopulmonary resuscitation (CPR) knowledge of hospital nurses and emergency medical personnel in Kermanshah, Iran. This descriptive cross-sectional study was conducted on 330 hospital nurses and 159 emergency medical personnel working in educational hospitals and emergency medical centers in Kermanshah. Data were collected using a validated and reliable (r = 0.74) researcher-made questionnaire consisting of a demographic characteristics questionnaire and the 2010 CPR knowledge questionnaire. Based on the most recent CPR guidelines, the knowledge of 19.5%, 78.6%, and 1.9% of the emergency medical staff was excellent, good, and moderate, respectively. None of the participants had poor knowledge. In addition, the knowledge of 20.2%, 65.4%, 14%, and 0.4% of the nurses in this study was excellent, good, moderate, and poor, respectively. There was no significant difference in CPR knowledge between hospital nurses and emergency medical staff. Moreover, no significant association was found between CPR knowledge and gender, age, work experience, field of study, previous occupation, and advanced resuscitation courses. However, CPR knowledge of individuals with training in basic CPR courses was higher than participants without training in these courses (P nurses and emergency medical personnel was in an acceptable range. Nevertheless, it is strongly recommended that nurses and emergency staff receive training according to the most recent CPR guidelines.

  18. Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies.

    Science.gov (United States)

    Deegan, Emily G; Stothers, Lynn; Kavanagh, Alex; Macnab, Andrew J

    2017-05-04

    There remains no gold standard for quantification of voluntary pelvic floor muscle (PFM) strength, despite international guidelines that recommend PFM assessment in females with urinary incontinence (UI). Methods currently reported for quantification of skeletal muscle strength across disciplines are systematically reviewed and their relevance for clinical and academic use related to the pelvic floor are described. A systematic review via Medline, PubMed, CINHAL, and the Cochrane database using key terms for pelvic floor anatomy and function were cross referenced with skeletal muscle strength quantification from 1946 to 2016. Full text peer-reviewed articles in English having female subjects with incontinence were identified. Each study was analyzed for use of controls, type of methodology as direct or indirect measures, benefits, and limitations of the technique. A total of 1586 articles were identified of which 50 met the inclusion criteria. Nine methodologies of determining PFM strength were described including: digital palpation, perineometer, dynamometry, EMG, vaginal cones, ultrasonography, magnetic resonance imaging, urine stream interruption test, and the Colpexin pull test. Thirty-two percent lacked a control group. Technical refinements in both direct and indirect instrumentation for PFM strength measurement are allowing for sensitivity. However, the most common methods of quantification remain digital palpation and perineometry; techniques that pose limitations and yield subjective or indirect measures of muscular strength. Dynamometry has potential as an accurate and sensitive tool, but is limited by inability to assess PFM strength during dynamic movements. © 2017 Wiley Periodicals, Inc.

  19. Safety assessment of a novel active ingredient, acetyl aspartic acid, according to the EU Cosmetics Regulation and the Scientific Committee on Consumer Safety guidelines.

    Science.gov (United States)

    Daly, P; Moran, G

    2015-10-01

    Acetyl aspartic acid (A-A-A) was proposed as a new novel active ingredient for use in cosmetics. The safety of A-A-A was assessed by following an in-house-developed 'New Ingredient Testing Strategy', which was designed in accordance with the Scientific Committee on Consumer Safety (SCCS) notes of guidance and the requirements of Annex I of the EU Cosmetics Regulation. The aim of the project was to determine whether A-A-A was safe for use in cosmetics and to determine a maximum permitted safe level in the formulations. A literature review was conducted, consulting over 40 different information sources. This highlighted a number of gaps which required testing data. A-A-A was tested for phototoxicity according to OECD test guideline 432, skin irritation according to OECD test guideline 439 and eye irritation according to OECD test guideline 437. Dermal absorption of A-A-A was measured according to OECD test guideline 428 and was used to calculate the margin of safety (MoS). Finally, A-A-A was tested in a human repeat insult patch test (HRIPT) and a 14-day in-use tolerance study. A-A-A was non-phototoxic and was non-irritating to skin and eyes in in vitro testing. Dermal absorption was calculated to be 5%. The MoS for A-A-A was 351, at a level of 5%, for all cosmetic product types, indicating no systemic safety toxicity concern. A-A-A at 5% under occlusive patch on a panel of 50 adult volunteers induced no skin irritation or allergic reaction in the HRIPT study. Finally, repeated application of A-A-A to the periocular area, twice per day for 14 days, in 21 female volunteers, demonstrated that 1% A-A-A was well tolerated following dermatological and ophthalmological assessment in a cosmetic formulation. A-A-A was assessed as safe by the cosmetic safety assessor for use in cosmetics at a level of 5% in all cosmetic product types, in line with the requirements of the EU Cosmetics Regulation and in accordance with the SCCS notes of guidance. © 2015 Society of Cosmetic

  20. Assessing compliance of cardiologists with the national cholesterol education program (NCEP III guidelines in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Salihu Hamisu M

    2004-05-01

    Full Text Available Abstract Introduction The NCEP III -ATP guidelines provide clear clinical directives for lipid management especially statins therapy in appropriate patient groups. Compliance of primary care physicians with these guidelines especially in ambulatory care settings has been shown to be poor. The compliance of cardiologist to these guidelines is less documented. Methods A retrospective chart review of 386 patients managed in a large urban cardiology practice was undertaken. Patients with documented contraindications to use of statins were excluded from the study. Only patients with two or more years of follow-up in the practice were included. Demographic variables and medical history including CAD or its equivalent and its major risk factors were identified. The proportion of patients on statins and adequacy of statins therapy were recorded. The lipid profiles of all patients were also analyzed. Results Fifteen patients with documented contraindications to statins therapy including persistent/severe LFT abnormalities, allergies, and gastrointestinal intolerance were excluded. A total of 371 patients were included in the analysis. The mean age for patients in the study was 65 years (range: 42–84. 236 (64% were males while 141 (36% were females. 161 (43% patients were on statins while 210 (57% weren't. 88 (62% of females were on stain compared to 116 (49% of males (p = 0.001. 68% of patients below the age of 50 yrs were not on statins compared with 55% of those greater than 50 yrs (p = 0.01. 38% of patients on statins therapy had sub-optimal lipid profile despite greater than two years of therapy. No statistically significant differences in race and use of satins were noted. Conclusion This study demonstrates a higher than expected prevalence of sub-optimal management of dyslipidemia among patients with established coronary heart disease without contraindications to statins managed by cardiologists. Cardiology and primary care practices require

  1. GRADE Equity Guidelines 3

    DEFF Research Database (Denmark)

    Welch, Vivian A; Akl, Elie A; Pottie, Kevin

    2017-01-01

    OBJECTIVE: The aim of this paper is to describe a conceptual framework for how to consider health equity in the GRADE (Grading Recommendations Assessment and Development Evidence) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working grou...

  2. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Wattjes, Mike P; Rovira, Àlex; Miller, David

    2015-01-01

    . This use of MRI can help predict treatment response and assess the efficacy and safety of new therapies. In the second part of the MAGNIMS (Magnetic Resonance Imaging in MS) network's guidelines on the use of MRI in MS, we focus on the implementation of this technique in prognostic and monitoring tasks. We...

  3. Impact of 2013 ASCO/CAP HER2 reporting guidelines in breast cancer: An assessment study from Indian oncology centre that primarily performs HER2 IHC testing with special emphasis on IHC equivocal category.

    Science.gov (United States)

    Pasricha, Sunil; Gupta, Gurudutt; Garg, Ritu; Sharma, Anila; Gandhi, Jatin S; Durga, Garima; Kamboj, Meenakshi; Grover, Shrruti; Mehta, Anurag

    2017-12-18

    The ASCO/CAP guidelines for HER2 reporting in breast cancer published in 2007 and were updated in 2013 to assure that the right patient receives the targeted therapy. The updated guidelines have lowered the threshold for HER2 positivity criteria and altered the equivocal category for both IHC and FISH. This first study from India addresses the impact of these updated guidelines in the various reporting categories at a tertiary care centre. We compared the trend of HER2 IHC reporting 1 year before (Period A) and 1 year after (Period B) the implementation of updated 2013 ASCO/CAP guidelines. All HER2 equivocal IHC cases of post 2013 guidelines were reclassified as per 2007 guidelines to detect additional number of cases that have been put into equivocal category. Reflex FISH correlation was also assessed to detect any additional cases eligible for anti HER2 therapy with implementation of these updated guidelines. With implementation of updated 2013 guidelines, there was significant decrease in the number of cases scored as 1+ (from 30.7% to 20.6%; P value: .0001) while significant increase in number of 2+ cases (from 20.2% to 27.3%; P value: .004). Post 2013 guidelines, 39% (64 cases) of tumors were additionally put into the equivocal category which would have been considered as negative (score 1+) as per 2007 guidelines. The reflex FISH testing in these equivocal cases resulted in detection of only 1.5% of additional cases eligible for anti HER2 therapy. With implementation of updated 2013 guidelines, there is no significant increase in HER2 positivity trend. However, there is appreciable increase in IHC equivocal cases which subsequently led to increased reflex FISH testing without significantly contributing to the detection of additional eligible cases for anti HER2 therapy, but resulted in delaying of definite HER2 status along with financial implications. © 2017 Wiley Periodicals, Inc.

  4. Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument.

    Science.gov (United States)

    Guo, Yi; Bian, Jiang; Leavitt, Trevor; Vincent, Heather K; Vander Zalm, Lindsey; Teurlings, Tyler L; Smith, Megan D; Modave, François

    2017-03-07

    Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality. The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM). We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers' scores to the criterion scores. Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70. We have developed and presented valid and reliable

  5. Quantification of ammonia-oxidizing bacteria populations in full-scale sewage activated sludge systems and assessment of system variables affecting their performance.

    Science.gov (United States)

    Limpiyakorn, T; Kurisu, F; Yagi, O

    2006-01-01

    This study carried out quantification of ammonia-oxidizing bacteria (AOB) populations in 12 full-scale sewage activated sludge systems that were different in ammonia removals and treatment processes during three different seasons. Experiment was divided into 3 parts: 1) analysis of AOB communities by PCR-DGGE-cloning-sequencing of 16S rRNA genes; 2) development of four real-time PCR primer sets for quantification of the particular AOB of interest; and 3) quantification of AOB populations by using the newly developed real-time PCR primer sets. The results suggested that all the primer sets gave good reproducibility and specificity for PCR amplification with the detection limits of 10(2) copies/PCR reaction. Although the 12 systems were different in several aspects, one of the identified sequence types of Nitrosomonas oligotropha cluster was the dominant AOB in every system and every season studied. However, the other sequence type of this cluster was not significantly involved in ammonia removals in the systems. The occurrence of N. communis cluster in the systems seemed to depend on the remaining oxygen concentrations in the sludge floc and thus the activity of aerobic heterotrophs in the aeration tanks. N. europaea-Nitrosococcus. mobilis solely existed in one A20 system of which the influent contained twice the chloride concentrations than those of other systems.

  6. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2016-06-01

    Full Text Available AUTHOR GUIDELINES Indian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/login Online SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s. http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols 1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic

  7. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2015-12-01

    Full Text Available Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.  http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionPAGE CONTENTSGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic-only material should be submitted and sent for peer review simultaneously with the primary manuscript.2. Reporting GuidelinesReporting guidelines have been developed for different study designs; examples include CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews and meta-analyses, and STARD for studies of diagnostic accuracy. Journals are encouraged to ask authors to follow these guidelines because

  8. Environmental risk assessment for new human pharmaceuticals in the European Union according to the draft guideline/discussion paper of January 2001.

    Science.gov (United States)

    Straub, Jürg Oliver

    2002-10-05

    Since 1993, an environmental risk assessment (ERA) for a new drug application has been stipulated by EU Directive 93/39/EEC amending Directive 65/65/EEC. In early 2001, after several unpublished draft versions for an ERA guideline, a draft guideline/discussion paper for an ERA for non-GMO-containing drugs was published by the European Medicines Evaluation Agency (EMEA). The draft guideline describes a step-wise, tiered procedure for the ERA. The first tier consists of deriving a crude predicted environmental concentration (PEC) in the aquatic compartment for the active pharmaceutical ingredient (API) or its major metabolites, based on predicted amounts used and specific removal rates in sewage treatment or surface waters. If this crude PEC is concerns are apparent, no further assessment is deemed necessary. Else, in the second tier, a crude predicted no-effect level (PNEC) for the aquatic compartment is to be extrapolated by dividing the lowest 50% effect concentration from acute ecotoxicity tests with algae, daphnia or fish (EC(50), LC(50)) by an assessment factor (usually 1000). If the ratio PEC/PNEC is <1, no further assessment is deemed necessary. Lastly, in the third tier, further considerations on a case-by-case basis are needed. This may encompass refining the environmental fate information and thereby the PEC, considering further environmental compartments and their respective PECs (up to and including field studies), but also refining the PNEC. While the ERA addresses mainly the API, excipients of the formulated drug should be considered as well. In the ease of medicinal products, the benefit for patients has relative precedence over environmental risks, meaning that even in the ease of an unacceptable residual risk for new drugs after third tier considerations, prohibition of a new API is not taken into consideration. Instead, possible mitigating or precautionary safety measures may consist of specific product labelling (i.e. package leaflets for the

  9. The role of skin conductivity in a low frequency exposure assessment for peripheral nerve tissue according to the ICNIRP 2010 guidelines

    Science.gov (United States)

    Schmid, Gernot; Cecil, Stefan; Überbacher, Richard

    2013-07-01

    Based on numerical computations using commercially available finite difference time domain code and a state-of-the art anatomical model of a 5-year old child, the influence of skin conductivity on the induced electric field strength inside the tissue for homogeneous front-to-back magnetic field exposure and homogeneous vertical electric field exposure was computed. Both ungrounded as well as grounded conditions of the body model were considered. For electric field strengths induced inside CNS tissue the impact of skin conductivity was found to be less than 15%. However, the results demonstrated that the use of skin conductivity values as obtainable from the most widely used data base of dielectric tissue properties and recommended by safety standards are not suitable for exposure assessment with respect to peripheral nerve tissue according to the ICNIRP 2010 guidelines in which the use of the induced electric field strengths inside the skin is suggested as a conservative surrogate for peripheral nerve exposure. This is due to the fact that the skin conductivity values derived from these data bases refer to the stratum corneum, the uppermost layer of the skin, which does not contain any nerve or receptor cells to be protected from stimulation effects. Using these skin conductivity values which are approximately a factor 250-500 lower than skin conductivity values used in studies on which the ICNIRP 2010 guidelines are based on, may lead to overestimations of the induced electric field strengths inside the skin by substantially more than a factor of 10. However, reliable conductivity data of deeper skin layers where nerve and preceptor cells are located is very limited. It is therefore recommended to include appropriate background information in the ICNIRP guidelines and the dielectric tissue property databases, and to put some emphasis on a detailed layer-specific characterization of skin conductivity in near future.

  10. States' Participation Guidelines for Alternate Assessments Based on Modified Academic Achievement Standards (AA-MAS) in 2010. Synthesis Report 82

    Science.gov (United States)

    Lazarus, Sheryl S.; Hodgson, Jennifer R.; Price, Lynn M.; Thurlow, Martha L.

    2011-01-01

    Federal legislation requires that all students participate in state accountability systems. Most students with disabilities participate in the regular assessment, with or without accommodations. Students with more significant cognitive disabilities participate in the Alternate Assessment based on Alternate Achievement Standards (AA-AAS). A few…

  11. Quantification of Endogenous Retinoids

    Science.gov (United States)

    Kane, Maureen A.; Napoli, Joseph L.

    2014-01-01

    Numerous physiological processes require retinoids, including development, nervous system function, immune responsiveness, proliferation, differentiation, and all aspects of reproduction. Reliable retinoid quantification requires suitable handling and, in some cases, resolution of geometric isomers that have different biological activities. Here we describe procedures for reliable and accurate quantification of retinoids, including detailed descriptions for handling retinoids, preparing standard solutions, collecting samples and harvesting tissues, extracting samples, resolving isomers, and detecting with high sensitivity. Sample-specific strategies are provided for optimizing quantification. Approaches to evaluate assay performance also are provided. Retinoid assays described here for mice also are applicable to other organisms including zebrafish, rat, rabbit, and human and for cells in culture. Retinoid quantification, especially that of retinoic acid, should provide insight into many diseases, including Alzheimer’s disease, type 2 diabetes, obesity, and cancer. PMID:20552420

  12. Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI Guidelines for the Assessment of Pneumonia in the Under 5s in Rural Malawi.

    Directory of Open Access Journals (Sweden)

    Ngozi Kalu

    Full Text Available The Cooking and Pneumonia Study (CAPS is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s in Malawi (www.capstudy.org. The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO integrated management of childhood illnesses (IMCI pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7 out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%. Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13 out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings.

  13. Practical Application of the Revised Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: A Case Study Approach.

    Science.gov (United States)

    Warren, Malissa; McCarthy, Mary S; Roberts, Pamela R

    2016-06-01

    Nutrition therapy is an essential component of the care plan for critically ill and injured patients. There is consensus that critically ill patients are at risk for malnutrition, and the associated consequences of increased infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and disproportionate mortality can be minimized with specialized enteral and/or parenteral nutrition therapy. In this article, we describe 2 case studies that are intended to introduce the nutrition support clinician to key updates in the recently released Guidelines for Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). The case studies demonstrate a pragmatic approach to nutrition therapy in the intensive care unit (ICU) and are intended to elicit dialogue for timely, appropriate nutrition care at policy meetings, professional conferences, and ICU daily rounds. While explicitly stated in the formal document, it is worth repeating that the guidelines are directed toward generalized patient populations, but as with any therapeutic intervention in the ICU, nutrition therapy should be tailored to the individual patient. In addition, protocols and procedures should reflect the local institutional culture and meet with approval of critical care clinicians. © 2016 American Society for Parenteral and Enteral Nutrition.

  14. Application of the condensed protocol for the NIA-AA guidelines for the neuropathological assessment of Alzheimer's disease in an academic clinical practice.

    Science.gov (United States)

    Bharadwaj, Rajnish; Cimino, Patrick J; Flanagan, Margaret E; Latimer, Caitlin S; Gonzalez-Cuyar, Luis F; Juric-Sekhar, Gordana; Montine, Thomas J; Marshall, Desiree A; Keene, C Dirk

    2018-02-01

    In response to concerns regarding resource expenditures required to implement fully the 2012 National Institute on Aging and the Alzheimer's Association (NIA-AA) Sponsored Guidelines for the neuropathological assessment of Alzheimer's disease (AD), we previously developed a sensitive and cost-reducing condensed protocol (CP) at the University of Washington (UW) Alzheimer's Disease Research Center (ADRC) that consolidated the recommended NIA-AA protocol into fewer cassettes requiring fewer immunohistochemical stains. The CP was not designed to replace NIA-AA protocols, but instead to make the NIA-AA criteria accessible to clinical and forensic neuropathology practices where resources limit full implementation of NIA-AA guidelines. In this regard, we developed practical criteria to instigate CP sampling and immunostaining, and applied these criteria in an academic clinical neuropathological practice. During the course of 1 year, 73 cases were sampled using the CP; of those, 53 (72.6%) contained histological features that prompted CP work-up. We found that the CP resulted in increased identification of AD and Lewy body disease neuropathological changes from what was expected using a clinical history-driven work-up alone, while saving approximately $900 per case. This study demonstrates the feasibility and cost-savings of the CP applied to a clinical autopsy practice, and highlights potentially unrecognised neurodegenerative disease processes in the general ageing community. © 2017 John Wiley & Sons Ltd.

  15. A practical approach for linearity assessment of calibration curves under the International Union of Pure and Applied Chemistry (IUPAC) guidelines for an in-house validation of method of analysis.

    Science.gov (United States)

    Sanagi, M Marsin; Nasir, Zalilah; Ling, Susie Lu; Hermawan, Dadan; Ibrahim, Wan Aini Wan; Naim, Ahmedy Abu

    2010-01-01

    Linearity assessment as required in method validation has always been subject to different interpretations and definitions by various guidelines and protocols. However, there are very limited applicable implementation procedures that can be followed by a laboratory chemist in assessing linearity. Thus, this work proposes a simple method for linearity assessment in method validation by a regression analysis that covers experimental design, estimation of the parameters, outlier treatment, and evaluation of the assumptions according to the International Union of Pure and Applied Chemistry guidelines. The suitability of this procedure was demonstrated by its application to an in-house validation for the determination of plasticizers in plastic food packaging by GC.

  16. Guidelines for assessing the valorization of a waste into cementitious material: dredged sediment for production of self compacting concrete

    Directory of Open Access Journals (Sweden)

    Rozas, F.

    2015-09-01

    Full Text Available This article presents some guidelines in order to analyse the feasibility of including a waste material in the production of a structural cementitious material. First of all, the compatibility of the waste with a cementitious material has to be assured; then, if necessary, a decontamination step will be carried out; after, decision on the type of material has to be taken based on different aspects, with special emphasis on the granulometry. As a last step, mechanical, environmental and durability properties have to be evaluated. Then the procedure is illustrated with a full example, obtaining a self compacting concrete (SCC including dredged sediment taken from a Spanish harbour.Este artículo presenta algunas directrices con el fin de analizar la posibilidad de incluir un material de desecho en la producción de un material base cemento estructural. En primer lugar, debe asegurarse la compatibilidad de los residuos con el material base cemento. Tras ello, si es necesario, se llevará a cabo la etapa de descontaminación del residuo. Después debe tomarse la decisión sobre el tipo de material a utilizar en base a diferentes aspectos, haciendo especial énfasis en la granulometría. Como último paso, deben evaluarse las propiedades mecánicas, ambientales y de durabilidad del producto final. El procedimiento a seguir se ilustra con un ejemplo concreto basado en la obtención de un hormigón autocompactante (SCC incluyendo en su fabricación sedimentos dragados tomados de un puerto español.

  17. Adherence to the integrated management of childhood illness guidelines in Namibia, Kenya, Tanzania and Uganda: evidence from the national service provision assessment surveys.

    Science.gov (United States)

    Krüger, Carsten; Heinzel-Gutenbrunner, Monika; Ali, Mohammed

    2017-12-13

    Integrated Management of Childhood Illness (IMCI) is regarded as a standard public health approach to lowering child mortality in developing countries. However, little is known about how health workers adhere to the guidelines at the national level in sub-Saharan African countries. Data from the Service Provision Assessment surveys of Namibia (NA) (survey year: 2009), Kenya (KE) (2010), Tanzania (TZ) (2006) and Uganda (UG) (2007) were analysed for adherence to the IMCI guidelines by health workers. Potential influencing factors included the survey country, patient's age, the different levels of the national health system, the training level of the health care provider (physician, non-physician clinician, nurse-midwife, auxiliary staff), and the status of re-training in IMCI. In total, 6856 children (NA: 1495; KE: 1890; TZ: 2469; UG: 1002 / male 51.2-53.5%) aged 2-73 months (2-24 months, 65.3%; median NA: 19 months; KE: 18 months; TZ: 16 months; UG: 15 months) were clinically assessed by 2006 health workers during the surveys. Less than 33% of the workers carried out assessment of all three IMCI danger signs, namely inability to eat/drink, vomiting everything, and febrile convulsions (NA: 11%; KE: 11%; TZ: 14%; UG: 31%) while the rate for assessing all three of the IMCI main symptoms of cough/difficult breathing, diarrhoea, and fever was < 60% (NA: 48%; KE: 34%; TZ: 50%; UG: 57%). Physical examination rates for fever (temperature) (NA: 97%; KE: 87%; TZ: 73%; UG: 90%), pneumonia (respiration rate/auscultation) (NA: 43%; KE: 24%; TZ: 25%; UG: 20%) and diarrhoea (dehydration status) (NA: 29%; KE: 19%; TZ: 20%; UG: 39%) varied widely and were highest when assessing children with the actual diagnosis of pneumonia and diarrhoea. Adherence rates tended to be higher in children ≤ 24 months, at hospitals, among higher-qualified staff (physician/non-physician clinician) and among those with recent IMCI re-training. Despite nationwide training in IMCI the adherence

  18. Advantages and Limitations of Focal Liver Lesion Assessment with Ultrasound Contrast Agents: Comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines.

    Science.gov (United States)

    Chiorean, Liliana; Tana, Claudio; Braden, Barbara; Caraiani, Cosmin; Sparchez, Zeno; Cui, Xin-Wu; Baum, Ulrich; Dietrich, Christoph F

    Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography. Due to US contrast agents (UCAs) and contrast-specific techniques, sonography offers the potential to show enhancement of liver lesions in a similar way as contrast-enhanced cross-sectional imaging techniques. The real-time assessment of liver perfusion throughout the vascular phases, without any risk of nephrotoxicity, represents one of the major advantages that this technique offers. CEUS has led to a dramatic improvement in the diagnostic accuracy of US and subsequently has been included in current guidelines as an important step in the diagnostic workup of focal liver lesions (FLLs), resulting in a better patient management and cost-effective therapy. The purpose of this review was to provide a detailed description of contrast agents used in different cross-sectional imaging procedures for the study of FLLs, focusing on characteristics, indications and advantages of UCAs in clinical practice. © 2016 S. Karger AG, Basel.

  19. Quantification of micronuclei in blood lymphocytes of patients exposed to gamma radiation for dose absorbed assessment; Quantificacao de micronucleos em linfocitos de pacientes expostas a radiacao gama para a avaliacao da dose absorvida

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Isvania Maria Serafim da Silva

    2003-02-15

    Dose assessment in an important step to evaluate biological effects as a result of individual exposure to ionizing radiation. The use of cytogenetic dosimetry based on the quantification of micronuclei in lymphocytes is very important to complement physical dosimetry, since the measurement of absorbed dose cannot be always performed. In this research, the quantification of micronuclei was carried out in order to evaluate absorbed dose as a result of radiotherapy with {sup 60}Co, using peripheral blood samples from 5 patients with cervical uterine cancer. For this purpose, an aliquot of whole blood from the individual patients was added in culture medium RPMI 1640 supplemented with fetal calf serum and phytohaemagglutinin. The culture was incubated for 44 hours. Henceforth, cytochalasin B was added to block the dividing lymphocytes in cytokinesis. The culture was returned to the incubator for further of 28 hours. Thus, cells were harvested, processed and analyzed. Values obtained considering micronuclei frequency after pelvis irradiation with absorption of 0,08 Gy and 1,8 Gy were, respectively, 0,0021 and 0,052. These results are in agreement with some recent researches that provided some standard values related to micronuclei frequency induced by gamma radiation exposure in different exposed areas for the human body. The results presented in this report emphasizes biological dosimetry as an important tool for dose assessment of either total or partial-body exposure to ionizing radiation, mainly in retrospective dose investigation. (author)

  20. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: nutritional assessment.

    Science.gov (United States)

    Ruiz-Santana, S; Arboleda Sánchez, J A; Abilés, J

    2011-11-01

    Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.

  1. Quality assessment of recent evidence-based clinical practice guidelines for management of type 2 diabetes mellitus in adults using the AGREE II instrument.

    Science.gov (United States)

    Anwer, Muhammad A; Al-Fahed, Ousama B; Arif, Samir I; Amer, Yasser S; Titi, Maher A; Al-Rukban, Mohammed O

    2017-09-25

    Type 2 diabetes mellitus (T2DM) is a worldwide and national public health problem that has a great impact on the population in Saudi Arabia. High-quality clinical practice guidelines (CPGs) are cornerstones in improving the health care provided for patients with diabetes. This study evaluated the methodological rigour, transparency, and applicability of recently published CPGs. Our group conducted a systematic search for recently published CPGs for T2DM. The searching and screening for Source CPGs were guided by tools from the ADAPTE methods with specific inclusion/exclusion criteria. Five reviewers using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument independently assessed the quality of the retrieved Source CPGs. Domains of Scope and purpose and Clarity of presentation received the highest scores in all CPGs. Most of the assessed CPGs (86%) were considered with high overall quality and were recommended for use. Rigour of development and applicability domains were together highest in 3 CPGs (43%). The overall high quality of DM CPGs published in the last 3 years demonstrated the continuous development and improvement in CPG methodologies and standards. Health care professionals should consider the quality of any CPG for T2DM before deciding to use it in their daily clinical practice. Three CPGs have been identified, using the AGREE criteria, as high-quality and trustworthy. Ideally, the resources provided by the AGREE trust including the AGREE II Instrument should be used by a clinician to scan through the large number of published T2DM CPGs to identify the CPGs with high methodological quality and applicability. © 2017 John Wiley & Sons, Ltd.

  2. Echocardiographic chamber quantification in a healthy Dutch population.

    Science.gov (United States)

    van Grootel, R W J; Menting, M E; McGhie, J; Roos-Hesselink, J W; van den Bosch, A E

    2017-12-01

    For accurate interpretation of echocardiographic measurements normative data are required, which are provided by guidelines. For this article, the hypothesis was that these cannot be extrapolated to the Dutch population, since in Dutch clinical practice often higher values are found, which may not be pathological but physiological. Therefore this study aimed to 1) obtain and propose normative values for cardiac chamber quantification in a healthy Dutch population and 2) determine influences of baseline characteristics on these measurements. Prospectively recruited healthy subjects, aged 20-72 years (at least 28 subjects per age decade, equally distributed for gender) underwent physical examination and 2D and 3D echocardiography. Both ventricles and atria were assessed and volumes were calculated. 147 subjects were included (age 44 ± 14 years, 50% female). Overall, feasibility was good for both linear and volumetric measurements. Linear and volumetric parameters were consistently higher than current guidelines recommend, while functional parameters were in line with the guidelines. This was more so in the older population. 3D volumes were higher than 2D volumes. Gender dependency was seen in all body surface area (BSA) corrected volumes and with increasing age, ejection fractions decreased. This study provides 2D and 3D echocardiographic reference ranges for both ventricles and atria derived from a healthy Dutch population. BSA indexed volumes are gender-dependent, age did not influence ventricular volumes and a rise in blood pressure was independently associated with increased right ventricular volumes. The higher volumes found may be indicative for the Dutch population being the tallest in the world.

  3. Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines

    Directory of Open Access Journals (Sweden)

    Aduragbemi Banke-Thomas

    2016-08-01

    Full Text Available Background: Lack of timely and quality emergency obstetric care (EmOC has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs. Since 2009, the global guideline, referred to as the ‘handbook’, has been used to monitor availability, utilization, and quality of EmOC. Objective: To assess application and explore experiences of researchers in LMICs in assessing EmOC. Design: Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. Results: Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each and Bangladesh and Ghana (three each. Most studies (17 were done at subnational levels with 23 studies using the ‘handbook’ alone, whereas the others combined the ‘handbook’ with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. Conclusions: There is clear justification to review how EmOC assessments are being conducted. Synergy between

  4. Accuracy of coronary plaque detection and assessment of interobserver agreement for plaque quantification using automatic coronary plaque analysis software on coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Laqmani, A.; Quitzke, M.; Creder, D.D.; Adam, G.; Lund, G. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclearmedicine; Klink, T. [Wuerzburg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology

    2016-10-15

    To evaluate the accuracy of automatic plaque detection and the interobserver agreement of automatic versus manually adjusted quantification of coronary plaques on coronary CT angiography (cCTA) using commercially available software. 10 cCTA datasets were evaluated using plaque software. First, the automatically detected plaques were verified. Second, two observers independently performed plaque quantification without revising the automatically constructed plaque contours (automatic approach). Then, each observer adjusted the plaque contours according to plaque delineation (adjusted approach). The interobserver agreement of both approaches was analyzed. 32 of 114 automatically identified findings were true-positive plaques, while 82 (72 %) were false-positive. 20 of 52 plaques (38 %) were missed by the software (false-negative). The automatic approach provided good interobserver agreement with relative differences of 0.9 ± 16.0 % for plaque area and -3.3 ± 33.8 % for plaque volume. Both observers independently adjusted all contours because they did not represent the plaque delineation. Interobserver agreement decreased for the adjusted approach with relative differences of 25.0 ± 24.8 % for plaque area and 20.0 ± 40.4 % for plaque volume. The automatic plaque analysis software is of limited value due to high numbers of false-positive and false-negative plaque findings. The automatic approach was reproducible but it necessitated adjustment of all constructed plaque contours resulting in deterioration of the interobserver agreement.

  5. The U.S. Salinity Laboratory (USDA-ARS) guidelines for assessing multi-scale soil salinity with proximal and remote sensing

    Science.gov (United States)

    Scudiero, Elia; Skaggs, Todd; Corwin, Dennis

    2017-04-01

    Soil salinity is a major threat to sustainable agriculture, especially in arid and semi-arid regions. Updated and accurate inventories of salinity in agronomically and environmentally relevant ranges (i.e., essential for producers and decision-makers to assure long term food production. Over the past three decades, scientists at the U.S. Salinity Laboratory (USDA-ARS) in Riverside, CA have developed proximal sensor (i.e., electrical resistivity and electromagnetic induction) and remote imagery (e.g., MODIS, Landsat, WorldView) methodologies for assessing soil salinity at multiple scales: field (0.5 ha to 1 km2), landscape (1 to 10 km2), and regional (10 to 105 km2) scales. The purpose of this contribution is to provide an overview of these scale-dependent salinity assessment approaches. Guidelines, special considerations, and strengths and limitations of each scale-specific approach are presented for characterizing spatial and temporal variation in soil salinity. To support the discussion, we present a regional scale dataset comprising salinity surveys over 22 fields in California, USA. The dataset is used to provide practical examples of field-, landscape-, and regional-scale soil salinity assessment.

  6. Evaluation of pediatric dentistry guidelines using the AGREE instrument.

    Science.gov (United States)

    Shah, Purvi; Moles, David R; Parekh, Susan; Ashley, Paul; Siddik, Dania

    2011-01-01

    Guidelines are used to inform clinical practice and improve the quality of health care. Poorly developed guidelines may emphasize the incorrect intervention. The purpose of this paper was to evaluate the quality of pediatric dentistry guidelines using the AGREE instrument. A search was carried out to identify pediatric dentistry guidelines up to November 2007. Three independent assessors evaluated the guidelines using the AGREE tool. Fifty-seven guidelines produced by 11 organisations were evaluated. Most guidelines assessed were of poor quality, as determined by the AGREE instrument. Consideration should be given to using the AGREE instrument in the development of new guidelines and review of existing guidelines.

  7. Guidelines for Assessment of Gait and Reference Values for Spatiotemporal Gait Parameters in Older Adults: The Biomathics and Canadian Gait Consortiums Initiative.

    Science.gov (United States)

    Beauchet, Olivier; Allali, Gilles; Sekhon, Harmehr; Verghese, Joe; Guilain, Sylvie; Steinmetz, Jean-Paul; Kressig, Reto W; Barden, John M; Szturm, Tony; Launay, Cyrille P; Grenier, Sébastien; Bherer, Louis; Liu-Ambrose, Teresa; Chester, Vicky L; Callisaya, Michele L; Srikanth, Velandai; Léonard, Guillaume; De Cock, Anne-Marie; Sawa, Ryuichi; Duque, Gustavo; Camicioli, Richard; Helbostad, Jorunn L

    2017-01-01

    Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities. Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the "Gait, cOgnitiOn & Decline" (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy-free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily)-participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV) of gait parameters were used for the analyses. Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls

  8. Guidelines for Assessment of Gait and Reference Values for Spatiotemporal Gait Parameters in Older Adults: The Biomathics and Canadian Gait Consortiums Initiative

    Directory of Open Access Journals (Sweden)

    Olivier Beauchet

    2017-08-01

    Full Text Available Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1 to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2 to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities.Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the “Gait, cOgnitiOn & Decline” (GOOD initiative and the Generation 100 (Gen 100 study. Only healthy—free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily—participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV of gait parameters were used for the analyses.Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls, were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded

  9. Quality and methods of developing practice guidelines

    Directory of Open Access Journals (Sweden)

    Clark Otavio

    2002-01-01

    Full Text Available Abstract Background It is not known whether there are differences in the quality and recommendations between evidence-based (EB and consensus-based (CB guidelines. We used breast cancer guidelines as a case study to assess for these differences. Methods Five different instruments to evaluate the quality of guidelines were identified by a literature search. We also searched MEDLINE and the Internet to locate 8 breast cancer guidelines. These guidelines were classified in three categories: evidence based, consensus based and consensus based with no explicit consideration of evidence (CB-EB. Each guideline was evaluated by three of the authors using each of the instruments. For each guideline we assessed the agreement among 14 decision points which were selected from the NCCN (National Cancer Comprehensive Network guidelines algorithm. For each decision point we recorded the level of the quality of the information used to support it. A regression analysis was performed to assess if the percentage of high quality evidence used in the guidelines development was related to the overall quality of the guidelines. Results Three guidelines were classified as EB, three as CB-EB and two as CB. The EB guidelines scored better than CB, with the CB-EB scoring in the middle among all instruments for guidelines quality assessment. No major disagreement in recommendations was detected among the guidelines regardless of the method used for development, but the EB guidelines had a better agreement with the benchmark guideline for any decision point. When the source of evidence used to support decision were of high quality, we found a higher level of full agreement among the guidelines' recommendations. Up to 94% of variation in the quality score among guidelines could be explained by the quality of evidence used for guidelines development. Conclusion EB guidelines have a better quality than CB guidelines and CB-EB guidelines. Explicit use of high quality evidence

  10. Introduction to uncertainty quantification

    CERN Document Server

    Sullivan, T J

    2015-01-01

    Uncertainty quantification is a topic of increasing practical importance at the intersection of applied mathematics, statistics, computation, and numerous application areas in science and engineering. This text provides a framework in which the main objectives of the field of uncertainty quantification are defined, and an overview of the range of mathematical methods by which they can be achieved. Complete with exercises throughout, the book will equip readers with both theoretical understanding and practical experience of the key mathematical and algorithmic tools underlying the treatment of uncertainty in modern applied mathematics. Students and readers alike are encouraged to apply the mathematical methods discussed in this book to their own favourite problems to understand their strengths and weaknesses, also making the text suitable as a self-study. This text is designed as an introduction to uncertainty quantification for senior undergraduate and graduate students with a mathematical or statistical back...

  11. Systematic review on tuberculosis transmission on aircraft and update of the European Centre for Disease Prevention and Control risk assessment guidelines for tuberculosis transmitted on aircraft (RAGIDA-TB).

    Science.gov (United States)

    Kotila, Saara M; Payne Hallström, Lara; Jansen, Niesje; Helbling, Peter; Abubakar, Ibrahim

    2016-01-01

    As a setting for potential tuberculosis (TB) transmission and contact tracing, aircraft pose specific challenges. Evidence-based guidelines are needed to support the related-risk assessment and contact-tracing efforts. In this study evidence of TB transmission on aircraft was identified to update the Risk Assessment Guidelines for TB Transmitted on Aircraft (RAGIDA-TB) of the European Centre for Disease Prevention and Control (ECDC). Electronic searches were undertaken from Medline (Pubmed), Embase and Cochrane Library until 19 July 2013. Eligible records were identified by a two-stage screening process and data on flight and index case characteristics as well as contact tracing strategies extracted. The systematic literature review retrieved 21 records. Ten of these records were available only after the previous version of the RAGIDA guidelines (2009) and World Health Organization guidelines on TB and air travel (2008) were published. Seven of the 21 records presented some evidence of possible in-flight transmission, but only one record provided substantial evidence of TB transmission on an aircraft. The data indicate that overall risk of TB transmission on aircraft is very low. The updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contract tracing and risk assessment.

  12. GRADE guidelines

    DEFF Research Database (Denmark)

    Guyatt, Gordon H; Thorlund, Kristian; Oxman, Andrew D

    2013-01-01

    , calculating summary measures requires converting to the same units of measurement for each study. The longest standing and most widely used approach is to divide the difference in means in each study by its standard deviation and present pooled results in standard deviation units (standardized mean difference...... in means is usually desirable. When the natural units of the outcome measure are not easily interpretable, choosing a threshold to create a binary outcome and presenting relative and absolute effects become a more attractive alternative. When studies use different measures of the same construct...... and absolute effects, presenting the ratio of the means of intervention and control groups, and presenting the results in minimally important difference units. We outline the merits and limitations of each alternative and provide guidance for meta-analysts and guideline developers....

  13. Field assessment of semi-aerobic condition and the methane correction factor for the semi-aerobic landfills provided by IPCC guidelines.

    Science.gov (United States)

    Jeong, Sangjae; Nam, Anwoo; Yi, Seung-Muk; Kim, Jae Young

    2015-02-01

    According to IPCC guidelines, a semi-aerobic landfill site produces one-half of the amount of CH4 produced by an equally-sized anaerobic landfill site. Therefore categorizing the landfill type is important on greenhouse gas inventories. In order to assess semi-aerobic condition in the sites and the MCF value for semi-aerobic landfill, landfill gas has been measured from vent pipes in five semi-aerobically designed landfills in South Korea. All of the five sites satisfied requirements of semi-aerobic landfills in 2006 IPCC guidelines. However, the ends of leachate collection pipes which are main entrance of air in the semi-aerobic landfill were closed in all five sites. The CH4/CO2 ratio in landfill gas, indicator of aerobic and anaerobic decomposition, ranged from 1.08 to 1.46 which is higher than the values (0.3-1.0) reported for semi-aerobic landfill sites and is rather close to those (1.0-2.0) for anaerobic landfill sites. The low CH4+CO2% in landfill gas implied air intrusion into the landfill. However, there was no evidence that air intrusion has caused by semi-aerobic design and operation. Therefore, the landfills investigated in this study are difficult to be classified as semi-aerobic landfills. Also MCF of 0.5 may significantly underestimate methane emissions compared to other researches. According to the carbon mass balance analyses, the higher MCF needs to be proposed for semi-aerobic landfills. Consequently, methane emission estimate should be based on field evaluation for the semi-aerobically designed landfills. Copyright © 2015. Published by Elsevier Ltd.

  14. Rapid quantification of viable Campylobacter on chicken carcasses by real-time PCR and propidium monoazide as a tool for quantitative risk assessment

    DEFF Research Database (Denmark)

    Josefsen, Mathilde Hartmann; Löfström, Charlotta; Hansen, Tina Beck

    2010-01-01

    of foodborne Campylobacter, combining real-time PCR (Q-PCR) with a simple propidium monoazide (PMA) sample treatment. In less than 3 hours, this method generates a signal from only viable and viable but non-culturable (VBNC) Campylobacter with an intact membrane. The method performance was evaluated......-values (R2 = 0.993), with a quantification range from 1×1021×107 CFU/ml. The correlation between the Campylobacter counts obtained by PMA-PCR and culture on naturally contaminated chickens was high (R2 = 0.844). The amplification efficiency of the Q-PCR method was not affected by chicken rinse matrix...... or by species of Campylobacter. No Q-PCR signals were obtained from artificially inoculated chicken rinse when PMA sample treatment was applied. In conclusion, this study presents a rapid tool for producing reliable quantitative data on viable Campylobacter in chicken carcass rinse. The proposed method does...

  15. Rapid Quantification of Viable Campylobacter Bacteria on Chicken Carcasses, Using Real-Time PCR and Propidium Monoazide Treatment, as a Tool for Quantitative Risk Assessment

    DEFF Research Database (Denmark)

    Josefsen, Mathilde Hartmann; Löfström, Charlotta; Hansen, Tina Beck

    2010-01-01

    of foodborne Campylobacter, combining real-time PCR (Q-PCR) with a simple propidium monoazide (PMA) sample treatment. In less than 3 hours, this method generates a signal from only viable and viable but non-culturable (VBNC) Campylobacter with an intact membrane. The method performance was evaluated......-values (R(2) = 0.993), with a quantification range from 1x10(2)-1x10(7) CFU/ml. The correlation between the Campylobacter counts obtained by PMA-PCR and culture on naturally contaminated chickens was high (R(2) = 0.844). The amplification efficiency of the Q-PCR method was not affected by chicken rinse...... matrix or by species of Campylobacter. No Q-PCR signals were obtained from artificially inoculated chicken rinse when PMA sample treatment was applied. In conclusion, this study presents a rapid tool for producing reliable quantitative data on viable Campylobacter in chicken carcass rinse. The proposed...

  16. Optimization of a widefield structured illumination microscope for non-destructive assessment and quantification of nuclear features in tumor margins of a primary mouse model of sarcoma.

    Directory of Open Access Journals (Sweden)

    Henry L Fu

    Full Text Available Cancer is associated with specific cellular morphological changes, such as increased nuclear size and crowding from rapidly proliferating cells. In situ tissue imaging using fluorescent stains may be useful for intraoperative detection of residual cancer in surgical tumor margins. We developed a widefield fluorescence structured illumination microscope (SIM system with a single-shot FOV of 2.1 × 1.6 mm (3.4 mm(2 and sub-cellular resolution (4.4 µm. The objectives of this work were to measure the relationship between illumination pattern frequency and optical sectioning strength and signal-to-noise ratio in turbid (i.e. thick samples for selection of the optimum frequency, and to determine feasibility for detecting residual cancer on tumor resection margins, using a genetically engineered primary mouse model of sarcoma. The SIM system was tested in tissue mimicking solid phantoms with various scattering levels to determine impact of both turbidity and illumination frequency on two SIM metrics, optical section thickness and modulation depth. To demonstrate preclinical feasibility, ex vivo 50 µm frozen sections and fresh intact thick tissue samples excised from a primary mouse model of sarcoma were stained with acridine orange, which stains cell nuclei, skeletal muscle, and collagenous stroma. The cell nuclei were segmented using a high-pass filter algorithm, which allowed quantification of nuclear density. The results showed that the optimal illumination frequency was 31.7 µm(-1 used in conjunction with a 4 × 0.1 NA objective (v=0.165. This yielded an optical section thickness of 128 µm and an 8.9 × contrast enhancement over uniform illumination. We successfully demonstrated the ability to resolve cell nuclei in situ achieved via SIM, which allowed segmentation of nuclei from heterogeneous tissues in the presence of considerable background fluorescence. Specifically, we demonstrate that optical sectioning of fresh intact thick tissues

  17. Assessment of fraction-specific toxicity and derivation of recommended soil quality guidelines for crude oil in agricultural/grassland soils

    Energy Technology Data Exchange (ETDEWEB)

    Leggett, S. [Matrix Solutions Inc., Jackson, MS (United States); Stephenson, G. [ESG International, Guelph, ON (Canada); Visser, S. [Calgary Univ., AB (Canada); Lee, K.; Bolton, A. [Anderson Exploration Ltd., Calgary, AB (Canada)

    2000-06-01

    A project was initiated in 1998 to collect scientific data through a combination of laboratory and field studies to help determine risk-based soil quality guidelines for petroleum hydrocarbons (PHC) in agricultural soils. The data obtained will provide useful information for the Alberta Tier I Criteria for Contaminated Soil Assessment and Remediation (CCSA) regarding the source and nature of ecotoxicity associated with PHC contaminated sites. The first phase of the project involved the collection of ecotoxicological data for specific hydrocarbon fractions to develop an approach to support ecologically relevant, risk-based, soil quality criteria for the protection of human health. The second phase involved the evaluation of short- and long-term risks associated with high concentrations of residual hydrocarbons in soils. Although the project is not scheduled to be completed until 2001, preliminary results are available regarding the toxicity of a crude oil mixture and two hydrocarbon fractions on terrestrial plant and animal species in topsoil. Data from both phases will be integrated to better understand the risk associated with hydrocarbon residuals in soil. The results will help regulators to establish relevant clean up standards for PHCs. They will also help industry to establish risk based clean-up standards for PHCs during site-specific risk assessments. 4 refs.

  18. THE WAY OF ASSESSING THE ADHERENCE TO MODERN DRUG THERAPY CLINICAL GUIDELINES AIMED AT REDUCING THE RISK OF RECURRENT STROKE (ACCORDING TO THE LIS-2 REGISTER

    Directory of Open Access Journals (Sweden)

    A. Yu. Suvorov

    2015-09-01

    Full Text Available Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219. The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.Results. Two groups of patients [with RSPI=0 (n=137 and RSPI>0 (n=82] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age was 2.04 [1.07-3.91] (p=0.031. Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032.Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.

  19. Quantification of micro stickies

    Science.gov (United States)

    Mahendra. Doshi; Jeffrey. Dyer; Salman. Aziz; Kristine. Jackson; Said M. Abubakr

    1997-01-01

    The objective of this project was to compare the different methods for the quantification of micro stickies. The hydrophobic materials investigated in this project for the collection of micro stickies were Microfoam* (polypropylene packing material), low density polyethylene film (LDPE), high density polyethylene (HDPE; a flat piece from a square plastic bottle), paper...

  20. Quantification of years of life lost attributable to chronic air pollution exposure in a health impact assessment: the case of Nantes; Quantification des annees de vie perdues attribuables aux expositions chroniques a la pollution atmospherique urbaine: le cas de Nantes

    Energy Technology Data Exchange (ETDEWEB)

    Guillois-Becel, Y.; Eilstein, D.; Glorennec, Ph.; Lefranc, A

    2007-05-15

    Background: When French regional planning for air quality first began, exposure-response functions from time-series studies were used to assess the short-term health impact of urban air pollution. The World Health Organisation also suggests that exposure-response functions from cohort studies be taken into account to evaluate the effects of chronic exposure and to quantify the prematurity of deaths related to chronic exposure to air pollution. This work characterizes the long term effects of air pollution in Nantes by considering years of life lost as well as the number of attributable deaths. methods: the study population is classified in birth cohorts. for each cohort, 2 survival curves are built based on current mortality conditions: the first is built for current exposure to air pollution and the second for exposure to a lower reference level of air pollution. The area between the 2 curves represents years of life lost attributable to urban air pollution. results: the estimated number of premature deaths due to air pollution is approximately 56, or about 2% of the deaths of those older than 30 years. The health impact on the Nantes population is estimated at 27.2 years of life lost attributable to urban air pollution in 1999 and 2388.1 years of life lost for the 1999-2008 period. This amounts to a decrease of roughly 4 months in the life expectancy of those aged 30 years. Conclusion: This study, which also identifies and discusses relevant errors and uncertainty, confirmed that air pollution in Nantes has significant health effects and that chronic exposure plays an essential role in this impact. the number of years of life lost and the reduction in life expectancy provide new reasons to reject the assumption that health effects are limited to the premature deaths of terminally-ill people. the expected health gains in Nantes associated with reduced although still moderate air pollution levels are on the same scale as, and possibly better than, those found in 9

  1. Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach.

    Science.gov (United States)

    Eslava-Schmalbach, Javier; Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter

    2017-12-01

    The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline

  2. Effective doses, guidelines & regulations.

    Science.gov (United States)

    Burch, Michael D

    2008-01-01

    categories usually required to satisfy comprehensive risk assessment process for the major toxins to currently adopt any of the international guidelines as regulations in the US. The major limitations that need to be overcome include: the capacity to deal with multiple toxin congeners, the absence of robust analytical methods for compliance monitoring, and the absence of certified toxin standards to support analyses. However, the current WHO provisional guideline for microcystin-LR, or the other national guideline variants that are based upon it, (e.g., Canadian, Australian) may be appropriate to adopt as a health advisory in the short-term, while regulations are developed. The bathing and recreationa water guidelines developed in other countries could also be translated fo use as recreational water guidelines situation in the US.

  3. An assessment of resuscitation quality in the television drama Emergency Room: guideline non-compliance and low-quality cardiopulmonary resuscitation lead to a favorable outcome?

    Science.gov (United States)

    Hinkelbein, Jochen; Spelten, Oliver; Marks, Jörg; Hellmich, Martin; Böttiger, Bernd W; Wetsch, Wolfgang A

    2014-08-01

    Two earlier studies found that outcome after cardiopulmonary resuscitation (CPR) in the television medical drama Emergency Room (ER) is not realistic. No study has yet evaluated CPR quality in ER. Retrospective analysis of CPR quality in episodes of ER. Three independent board-certified emergency physicians trained in CPR and the American Heart Association (AHA) guidelines reviewed ER episodes in two 5-year time-frames (2001-2005 and 2005-2009). Congruency with the corresponding 2000 and 2005 AHA guidelines was determined for each CPR scene. None. None. To evaluate whether CPR is in agreement with the specific algorithms of the AHA guidelines. Fisher's exact test and Mann-Whitney-U-test were used to evaluate statistical significance (PCPR scene was in agreement with the published AHA guidelines. However, low-quality CPR and non-compliance with the guidelines resulted in favorable outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2014-03-01

    Full Text Available Guidelines for Article Submission   SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION 1.1      Subheading of the content  1.1.1   Subheading of the content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples:   Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from

  5. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2015-10-01

    Full Text Available Guidelines for Article Submission   SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION 1.1      Subheading of the Content  1.1.1   Subheading of the Content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples:   Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from

  6. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2016-03-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second p age and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1 INTRODUCTION 1.1 Subheading of the Content 1.1.1 Subheading of the Content For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples:   Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from http://www.teachingenglish.org

  7. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2015-03-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1 INTRODUCTION 1.1 Subheading of the content 1.1.1 Subheading of the content For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Back Matter| 79 80 | STUDIES IN ENGLISH LANGUAGE AND EDUCATION, Volume 1, Number 1, March 2014 Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v

  8. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2014-09-01

    Full Text Available Guidelines for Article Submission   SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION 1.1      Subheading of the content  1.1.1   Subheading of the content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples:   Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from

  9. Clinical trial design for systemic agents in patients with brain metastases from solid tumours: a guideline by the Response Assessment in Neuro-Oncology Brain Metastases working group.

    Science.gov (United States)

    Camidge, D Ross; Lee, Eudocia Q; Lin, Nancy U; Margolin, Kim; Ahluwalia, Manmeet S; Bendszus, Martin; Chang, Susan M; Dancey, Janet; de Vries, Elisabeth G E; Harris, Gordon J; Hodi, F Stephen; Lassman, Andrew B; Macdonald, David R; Peereboom, David M; Schiff, David; Soffietti, Ricardo; van den Bent, Martin J; Wefel, Jeffrey S; Wen, Patrick Y

    2018-01-01

    Patients with active CNS disease are often excluded from clinical trials, and data regarding the CNS efficacy of systemic agents are usually obtained late in the drug development process or not at all. In this guideline from the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group, we provide detailed recommendations on when patients with brain metastases from solid tumours should be included or excluded in clinical trials of systemic agents. We also discuss the limitations of retrospective studies in determining the CNS efficacy of systemic drugs. Inclusion of patients with brain metastases early on in the clinical development of a drug or a regimen is needed to generate appropriate CNS efficacy or non-efficacy signals. We consider how to optimally incorporate or exclude such patients in systemic therapy trials depending on the likelihood of CNS activity of the agent by considering three scenarios: drugs that are considered very unlikely to have CNS antitumour activity or efficacy; drugs that are considered very likely to have CNS activity or efficacy; and drugs with minimal baseline information on CNS activity or efficacy. We also address trial design issues unique to patients with brain metastases, including the selection of appropriate CNS endpoints in systemic therapy trials. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Development of a diagnostic test set to assess agreement in breast pathology: practical application of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS).

    Science.gov (United States)

    Oster, Natalia V; Carney, Patricia A; Allison, Kimberly H; Weaver, Donald L; Reisch, Lisa M; Longton, Gary; Onega, Tracy; Pepe, Margaret; Geller, Berta M; Nelson, Heidi D; Ross, Tyler R; Tosteson, Aanna N A; Elmore, Joann G

    2013-02-05

    Diagnostic test sets are a valuable research tool that contributes importantly to the validity and reliability of studies that assess agreement in breast pathology. In order to fully understand the strengths and weaknesses of any agreement and reliability study, however, the methods should be fully reported. In this paper we provide a step-by-step description of the methods used to create four complex test sets for a study of diagnostic agreement among pathologists interpreting breast biopsy specimens. We use the newly developed Guidelines for Reporting Reliability and Agreement Studies (GRRAS) as a basis to report these methods. Breast tissue biopsies were selected from the National Cancer Institute-funded Breast Cancer Surveillance Consortium sites. We used a random sampling stratified according to woman's age (40-49 vs. ≥50), parenchymal breast density (low vs. high) and interpretation of the original pathologist. A 3-member panel of expert breast pathologists first independently interpreted each case using five primary diagnostic categories (non-proliferative changes, proliferative changes without atypia, atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma). When the experts did not unanimously agree on a case diagnosis a modified Delphi method was used to determine the reference standard consensus diagnosis. The final test cases were stratified and randomly assigned into one of four unique test sets. We found GRRAS recommendations to be very useful in reporting diagnostic test set development and recommend inclusion of two additional criteria: 1) characterizing the study population and 2) describing the methods for reference diagnosis, when applicable.

  11. HCV core-antigen assay as an alternative to HCV RNA quantification: A correlation study for the assessment of HCV viremia.

    Science.gov (United States)

    Alonso, Roberto; Pérez-García, Felipe; López-Roa, Paula; Alcalá, Luis; Rodeño, Pilar; Bouza, Emilio

    2017-02-25

    Detection of hepatitis C virus (HCV) RNA and the HCV core antigen assay (HCV-Ag) are reliable techniques for the diagnosis of active and chronic HCV infection. Our aim was to evaluate the HCV-Ag assay as an alternative to quantification of HVC RNA. A comparison was made of the sensitivity and specificity of an HCV-Ag assay (204 serum samples) with those of a PCR assay, and the correlation between the two techniques was determined. The sensitivity and specificity of HCV-Ag was 76.6% and 100%, respectively. Both assays were extremely well correlated (Pearson coefficient=0.951). The formula (LogCV=1.15*LogAg+2.26) was obtained to calculate the viral load by PCR from HCV-Ag values. HCV-Ag was unable to detect viral loads below 5000IU/mL. Although the HCV-Ag assay was less sensitive than the PCR assay, the correlation between both assays was excellent. HCV-Ag can be useful as a first step in the diagnosis of acute or chronic HCV infection and in emergency situations. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  12. An ontology-aware integration of clinical models, terminologies and guidelines: an exploratory study of the Scale for the Assessment and Rating of Ataxia (SARA).

    Science.gov (United States)

    Maarouf, Haitham; Taboada, María; Rodriguez, Hadriana; Arias, Manuel; Sesar, Ángel; Sobrido, María Jesús

    2017-12-06

    Electronic rating scales represent an important resource for standardized data collection. However, the ability to exploit reasoning on rating scale data is still limited. The objective of this work is to facilitate the integration of the semantics required to automatically interpret collections of standardized clinical data. We developed an electronic prototype for the Scale of the Assessment and Rating of Ataxia (SARA), broadly used in neurology. In order to address the modeling challenges of the SARA, we propose to combine the best performances from OpenEHR clinical archetypes, guidelines and ontologies. A scaled-down version of the Human Phenotype Ontology (HPO) was built, extracting the terms that describe the SARA tests from free-text sources. This version of the HPO was then used as backbone to normalize the content of the SARA through clinical archetypes. The knowledge required to exploit reasoning on the SARA data was modeled as separate information-processing units interconnected via the defined archetypes. Each unit used the most appropriate technology to formally represent the required knowledge. Based on this approach, we implemented a prototype named SARA Management System, to be used for both the assessment of cerebellar syndrome and the production of a clinical synopsis. For validation purposes, we used recorded SARA data from 28 anonymous subjects affected by Spinocerebellar Ataxia Type 36 (SCA36). When comparing the performance of our prototype with that of two independent experts, weighted kappa scores ranged from 0.62 to 0.86. The combination of archetypes, phenotype ontologies and electronic information-processing rules can be used to automate the extraction of relevant clinical knowledge from plain scores of rating scales. Our results reveal a substantial degree of agreement between the results achieved by an ontology-aware system and the human experts.

  13. Perceived barriers to guideline adherence: a survey among general practitioners

    NARCIS (Netherlands)

    Lugtenberg, M.; Burgers, J.S.; Besters, C.F.; Han, D.; Westert, G.P.

    2011-01-01

    BACKGROUND: Despite considerable efforts to promote and support guideline use, adherence is often suboptimal. Barriers to adherence vary not only across guidelines but also across recommendations within guidelines. The aim of this study was to assess the perceived barriers to guideline adherence

  14. Validation of evidence-based clinical practice guideline: Nursing ...

    African Journals Online (AJOL)

    The overall assessment of the guideline revealed that two-thirds of academic appraisers strongly recommended the guideline to be used in practice and most of practitioner nurses and practitioner physicians recommended the guideline to be in practice. Conclusion: The development of this guideline was based on the ...

  15. AUTHOR GUIDELINES

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2014-12-01

    Full Text Available AUTHOR GUIDELINESIndian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/loginOnline SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.SectionsEditorial:On issues of current public health needAbout 1000 – 1200 wordsReferences: 5 – 10 (PubMed - Citation preferredInvited Commentary:Brief, provocative, opinionated communicationsOn issues of current public health needMain Text: 750-1000 words excluding referencesReferences: 5 – 10 (PubMed - Citation preferredOriginal Article:Articles from Original ResearchStructured abstract: 250 wordsMain Text: 2500 - 3000 words, IMRD formatKey Words: 5 - 8References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4*Certificate of clearance from respective Institutional Ethical Committee (IECReview Article:On subject of public health relevanceAbstract: 250 wordsMain Text: 2500 - 3000 wordsKey Words: 3 - 4References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4Short Communication / Article:Short report of a research project / outbreakMain Text : 1000 – 1200 wordsReferences: 10 – 15 (PubMed - Citation preferredTable / Figure: 01*Certificate of clearance from respective Institutional Ethical Committee (IECReport from the field

  16. Methodological quality of guidelines in gastroenterology.

    Science.gov (United States)

    Malheiro, Rui; de Monteiro-Soares, Matilde; Hassan, Cesare; Dinis-Ribeiro, Mário

    2014-06-01

    Clinical guidelines are a common feature in modern endoscopy practice and they are being produced faster than ever. However, their methodological quality is rarely assessed. This study evaluated the methodological quality of current clinical guidelines in the field of gastroenterology, with an emphasis on endoscopy. Practice guidelines published by the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), British Society of Gastroenterology (BSG), National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN) were searched between September and October 2012 and evaluated using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument (23 items, scores 1 - 7 for each item; higher scores mean better quality). A total of 100 guidelines were assessed. The mean number of items scoring 6 or 7 per guideline was 9.2 (out of 23 items). Overall, 99 % of guidelines failed to include the target population in the development process, and 96 % did not report facilitators and barriers to guideline application. In addition, 86 % did not include advice or tools, and 94 % did not present monitoring or auditing criteria. The global methodological quality of clinical guidelines in the field of gastroenterology is poor, particularly regarding involvement of the target population in the development of guidelines and in the provision of clear suggestions to practitioners. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Quantification of residual antibiotics in cow manure being spread over agricultural land and assessment of their behavioral effects on antibiotic resistant bacteria.

    Science.gov (United States)

    Yeom, Ji-Ran; Yoon, Soon-Uk; Kim, Chang-Gyun

    2017-09-01

    Antibiotic resistant bacteria (ARB) in livestock manure used as fertilizer and spread over agriculture land, may pose a threat to the health of humans. Considering this, the concentrations of tetracycline (TC), oxytetracycline (OTC), and sulfathiazole (STZ) in the surface soil were quantified using LC-MS. These antibiotics have been used in livestock and are found in fertilizer produced from livestock excretions. Species of ABR were identified using 16S rDNA. Soil samples were collected at depths of 0, 7, and 15 cm from farmland in Incheon (South Korea). In the surface soil, three compounds were detected: TC (17.74 μg/kg), OTC (0.78 μg/kg), and STZ (0.23 μg/kg). However, except for STZ, antibiotics were not detected in the deeper samples. Overall, TC can form a chelated complex with cations, which consequently enhances its adsorption to the organic matter and metals in soil. This property can significantly reduce the mobility of TC (to lower than that of STZ). The result of 16S rDNA gene analysis indicated that Pseudomonas spp., Arthrobacter spp., and Rhodococcus spp. showed persistent resistance to the three antibiotics tested. DNA quantification results revealed strong resistance of Pseudomonas spp. to STZ, whereas Arthrobacter spp. and Rhodococcus spp. had resistance to TC and OTC. Antibiotics biodegradation suggested ability of ARB to grow in soil samples in presence of residual antibiotics during 13 days incubation. The concentrations of STZ, TC, and OTC reduced as much as 23.53, 35.60 and 66.88%, respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

    Science.gov (United States)

    Wormser, Gary P; Dattwyler, Raymond J; Shapiro, Eugene D; Halperin, John J; Steere, Allen C; Klempner, Mark S; Krause, Peter J; Bakken, Johan S; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J Stephen; Nadelman, Robert B

    2006-11-01

    Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.

  19. Using field data to assess the effects of pesticides on crustacea in freshwater aquatic ecosystems and verifying the level of protection provided by water quality guidelines.

    Science.gov (United States)

    Guy, Martha; Singh, Lucina; Mineau, Pierre

    2011-07-01

    The purpose of this study was to investigate how well single-species laboratory data predict real-world pesticide toxicity effects on Crustacea. Data from field pesticide exposures from experimental mesocosm and small pond studies were converted into toxicity units (TUs) by dividing measured pesticide concentrations by the L(E)C50 for Daphnia or acute 5% hazard concentration for Crustacea (HC5-C). The proportion of crustacean taxa significantly affected by the pesticide treatment, called the count ratio of effect, was used in logistic regression models. Of 200 possible logistic model combinations of the TUs, fate, physicochemical variables, and structural variables versus the count ratio of effect for the mesocosm data, the best model was found to incorporate log(TU HC5-C). This model was used to convert pesticide water quality guidelines from around the world into estimates of the proportion of crustacean taxa predicted to be impacted by exposure to a pesticide at the water quality guideline concentration. This analysis suggests 64% of long-term water quality guidelines and 88% of short-term pesticide water quality guidelines are not protective of the aquatic life they are designed to protect. We conclude that empirically derived data from mesocosm studies should be incorporated into water quality guideline derivation for pesticides where available. Also, interspecific differences in susceptibility should be accounted for more accurately to ensure water quality guidelines are adequately protective against the adverse effects of pesticide exposure. Copyright © 2011 SETAC.

  20. Quantification of carbon nanomaterials in vivo.

    Science.gov (United States)

    Wang, Haifang; Yang, Sheng-Tao; Cao, Aoneng; Liu, Yuanfang

    2013-03-19

    this Account, we review the in vivo quantification methods of carbon NMs, focusing on isotopic labeling and tracing methods, and summarize the related labeling, purification, bio-sampling, and detection of carbon NMs. We also address the advantages, applicable situations, and limits of various labeling and tracing methods and propose guidelines for choosing suitable labeling methods. A collective analysis of the ADME information on various carbon NMs in vivo would provide general principles for understanding the fate of carbon NMs and the effects of chemical functionalization and aggregation of carbon NMs on their ADME/T in vivo and their implications in nanotoxicology and biosafety evaluations.

  1. Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women’s Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy

    Directory of Open Access Journals (Sweden)

    Holly Ockenden

    2016-11-01

    Full Text Available The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey, related to women’s knowledge and perceptions of the current gestational weight gain guidelines (GWG, as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7 and pilot testing items in a small sample (n = 5 of pregnant women and recent mothers (target population. Test re-test reliability was assessed among a sample (n = 71 of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC, those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15–25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.

  2. Standardized MRD quantification in European ALL trials: proceedings of the Second International Symposium on MRD assessment in Kiel, Germany, 18-20 September 2008

    DEFF Research Database (Denmark)

    Brüggemann, M; Schrauder, A; Raff, T

    2010-01-01

    Assessment of minimal residual disease (MRD) has acquired a prominent position in European treatment protocols for patients with acute lymphoblastic leukemia (ALL), on the basis of its high prognostic value for predicting outcome and the possibilities for implementation of MRD diagnostics...... assessment of response to treatment in adult and childhood ALL, and provides a sound basis for the comparison of MRD results between different treatment protocols....

  3. Methodological considerations in quantification of oncological FDG PET studies.

    Science.gov (United States)

    Vriens, Dennis; Visser, Eric P; de Geus-Oei, Lioe-Fee; Oyen, Wim J G

    2010-07-01

    This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and research. Structural PubMed searches have been performed for the many factors affecting quantification of glucose metabolism by FDG PET. Review articles and references lists have been used to supplement the search findings. Biological factors such as fasting blood glucose level, FDG uptake period, FDG distribution and clearance, patient motion (breathing) and patient discomfort (stress) all influence quantification. Acquisition parameters should be adjusted to maximize the signal to noise ratio without exposing the patient to a higher than strictly necessary radiation dose. This is especially challenging in pharmacokinetic analysis, where the temporal resolution is of significant importance. The literature is reviewed on the influence of attenuation correction on parameters for glucose metabolism, the effect of motion, metal artefacts and contrast agents on quantification of CT attenuation-corrected images. Reconstruction settings (analytical versus iterative reconstruction, post-reconstruction filtering and image matrix size) all potentially influence quantification due to artefacts, noise levels and lesion size dependency. Many region of interest definitions are available, but increased complexity does not necessarily result in improved performance. Different methods for the quantification of the tissue of interest can introduce systematic and random inaccuracy. This review provides an up-to-date overview of the many factors that influence quantification of glucose metabolism by FDG PET.

  4. How Severely Is DNA Quantification Hampered by RNA Co-extraction?

    Science.gov (United States)

    Sanchez, Ignacio; Remm, Matthieu; Frasquilho, Sonia; Betsou, Fay; Mathieson, William

    2015-10-01

    The optional RNase digest that is part of many DNA extraction protocols is often omitted, either because RNase is not provided in the kit or because users do not want to risk contaminating their laboratory. Consequently, co-eluting RNA can become a "contaminant" of unknown magnitude in a DNA extraction. We extracted DNA from liver, lung, kidney, and heart tissues and established that 28-52% of the "DNA" as assessed by spectrophotometry is actually RNA (depending on tissue type). Including an RNase digest in the extraction protocol reduced 260:280 purity ratios. Co-eluting RNA drives an overestimation of DNA yield when quantification is carried out using OD 260 nm spectrophotometry, or becomes an unquantified contaminant when spectrofluorometry is used for DNA quantification. This situation is potentially incompatible with the best practice guidelines for biobanks issued by organizations such as the International Society for Biological and Environmental Repositories, which state that biospecimens should be accurately characterized in terms of their identity, purity, concentration, and integrity. Consequently, we conclude that an RNase digest must be included in DNA extractions if pure DNA is required. We also discuss the implications of unquantified RNA contamination in DNA samples in the context of laboratory accreditation schemes.

  5. Uncertainty quantification in wind farm flow models

    DEFF Research Database (Denmark)

    Murcia Leon, Juan Pablo

    uncertainties through a model chain are presented and applied to several wind energy related problems such as: annual energy production estimation, wind turbine power curve estimation, wake model calibration and validation, and estimation of lifetime equivalent fatigue loads on a wind turbine. Statistical...... the uncertainty in the lifetime performance of a wind turbine under realistic inflow conditions. Operational measurements of several large offshore wind farms are used to perform model calibration and validation of several stationary wake models. These results provide a guideline to identify the regions in which......This thesis formulates a framework to perform uncertainty quantification within wind energy. This framework has been applied to some of the most common models used to estimate the annual energy production in the planning stages of a wind energy project. Efficient methods to propagate input...

  6. Assessing Climate Vulnerability and Resilience of a Major Water Resource System - Inverting the Paradigm for Specific Risk Quantification at Decision Making Points of Impact

    Science.gov (United States)

    Murphy, K. W.; Ellis, A. W.; Skindlov, J. A.

    2015-12-01

    Water resource systems have provided vital support to transformative growth in the Southwest United States and the Phoenix, Arizona metropolitan area where the Salt River Project (SRP) currently satisfies 40% of the area's water demand from reservoir storage and groundwater. Large natural variability and expectations of climate changes have sensitized water management to risks posed by future periods of excess and drought. The conventional approach to impacts assessment has been downscaled climate model simulations translated through hydrologic models; but, scenario ranges enlarge as uncertainties propagate through sequential levels of modeling complexity. The research often does not reach the stage of specific impact assessments, rendering future projections frustratingly uncertain and unsuitable for complex decision-making. Alternatively, this study inverts the common approach by beginning with the threatened water system and proceeding backwards to the uncertain climate future. The methodology is built upon reservoir system response modeling to exhaustive time series of climate-driven net basin supply. A reservoir operations model, developed with SRP guidance, assesses cumulative response to inflow variability and change. Complete statistical analyses of long-term historical watershed climate and runoff data are employed for 10,000-year stochastic simulations, rendering the entire range of multi-year extremes with full probabilistic characterization. Sets of climate change projections are then translated by temperature sensitivity and precipitation elasticity into future inflow distributions that are comparatively assessed with the reservoir operations model. This approach provides specific risk assessments in pragmatic terms familiar to decision makers, interpretable within the context of long-range planning and revealing a clearer meaning of climate change projections for the region. As a transferable example achieving actionable findings, the approach can

  7. A practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: referral indications for cancer predisposition assessment.

    Science.gov (United States)

    Hampel, Heather; Bennett, Robin L; Buchanan, Adam; Pearlman, Rachel; Wiesner, Georgia L

    2015-01-01

    The practice guidelines of the American College of Medical Genetics and Genomics (ACMG) and the National Society of Genetic Counselors (NSGC) are developed by members of the ACMG and NSGC to assist medical geneticists, genetic counselors, and other health-care providers in making decisions about appropriate management of genetic concerns, including access to and/or delivery of services. Each practice guideline focuses on a clinical or practice-based issue and is the result of a review and analysis of current professional literature believed to be reliable. As such, information and recommendations within the ACMG and NSGC joint practice guidelines reflect the current scientific and clinical knowledge at the time of publication, are current only as of their publication date, and are subject to change without notice as advances emerge. In addition, variations in practice, which take into account the needs of the individual patient and the resources and limitations unique to the institution or type of practice, may warrant approaches, treatments, and/or procedures that differ from the recommendations outlined in this guideline. Therefore, these recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. Genetic counseling practice guidelines are never intended to displace a health-care provider's best medical judgment based on the clinical circumstances of a particular patient or patient population. Practice guidelines are published by the ACMG or the NSGC for educational and informational purposes only, and neither the ACMG nor the NSGC "approve" or "endorse" any specific methods, practices, or sources of information.Cancer genetic consultation is an important aspect of the care of individuals at increased risk of a hereditary cancer syndrome. Yet several patient, clinician, and system-level barriers hinder identification of individuals appropriate for cancer genetics

  8. Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007-2016).

    Science.gov (United States)

    Mòdol, Josep M; Roure, Sílvia; Smithson, Àlex; Fernández-Rivas, Gema; Esquerrà, Anna; Robert, Neus; Méndez, María; Ramos, Javier; Carreres, Anna; Valerio, Lluís

    2017-09-11

    Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia. After 10 years of surveillance

  9. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  10. Development of environmental guidelines for electronic appliances

    DEFF Research Database (Denmark)

    Legarth, Jens Brøbech; Alting, Leo; Erichsen, Hanne K. Linnet

    1994-01-01

    This paper presents a general method for the development of environmental guidelines for complex products. The method is based on the life cycle concept. The application of life cycle assessment methods reveals the peak environmental impacts, and their source resulting in environmental guidelines...

  11. Quantification of beta-cell function during IVGTT in Type II and non-diabetic subjects: assessment of insulin secretion by mathematical methods

    DEFF Research Database (Denmark)

    Kjems, L L; Vølund, A; Madsbad, Sten

    2001-01-01

    AIMS/HYPOTHESIS: We compared four methods to assess their accuracy in measuring insulin secretion during an intravenous glucose tolerance test in patients with Type II (non-insulin-dependent) diabetes mellitus and with varying beta-cell function and matched control subjects. METHODS: Eight control...... subjects and eight Type II diabetic patients underwent an intravenous glucose tolerance test with tolbutamide and an intravenous bolus injection of C-peptide to assess C-peptide kinetics. Insulin secretion rates were determined by the Eaton deconvolution (reference method), the Insulin SECretion method...... (ISEC) based on population kinetic parameters as well as one-compartment and two-compartment versions of the combined model of insulin and C-peptide kinetics. To allow a comparison of the accuracy of the four methods, fasting rates and amounts of insulin secreted during the first phase (0-10 min...

  12. Optimized Heart Sampling and Systematic Evaluation of Cardiac Therapies in Mouse Models of Ischemic Injury: Assessment of Cardiac Remodeling and Semi-Automated Quantification of Myocardial Infarct Size.

    Science.gov (United States)

    Valente, Mariana; Araújo, Ana; Esteves, Tiago; Laundos, Tiago L; Freire, Ana G; Quelhas, Pedro; Pinto-do-Ó, Perpétua; Nascimento, Diana S

    2015-12-02

    Cardiac therapies are commonly tested preclinically in small-animal models of myocardial infarction. Following functional evaluation, post-mortem histological analysis is essential to assess morphological and molecular alterations underlying the effectiveness of treatment. However, non-methodical and inadequate sampling of the left ventricle often leads to misinterpretations and variability, making direct study comparisons unreliable. Protocols are provided for representative sampling of the ischemic mouse heart followed by morphometric analysis of the left ventricle. Extending the use of this sampling to other types of in situ analysis is also illustrated through the assessment of neovascularization and cellular engraftment in a cell-based therapy setting. This is of interest to the general cardiovascular research community as it details methods for standardization and simplification of histo-morphometric evaluation of emergent heart therapies. © 2015 by John Wiley & Sons, Inc. Copyright © 2015 John Wiley & Sons, Inc.

  13. Quantification of beta-cell function during IVGTT in Type II and non-diabetic subjects: assessment of insulin secretion by mathematical methods

    DEFF Research Database (Denmark)

    Kjems, L L; Vølund, A; Madsbad, Sten

    2001-01-01

    AIMS/HYPOTHESIS: We compared four methods to assess their accuracy in measuring insulin secretion during an intravenous glucose tolerance test in patients with Type II (non-insulin-dependent) diabetes mellitus and with varying beta-cell function and matched control subjects. METHODS: Eight control...... subjects and eight Type II diabetic patients underwent an intravenous glucose tolerance test with tolbutamide and an intravenous bolus injection of C-peptide to assess C-peptide kinetics. Insulin secretion rates were determined by the Eaton deconvolution (reference method), the Insulin SECretion method......-phase insulin response (r = 0.78). The two-compartment combined model failed to provide reliable estimates of insulin secretion in three of the control subjects and in two patients with Type II diabetes. The four methods were accurate with respect to mean basal and first-phase secretion response. The one...

  14. Heterogeneity of CD8+ tumor-infiltrating lymphocytes in non-small-cell lung cancer: impact on patient prognostic assessments and comparison of quantification by different sampling strategies

    Science.gov (United States)

    Obeid, Joseph M.; Wages, Nolan A.; Hu, Yinin; Deacon, Donna H.

    2017-01-01

    Introduction Infiltration of non-small-cell lung cancer (NSCLC) by CD8+ T lymphocytes predicts improved patient survival; however, heterogeneity of intratumoral localization complicates this assessment. Strategies for tumor sampling may not accurately represent the whole tumor. We hypothesized that sampling strategies may alter the identification of tumors with high CD8 density and affect the prognostic significance. Patients and methods Twenty-three primary NSCLC tumors were immunohistochemically stained for CD8 and were assessed using automated software with eight different sampling strategies or the whole tumor. Results of all sampling strategies were compared to the whole tumor counts (paired t tests, Pearson’s r). Associations between CD8 densities and overall survival were assessed (log-rank test). Results Counts from all eight sampling strategies significantly correlated with whole tumor counts (p ≤ 0.001). However, the magnitude of CD8+ cell counts and categorization into high vs low infiltrate groups were affected by the sampling strategy. The most concordant values were derived from random sampling of 20 % of the tumor, a simulated core biopsy, or from sampling the tumor center. TIL infiltration was associated with survival when sampling the center (p = 0.038), but not the invasive margin (p > 0.2) or other strategies. Conclusion Different tumor sampling strategies may yield discordant TIL density results and different stratification for risk assessment. Small biopsies may be particularly unrepresentative. Random sampling of larger tumor areas is recommended. Enumerating CD8+ T cells in the tumor center may have prognostic value. PMID:27770170

  15. Assessing the effect of a guideline change on drug use prevalence by including the birth cohort dimension : the case of benzodiazepines

    NARCIS (Netherlands)

    Bijlsma, Maarten J.; Hak, Eelko; Bos, Jens; De Jong-van den Berg, Lolkje T. W.; Janssen, Fanny

    Purpose The aim of this study was to investigate whether including the birth cohort dimension in time series analysis leads to a more accurate estimation of the (long-term) effect of a guideline change on the trend of benzodiazepine use. Methods We calculated age-specific (20-84years) and

  16. A quantification of damage and assessment of economic loss due to crop raiding by Asian Elephant Elephas maximus (Mammalia: Proboscidea: Elephantidae: a case study of Manas National Park, Assam, India

    Directory of Open Access Journals (Sweden)

    Naba K. Nath

    2015-02-01

    Full Text Available A study was carried out in Manas National Park, Assam in northeastern India between 2007 and 2009 to understand the magnitude of human-elephant conflict through a quantification of damage and assessment of economic loss. A cluster of six villages adjacent to the Park was selected for this study. Five major agricultural crops were grown during the study period of which three were raided by elephants: winter paddy, autumn paddy and pulses. Paddy was the principle crop central to the farmers’ subsistence. Winter paddy was the most cultivated crop and autumn paddy was the least cultivated. The incidence rate of crop raiding was highest for autumn paddy and lowest for pulses. Overall economic loss due to crop raiding was negligible, however at the individual farmer level, it was quite high. The study revealed that human-elephant conflict is not so severe, indicating ample opportunity for human-elephant coexistence in the region. Crop fields adjacent to the Park were particularly vulnerable to crop raiding which necessitates creation of a buffer zone. The frequency of raiding and the extent of damage was found to be significantly less in crop fields which were guarded by farmers. This was due to traditional crop guarding practices being followed in the region, the strengthening of which could effectively reduce annual crop loss and thus human-elephant conflict could be minimized to a large extent.

  17. Quantification of myocardial perfusion by cardiovascular magnetic resonance.

    Science.gov (United States)

    Jerosch-Herold, Michael

    2010-10-08

    The potential of contrast-enhanced cardiovascular magnetic resonance (CMR) for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community.

  18. How to develop guidelines for clinical practice.

    Science.gov (United States)

    Jaeschke, R; Jankowski, M; Brozek, J; Antonelli, M

    2009-09-01

    Recent decades have seen an explosion of clinical practice guidelines documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines' quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations.

  19. Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline.

    Science.gov (United States)

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M; Jones, Peter H; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M; Virani, Salim S

    2016-03-01

    Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown. We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed. Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers' ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥ 7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively. A case-based educational intervention was associated with significant increase in providers' knowledge towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline. Published by Elsevier Ireland Ltd.

  20. Case-based Educational Intervention to Assess Change in Providers’ Knowledge and Attitudes Towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

    Science.gov (United States)

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M.; Jones, Peter H.; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M.; Virani, Salim S.

    2017-01-01

    Objective Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown. Methods We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed. Results Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers’ ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively. Conclusions A case-based educational intervention was associated with significant improvements in providers’ knowledge and attitudes towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline. PMID:26773472

  1. Physical Activity Guidelines

    Science.gov (United States)

    ... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource for ...

  2. Interpreting procedures from descriptive guidelines.

    Science.gov (United States)

    Peleg, Mor; Gutnik, Lily A; Snow, Vincenza; Patel, Vimla L

    2006-04-01

    Errors in clinical practice guidelines may translate into errors in real-world clinical practice. The best way to eliminate these errors is to understand how they are generated, thus enabling the future development of methods to catch errors made in creating the guideline before publication. We examined the process by which a medical expert from the American College of Physicians (ACP) created clinical algorithms from narrative guidelines, as a case study. We studied this process by looking at intermediate versions produced during the algorithm creation. We identified and analyzed errors that were generated at each stage, categorized them using Knuth's classification scheme, and studied patterns of errors that were made over the set of algorithm versions that were created. We then assessed possible explanations for the sources of these errors and provided recommendations for reducing the number of errors, based on cognitive theory and on experience drawn from software engineering methodologies.

  3. Integrating Allergen Analysis Within a Risk Assessment Framework: Approaches to Development of Targeted Mass Spectrometry Methods for Allergen Detection and Quantification in the iFAAM Project.

    Science.gov (United States)

    Nitride, Chiara; Lee, Victoria; Baricevic-Jones, Ivona; Adel-Patient, Karine; Baumgartner, Sabine; Mills, E N Clare

    2017-12-05

    Allergen analysis is central to implementing and monitoring food allergen risk assessment and management processes by the food industry, but current methods for the determination of allergens in foods give highly variable results. The European Union-funded "Integrated Approaches to Food Allergen and Allergy Risk Management" (iFAAM) project has been working to address gaps in knowledge regarding food allergen management and analysis, including the development of novel MS and immuno-based allergen determination methods. Common allergenic food ingredients (peanut, hazelnut, walnut, cow's milk [Bos domesticus], and hen's egg [Gallus domesticus]) and common food matrixes (chocolate dessert and cookie) have been used for both clinical studies and analytical method development to ensure that the new methods are clinically relevant. Allergen molecules have been used as analytical targets and allergenic ingredients incurred into matrixes at levels close to reference doses that may trigger the use of precautionary allergen labeling. An interlaboratory method comparison has been undertaken for the determination of peanut in chocolate dessert using MS and immuno-based methods. The iFAAM approach has highlighted the need for methods to report test results in allergenic protein. This will allow food business operators to use them in risk assessments that are founded on clinical study data in which protein has been used as a measure of allergenic potency.

  4. Application of the homology method for quantification of low-attenuation lung region in patients with and without COPD

    Directory of Open Access Journals (Sweden)

    Nishio M

    2016-09-01

    Full Text Available Mizuho Nishio,1 Kazuaki Nakane,2 Yutaka Tanaka3 1Clinical PET Center, Institute of Biomedical Research and Innovation, Hyogo, Japan; 2Department of Molecular Pathology, Osaka University Graduate School of Medicine and Health Science, Osaka, Japan; 3Department of Radiology, Chibune General Hospital, Osaka, Japan Background: Homology is a mathematical concept that can be used to quantify degree of contact. Recently, image processing with the homology method has been proposed. In this study, we used the homology method and computed tomography images to quantify emphysema.Methods: This study included 112 patients who had undergone computed tomography and pulmonary function test. Low-attenuation lung regions were evaluated by the homology method, and homology-based emphysema quantification (b0, b1, nb0, nb1, and R was performed. For comparison, the percentage of low-attenuation lung area (LAA% was also obtained. Relationships between emphysema quantification and pulmonary function test results were evaluated by Pearson’s correlation coefficients. In addition to the correlation, the patients were divided into the following three groups based on guidelines of the Global initiative for chronic Obstructive Lung Disease: Group A, nonsmokers; Group B, smokers without COPD, mild COPD, and moderate COPD; Group C, severe COPD and very severe COPD. The homology-based emphysema quantification and LAA% were compared among these groups.Results: For forced expiratory volume in 1 second/forced vital capacity, the correlation coefficients were as follows: LAA%, -0.603; b0, -0.460; b1, -0.500; nb0, -0.449; nb1, -0.524; and R, -0.574. For forced expiratory volume in 1 second, the coefficients were as follows: LAA%, -0.461; b0, -0.173; b1, -0.314; nb0, -0.191; nb1, -0.329; and R, -0.409. Between Groups A and B, difference in nb0 was significant (P-value = 0.00858, and those in the other types of quantification were not significant.Conclusion: Feasibility of the

  5. Future directions in dialysis quantification.

    Science.gov (United States)

    Lindsay, R M; Sternby, J

    2001-01-01

    The influence of dialysis prescription on outcome is well established, and currently the amount of dialysis prescribed is based on small molecular weight toxin removal as represented by the clearance of urea. The "normalized dose of dialysis" (Kt/V(urea)) concept is well established. Most techniques for dialysis quantification require that blood samples be taken at the beginning and after the completion of dialysis. The postdialysis sample, however, gives cause for concern because of the "rebound phenomenon" due to nonuniform distribution of urea among body compartments. Blood samples give "indirect" measures of dialysis quantification. Thus direct urea concentration measurements in dialysate may be superior in urea kinetic modeling and these may be made "real time" during dialysis. It is with real-time monitoring that future advances in dialysis quantification will take place. These will be of two types. The first will analyze blood water or dialysate samples for urea content multiple times throughout the treatment; the second will assess the on-line clearance of urea using surrogate molecules such as sodium chloride, the clearance being determined by conductivity measurements. On-line urea monitoring is based on the action of urease on urea in a water solution and measurement of the resultant ammonium ions, which are measured directly by a specific electrode or indirectly by conductivity changes. Differences in blood-side versus dialysate-side urea monitors exist which reflect the parameters they can provide, but with both, the standard urea kinetic measurements of Kt/V and nPCR (nPNA) are easily obtainable. A range of additional parameters can be derived from dialysate-side monitoring such as "whole-body Kt/V," "pretreatment urea mass" and "whole-body urea clearance," which are worthy of future studies to determine their roles in adequacy assessment. Conductivity clearance measurements are made by examining the conductivity differences between dialysate inlet

  6. Comparative evaluation of the isolation and quantification of stem cells derived from dental pulp and periodontal ligament of a permanent tooth and to assess their viability and proliferation on a platelet-rich fibrin scaffold.

    Science.gov (United States)

    Khurana, Rohit; Kudva, Praveen Bhasker; Husain, Syed Yawer

    2017-01-01

    The present study aims to comparatively evaluate the isolation and quantification of stem cells derived from dental pulp and periodontal ligament of a permanent tooth and to assess their viability and proliferation on a platelet-rich fibrin (PRF) scaffold. A total of 15 systemically healthy individuals between the age group of 15-25 years requiring third molar or orthodontic premolar extractions. Teeth were extracted atraumatically and transported to the laboratory. Stem cells were isolated from dental pulp and periodontal ligament. After attaining more than 90% confluency by the 7th day, these cells were tested for their viability and characterization. Stem cells were also incubated with PRF and viability was assessed on the 7th day. The mean number of cell for dental pulp stem cells (DPSCs) and periodontal ligament stem cell (PDLSC) was statistically insignificant (P > 0.05). The mean live cell viability was compared between DPSC (98.07%) and PDLSC (98%). Both DPSC and PDLSC showed a high percentage of expression of CD73 markers, 30.40% and 29.80%, respectively. However, DPSCs and PDLSCs lacked expression of CD34 expressing only 3.47% and 3.53%, respectively. PRF membrane as a scaffold exhibited no cytotoxic effects on DPCS's or PDLSC's. The cell viability of cells cultured with PRF was statistically insignificant (P > 0.05) when compared to the cells cultured with culture media. The study thus indicates that dental pulp and periodontal ligament are both rich sources of mesenchymal stem cells and can be successfully used for obtaining stem cells. PRF exhibits no cytotoxic effects on the cells and can be used in conjunction with dental stem cells.

  7. Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument

    OpenAIRE

    Guo, Yi; Bian, Jiang; Leavitt, Trevor; Vincent, Heather K; Vander Zalm, Lindsey; Teurlings, Tyler L; Smith, Megan D; Modave, Fran?ois

    2017-01-01

    Background Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of s...

  8. Awareness and Compliance with Guidelines on Occupational ...

    African Journals Online (AJOL)

    Saharan Africa is increased by non-adherence to the principles of infection prevention practices. This study assessed the level of awareness and compliance with guideline on occupational exposure to HIV by health care workers (HCW).

  9. [Application of robustness test for assessment of the measurement uncertainty at the end of development phase of a chromatographic method for quantification of water-soluble vitamins].

    Science.gov (United States)

    Ihssane, B; Bouchafra, H; El Karbane, M; Azougagh, M; Saffaj, T

    2016-05-01

    We propose in this work an efficient way to evaluate the measurement of uncertainty at the end of the development step of an analytical method, since this assessment provides an indication of the performance of the optimization process. The estimation of the uncertainty is done through a robustness test by applying a Placquett-Burman design, investigating six parameters influencing the simultaneous chromatographic assay of five water-soluble vitamins. The estimated effects of the variation of each parameter are translated into standard uncertainty value at each concentration level. The values obtained of the relative uncertainty do not exceed the acceptance limit of 5%, showing that the procedure development was well done. In addition, a statistical comparison conducted to compare standard uncertainty after the development stage and those of the validation step indicates that the estimated uncertainty are equivalent. The results obtained show clearly the performance and capacity of the chromatographic method to simultaneously assay the five vitamins and suitability for use in routine application. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  10. Quality of qualitative research in the health sciences: Analysis of the common criteria present in 58 assessment guidelines by expert users.

    Science.gov (United States)

    Santiago-Delefosse, M; Gavin, A; Bruchez, C; Roux, P; Stephen, S L

    2016-01-01

    The number of qualitative research methods has grown substantially over the last thirty years, both in social sciences and, more recently, in health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. These guidelines, however, include many discrepancies, both in terms of vocabulary and structure. Many expert evaluators also decry the absence of consensual and reliable evaluation tools. To address this gap, we present the results of an evaluation of 58 existing guidelines in four major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology/psychiatry, research methods and organization) by expert (n = 16) and peer (n = 40) users (e.g., article reviewers, experts allocating funds, editors). This research was conducted between 2011 and 2014 at the University of Lausanne in Switzerland. Experts met during three workshops spread over this period. A series of 12 consensual essential criteria, along with definitions, stemmed from a question in a semi-qualitative evaluation questionnaire that we developed. Although there is consensus on the name of the criteria, we highlight limitations on the ability to compare specific definitions of criteria across health science fields. We conclude that each criterion must be explained to come to broader consensus and identify definitions that are easily operational and consensual to all fields examined. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India.

    Science.gov (United States)

    Sharma, Surendra K; Ryan, H; Khaparde, Sunil; Sachdeva, K S; Singh, Achintya D; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

    2017-04-01

    Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

  12. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

    Directory of Open Access Journals (Sweden)

    Surendra K Sharma

    2017-01-01

    Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

  13. Quantification of Permafrost Creep by Remote Sensing

    Science.gov (United States)

    Roer, I.; Kaeaeb, A.

    2008-12-01

    Rockglaciers and frozen talus slopes are distinct landforms representing the occurrence of permafrost conditions in high mountain environments. The interpretation of ongoing permafrost creep and its reaction times is still limited due to the complex setting of interrelating processes within the system. Therefore, a detailed monitoring of rockglaciers and frozen talus slopes seems advisable to better understand the system as well as to assess possible consequences like rockfall hazards or debris-flow starting zones. In this context, remote sensing techniques are increasingly important. High accuracy techniques and data with high spatial and temporal resolution are required for the quantification of rockglacier movement. Digital Terrain Models (DTMs) derived from optical stereo, synthetic aperture radar (SAR) or laser scanning data are the most important data sets for the quantification of permafrost-related mass movements. Correlation image analysis of multitemporal orthophotos allow for the quantification of horizontal displacements, while vertical changes in landform geometry are computed by DTM comparisons. In the European Alps the movement of rockglaciers is monitored over a period of several decades by the combined application of remote sensing and geodetic methods. The resulting kinematics (horizontal and vertical displacements) as well as spatio-temporal variations thereof are considered in terms of rheology. The distinct changes in process rates or landform failures - probably related to permafrost degradation - are analysed in combination with data on surface and subsurface temperatures and internal structures (e.g., ice content, unfrozen water content).

  14. Improved quantification of cerebral hemodynamics using individualized time thresholds for assessment of peak enhancement parameters derived from dynamic susceptibility contrast enhanced magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Christian Nasel

    Full Text Available Assessment of cerebral ischemia often employs dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC-MRI with evaluation of various peak enhancement time parameters. All of these parameters use a single time threshold to judge the maximum tolerable peak enhancement delay that is supposed to reliably differentiate sufficient from critical perfusion. As the validity of this single threshold approach still remains unclear, in this study, (1 the definition of a threshold on an individual patient-basis, nevertheless (2 preserving the comparability of the data, was investigated.The histogram of time-to-peak (TTP values derived from DSC-MRI, the so-called TTP-distribution curve (TDC, was modeled using a double-Gaussian model in 61 patients without severe cerebrovascular disease. Particular model-based zf-scores were used to describe the arterial, parenchymal and venous bolus-transit phase as time intervals Ia,p,v. Their durations (delta Ia,p,v, were then considered as maximum TTP-delays of each phase.Mean-R2 for the model-fit was 0.967. Based on the generic zf-scores the proposed bolus transit phases could be differentiated. The Ip-interval reliably depicted the parenchymal bolus-transit phase with durations of 3.4 s-10.1 s (median = 4.3s, where an increase with age was noted (∼30 ms/year.Individual threshold-adjustment seems rational since regular bolus-transit durations in brain parenchyma obtained from the TDC overlap considerably with recommended critical TTP-thresholds of 4 s-8 s. The parenchymal transit time derived from the proposed model may be utilized to individually correct TTP-thresholds, thereby potentially improving the detection of critical perfusion.

  15. Improved Quantification of Cerebral Hemodynamics Using Individualized Time Thresholds for Assessment of Peak Enhancement Parameters Derived from Dynamic Susceptibility Contrast Enhanced Magnetic Resonance Imaging

    Science.gov (United States)

    Nasel, Christian; Kalcher, Klaudius; Boubela, Roland; Moser, Ewald

    2014-01-01

    Purpose Assessment of cerebral ischemia often employs dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC-MRI) with evaluation of various peak enhancement time parameters. All of these parameters use a single time threshold to judge the maximum tolerable peak enhancement delay that is supposed to reliably differentiate sufficient from critical perfusion. As the validity of this single threshold approach still remains unclear, in this study, (1) the definition of a threshold on an individual patient-basis, nevertheless (2) preserving the comparability of the data, was investigated. Methods The histogram of time-to-peak (TTP) values derived from DSC-MRI, the so-called TTP-distribution curve (TDC), was modeled using a double-Gaussian model in 61 patients without severe cerebrovascular disease. Particular model-based zf-scores were used to describe the arterial, parenchymal and venous bolus-transit phase as time intervals Ia,p,v. Their durations (delta Ia,p,v), were then considered as maximum TTP-delays of each phase. Results Mean-R2 for the model-fit was 0.967. Based on the generic zf-scores the proposed bolus transit phases could be differentiated. The Ip-interval reliably depicted the parenchymal bolus-transit phase with durations of 3.4 s–10.1 s (median = 4.3s), where an increase with age was noted (∼30 ms/year). Conclusion Individual threshold-adjustment seems rational since regular bolus-transit durations in brain parenchyma obtained from the TDC overlap considerably with recommended critical TTP-thresholds of 4 s–8 s. The parenchymal transit time derived from the proposed model may be utilized to individually correct TTP-thresholds, thereby potentially improving the detection of critical perfusion. PMID:25521121

  16. A new 2D-based method for myocardial velocity strain and strain rate quantification in a normal adult and paediatric population: assessment of reference values

    Directory of Open Access Journals (Sweden)

    Arcidiacono C

    2009-02-01

    Full Text Available Abstract Background Recent advances in technology have provided the opportunity for off-line analysis of digital video-clips of two-dimensional (2-D echocardiographic images. Commercially available software that follows the motion of cardiac structures during cardiac cycle computes both regional and global velocity, strain, and strain rate (SR. The present study aims to evaluate the clinical applicability of the software based on the tracking algorithm feature (studied for cardiology purposes and to derive the reference values for longitudinal and circumferential strain and SR of the left ventricle in a normal population of children and young adults. Methods 45 healthy volunteers (30 adults: 19 male, 11 female, mean age 37 ± 6 years; 15 children: 8 male, 7 female, mean age 8 ± 2 years underwent transthoracic echocardiographic examination; 2D cine-loops recordings of apical 4-four 4-chamber (4C and 2-chamber (2C views and short axis views were stored for off-line analysis. Computer analyses were performed using specific software relying on the algorithm of optical flow analysis, specifically designed to track the endocardial border, installed on a Windows™ based computer workstation. Inter and intra-observer variability was assessed. Results The feasibility of measurements obtained with tissue tracking system was higher in apical view (100% for systolic events; 64% for diastolic events than in short axis view (70% for systolic events; 52% for diastolic events. Longitudinal systolic velocity decreased from base to apex in all subjects (5.22 ± 1.01 vs. 1.20 ± 0.88; p Values of global systolic SR, both longitudinal and circumferential, were significantly higher in children than in adults (-1.3 ± 0.2, vs. -1.11 ± 0.2, p = 0.006; -1.9 ± 0.6 vs. -1.6 ± 0.5, p = 0.0265, respectively. No significant differences in longitudinal and circumferential systolic velocities were identified for any segment when comparing adults with children. Conclusion

  17. EAU guidelines on chronic pelvic pain.

    Science.gov (United States)

    Fall, Magnus; Baranowski, Andrew P; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J; Oberpenning, Frank; de C Williams, Amanda C

    2010-01-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients. Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references. The full text of the guidelines is available through the EAU Central Office and the EAU Web site (www.uroweb.org). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP. A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP.

  18. Wrappers, Aspects, Quantification and Events

    Science.gov (United States)

    Filman, Robert E.

    2005-01-01

    Talk overview: Object infrastructure framework (OIF). A system development to simplify building distributed applications by allowing independent implementation of multiple concern. Essence and state of AOP. Trinity. Quantification over events. Current work on a generalized AOP technology.

  19. Verb aspect, alternations and quantification

    Directory of Open Access Journals (Sweden)

    Svetla Koeva

    2015-11-01

    Full Text Available Verb aspect, alternations and quantification In this paper we are briefly discuss the nature of Bulgarian verb aspect and argue that the verb aspect pairs are different lexical units with different (although related meaning, different argument structure (reflecting categories, explicitness and referential status of arguments and different sets of semantic and syntactic alternations. The verb prefixes resulting in perfective verbs derivation in some cases can be interpreted as lexical quantifiers as well. Thus the Bulgarian verb aspect is related (in different way both with the potential for the generation of alternations and with the prefixal lexical quantification. It is shown that the scope of the lexical quantification by means of verbal prefixes is the quantified verb phrase and the scope remains constant in all derived alternations. The paper concerns the basic issues of these complex problems, while the detailed description of the conditions satisfying particular alternation or particular lexical quantification are subject of a more detailed study.

  20. Home-based Palliative Services under Two Local Self-government Institutions of Kerala, India: An Assessment of Compliance with Policy and Guidelines to Local Self-government Institutions.

    Science.gov (United States)

    Jayalakshmi, Rajeev; Suhita, Chatterjee Chopra

    2017-01-01

    In contrast to India's poor performance in palliative and end-of-life care, the state of Kerala has gained considerable attention for its palliative care (PC) policy. This study tried to understand the structure, organization, and delivery of the program currently offered to the rural population, and its conformity to the state's PC policy and guidelines for Local Self-government Institutions (LSGIs). A descriptive research design involving a review of Kerala palliative policy and guidelines for LSGIs was followed by direct field observation and interviews of stakeholders. Two LSGIs in rural Kerala served also by a nongovernmental organization (NGO), were selected. Data were collected from health workers (doctors, nurses, and PC nurses), government stakeholders (LSGI members and representatives of the National Health Mission), and the health workers and officials of NGO. The program in two LSGIs varies considerably in terms of composition of the palliative team, infrastructure and human resource, cost, and type of service provided to the community. A comparative assessment with a nongovernmental service provider shows that the services offered by the LSGIs seemed to be restricted in scope to meet the needs of the resource-stricken community. Compliance with policy guidelines seems to be poor for both the LSGIs. Despite a robust policy, the palliative program lacks a public health approach to end-of-life care. A structural reconfiguration of the delivery system is needed, involving greater state responsibility and political will in integrating PC within a broader social organization of care.

  1. Training load quantification in triathlon

    OpenAIRE

    Cejuela Anta, Roberto; Esteve-Lanao, Jonathan

    2011-01-01

    There are different Indices of Training Stress of varying complexity, to quantification Training load. Examples include the training impulse (TRIMP), the session (RPE), Lucia’s TRIMP or Summated Zone Score. But the triathlon, a sport to be combined where there are interactions between different segments, is a complication when it comes to quantify the training. The aim of this paper is to review current methods of quantification, and to propose a scale to quantify the training load in triathl...

  2. Dutch Venous Ulcer guideline update.

    Science.gov (United States)

    Maessen-Visch, M Birgitte; de Roos, Kees-Peter

    2014-05-01

    The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Quality of primary care guidelines for acute low back pain.

    NARCIS (Netherlands)

    van Tulder, Maurits W.; Tuut, Mariska; Pennick, Victoria; Bombardier, Claire; Assendelft, Willem J J

    2004-01-01

    STUDY DESIGN: Systematic review of clinical guidelines. OBJECTIVES: To assess the methodologic quality of existing guidelines for the management of acute low back pain. SUMMARY OF BACKGROUND DATA: Guidelines are playing an increasingly important role in evidence-based practice. After publication of

  4. How nurses seek and evaluate clinical guidelines on the Internet

    NARCIS (Netherlands)

    Verhoeven, F.; Steehouder, M.F.; Hendrix, Ron M.G.; van Gemert-Pijnen, Julia E.W.C.

    2010-01-01

    Aim: This paper is a report of a study conducted to assess nurses’ information-seeking strategies and problems encountered when seeking clinical guidelines on the Internet, and to investigate the criteria they apply when evaluating the guidelines and the websites communicating the guidelines. -

  5. Public informations guidelines

    Energy Technology Data Exchange (ETDEWEB)

    None

    1986-06-01

    The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities.

  6. Guideline clinical nutrition in patients with stroke.

    Science.gov (United States)

    Wirth, Rainer; Smoliner, Christine; Jäger, Martin; Warnecke, Tobias; Leischker, Andreas H; Dziewas, Rainer

    2013-12-01

    Stroke is regularly accompanied by dysphagia and other factors associated with decreased nutritional intake. Dysphagia with aspiration pneumonia and insufficient nutritional intake lead to worse outcome after stroke.This guideline is the first chapter of the guideline "Clinical Nutrition in Neurology" of the German Society for Clinical Nutrition (DGEM) which itself is one part of a comprehensive guideline about all areas of Clinical Nutrition. The thirty-one recommendations of the guideline are based on a systematic literature search and review, last updated December 31, 2011. All recommendations were discussed and consented at several consensus conferences with the entire DGEM guideline group. The recommendations underline the importance of an early screening and assessment of dysphagia and give advice for an evidence based and comprehensive nutritional management to avoid aspiration, malnutrition and dehydration.

  7. After Guidelines, What?

    Directory of Open Access Journals (Sweden)

    Dennis M Bowie

    2004-01-01

    Full Text Available In a recent survey, Canadian Thoracic Society (CTS members indicated that they feel our association should be involved in the production of guidelines (1. There is evidence in the literature that suggests guidelines can have some effect in changing behaviour, although this is variable and modest at best. Certainly, the production of guidelines is not without costs, particularly in time spent by experts in reviewing the literature and producing them. For good reasons, delays frequently occur in their production, often leading to recommendations that may be outdated. People sometimes forget that one of the most important reasons for producing guidelines is to identify questions that require future research.

  8. New worldwide lipid guidelines.

    Science.gov (United States)

    Saraf, Smriti; Ray, Kausik K

    2015-07-01

    Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in most countries. Modification of common risk factors such as dyslipidaemia can result in significant reduction of ASCVD incidence in the population and improve clinical outcomes. The purpose of this review is to discuss and compare the latest worldwide lipid guidelines, and to demonstrate the variation in practice in different parts of the world. The lipid guidelines have recently been updated in different countries. The National Institute for Health and Care Excellence (NICE) guidelines in the United Kingdom were issued in July 2014, are risk based and are broadly similar to the American College of Cardiology/American Heart Association task force guidelines that were published in November 2013. Both these guidelines are in variance with both the Canadian Guidelines and the European Society of Cardiology/European Atherosclerosis Society guidelines 2011, which are target based and have different risk scoring systems, which results in significant variation in practice and increased healthcare costs in certain countries. The difference in guidelines in different countries makes it difficult for the clinician to standardize the treatment provided to individuals. The variance in risk scoring systems makes it difficult to compare risk prediction tools across countries and hence the optimum treatment available for a given population. Standardization of guidelines based on randomized controlled trial data and validation and calibration of various risk scoring systems could help improve clinical outcomes in this high-risk group of individuals at risk of ASCVD within individual countries.

  9. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition.

    Science.gov (United States)

    Mehta, Nilesh M; Skillman, Heather E; Irving, Sharon Y; Coss-Bu, Jorge A; Vermilyea, Sarah; Farrington, Elizabeth Anne; McKeever, Liam; Hall, Amber M; Goday, Praveen S; Braunschweig, Carol

    2017-07-01

    This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and 2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The

  10. GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale.

    Science.gov (United States)

    Welch, Vivian A; Akl, Elie A; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed T; de Beer, Hans; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg; Morton, Rachael; Mosdol, Annhild; Petkovic, Jennifer; Schünemann, Holger J; Sharaf, Ravi N; Singh, Jasvinder A; Stanev, Roger; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

    2017-10-01

    This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Domestic and foreign trends in the prevalence of heart failure and the necessity of next-generation artificial hearts: a survey by the Working Group on Establishment of Assessment Guidelines for Next-Generation Artificial Heart Systems.

    Science.gov (United States)

    Tatsumi, Eisuke; Nakatani, Takeshi; Imachi, Kou; Umezu, Mitsuo; Kyo, Shun-Ei; Sase, Kazuhiro; Takatani, Setsuo; Matsuda, Hikaru

    2007-01-01

    A series of guidelines for development and assessment of next-generation medical devices has been drafted under an interagency collaborative project by the Ministry of Health, Labor and Welfare and the Ministry of Economy, Trade and Industry. The working group for assessment guidelines of next-generation artificial hearts reviewed the trend in the prevalence of heart failure and examined the potential usefulness of such devices in Japan and in other countries as a fundamental part of the process of establishing appropriate guidelines. At present, more than 23 million people suffer from heart failure in developed countries, including Japan. Although Japan currently has the lowest mortality from heart failure among those countries, the number of patients is gradually increasing as our lifestyle becomes more Westernized; the associated medical expenses are rapidly growing. The number of heart transplantations, however, is limited due to the overwhelming shortage of donor hearts, not only in Japan but worldwide. Meanwhile, clinical studies and surveys have revealed that the major causes of death in patients undergoing long-term use of ventricular assist devices (VADs) were infection, thrombosis, and mechanical failure, all of which are typical of VADs. It is therefore of urgent and universal necessity to develop next-generation artificial hearts that have excellent durability to provide at least 2 years of event-free operation with a superior quality of life and that can be used for destination therapy to save patients with irreversible heart failure. It is also very important to ensure that an environment that facilitates the development, testing, and approval evaluation processes of next-generation artificial hearts be established as soon as possible.

  12. Assessment of five different guideline indication criteria for spirometry, including modified GOLD criteria, in order to detect COPD: data from 5,315 subjects in the PLATINO study.

    Science.gov (United States)

    Luize, Ana P; Menezes, Ana Maria B; Perez-Padilla, Rogelio; Muiño, Adriana; López, Maria Victorina; Valdivia, Gonzalo; Lisboa, Carmem; Montes de Oca, Maria; Tálamo, Carlos; Celli, Bartolomé; Nascimento, Oliver A; Gazzotti, Mariana R; Jardim, José R

    2014-10-30

    Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity. Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria. Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status. Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8). There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity.

  13. D 59 Design Guidelines

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Lamberti, Alberto

    The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

  14. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), David, CA (United States)

    2012-04-01

    The purpose of this measure guideline is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  15. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  16. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2016-01-01

    and symptoms. CHW treatment registers were reviewed to identify children eligible for referral according to training guidelines (temperature of ≥38.5 °C), to assess whether CHWs adhered to the guidelines and referred them. Factors associated with adherence were examined with logistic regression models. Results...... to the referral guideline. Methods A secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe...

  17. Methodological considerations in quantification of oncological FDG PET studies

    Energy Technology Data Exchange (ETDEWEB)

    Vriens, Dennis; Visser, Eric P.; Geus-Oei, Lioe-Fee de; Oyen, Wim J.G. [Radboud University Nijmegen Medical Centre, Department of Nuclear Medicine, Nijmegen (Netherlands)

    2010-07-15

    This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and research. Structural PubMed searches have been performed for the many factors affecting quantification of glucose metabolism by FDG PET. Review articles and references lists have been used to supplement the search findings. Biological factors such as fasting blood glucose level, FDG uptake period, FDG distribution and clearance, patient motion (breathing) and patient discomfort (stress) all influence quantification. Acquisition parameters should be adjusted to maximize the signal to noise ratio without exposing the patient to a higher than strictly necessary radiation dose. This is especially challenging in pharmacokinetic analysis, where the temporal resolution is of significant importance. The literature is reviewed on the influence of attenuation correction on parameters for glucose metabolism, the effect of motion, metal artefacts and contrast agents on quantification of CT attenuation-corrected images. Reconstruction settings (analytical versus iterative reconstruction, post-reconstruction filtering and image matrix size) all potentially influence quantification due to artefacts, noise levels and lesion size dependency. Many region of interest definitions are available, but increased complexity does not necessarily result in improved performance. Different methods for the quantification of the tissue of interest can introduce systematic and random inaccuracy. This review provides an up-to-date overview of the many factors that influence quantification of glucose metabolism by FDG PET. (orig.) 3.

  18. Methodological considerations in quantification of oncological FDG PET studies.

    NARCIS (Netherlands)

    Vriens, D.; Visser, E.P.; Geus-Oei, L.F. de; Oyen, W.J.G.

    2010-01-01

    PURPOSE: This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and

  19. Quantification of Rain Induced Artifacts on Digital Satellite Television ...

    African Journals Online (AJOL)

    The presence of artifacts on the high definition television (TV) content and the eventual loss of the digital TV signals to rain is still a major concern to satellite operators, ... The degrading effect is assessed using a subjective experimental approach, which is based on the quantification of the artifacts ruining user's Quality of ...

  20. MRI-based quantification of brain damage in cerebrovascular disorders

    NARCIS (Netherlands)

    de Bresser, J.H.J.M.

    2011-01-01

    Brain diseases can lead to diverse structural abnormalities that can be assessed on magnetic resonance imaging (MRI) scans. These abnormalities can be quantified by (semi-)automated techniques. The studies described in this thesis aimed to optimize and apply cerebral quantification techniques in

  1. Literacy and Language Education: The Quantification of Learning

    Science.gov (United States)

    Gibb, Tara

    2015-01-01

    This chapter describes international policy contexts of adult literacy and language assessment and the shift toward standardization through measurement tools. It considers the implications the quantification of learning outcomes has for pedagogy and practice and for the social inclusion of transnational migrants.

  2. NCCN Practice Guidelines for Cancer Pain.

    Science.gov (United States)

    Benedetti, C; Brock, C; Cleeland, C; Coyle, N; Dubé, J E; Ferrell, B; Hassenbusch, S; Janjan, N A; Lema, M J; Levy, M H; Loscalzo, M J; Lynch, M; Muir, C; Oakes, L; O'Neill, A; Payne, R; Syrjala, K L; Urba, S; Weinstein, S M

    2000-11-01

    The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.

  3. Risk Assessment

    Science.gov (United States)

    How the EPA conducts risk assessment to protect human health and the environment. Several assessments are included with the guidelines, models, databases, state-based RSL Tables, local contacts and framework documents used to perform these assessments.

  4. Micro-RNA quantification using DNA polymerase and pyrophosphate quantification.

    Science.gov (United States)

    Yu, Hsiang-Ping; Hsiao, Yi-Ling; Pan, Hung-Yin; Huang, Chih-Hung; Hou, Shao-Yi

    2011-12-15

    A rapid quantification method for micro-RNA based on DNA polymerase activity and pyrophosphate quantification has been developed. The tested micro-RNA serves as the primer, unlike the DNA primer in all DNA sequencing methods, and the DNA probe serves as the template for DNA replication. After the DNA synthesis, the pyrophosphate detection and quantification indicate the existence and quantity of the tested miRNA. Five femtomoles of the synthetic RNA could be detected. In 20-100 μg RNA samples purified from SiHa cells, the measurement was done using the proposed assay in which hsa-miR-16 and hsa-miR-21 are 0.34 fmol/μg RNA and 0.71 fmol/μg RNA, respectively. This simple and inexpensive assay takes less than 5 min after total RNA purification and preparation. The quantification is not affected by the pre-miRNA which cannot serve as the primer for the DNA synthesis in this assay. This assay is general for the detection of the target RNA or DNA with a known matched DNA template probe, which could be widely used for detection of small RNA, messenger RNA, RNA viruses, and DNA. Therefore, the method could be widely used in RNA and DNA assays. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. GMO quantification: valuable experience and insights for the future.

    Science.gov (United States)

    Milavec, Mojca; Dobnik, David; Yang, Litao; Zhang, Dabing; Gruden, Kristina; Zel, Jana

    2014-10-01

    Cultivation and marketing of genetically modified organisms (GMOs) have been unevenly adopted worldwide. To facilitate international trade and to provide information to consumers, labelling requirements have been set up in many countries. Quantitative real-time polymerase chain reaction (qPCR) is currently the method of choice for detection, identification and quantification of GMOs. This has been critically assessed and the requirements for the method performance have been set. Nevertheless, there are challenges that should still be highlighted, such as measuring the quantity and quality of DNA, and determining the qPCR efficiency, possible sequence mismatches, characteristics of taxon-specific genes and appropriate units of measurement, as these remain potential sources of measurement uncertainty. To overcome these problems and to cope with the continuous increase in the number and variety of GMOs, new approaches are needed. Statistical strategies of quantification have already been proposed and expanded with the development of digital PCR. The first attempts have been made to use new generation sequencing also for quantitative purposes, although accurate quantification of the contents of GMOs using this technology is still a challenge for the future, and especially for mixed samples. New approaches are needed also for the quantification of stacks, and for potential quantification of organisms produced by new plant breeding techniques.

  6. Agreement between Cochrane Neonatal reviews and clinical practice guidelines for newborns in Denmark a cross sectional study

    DEFF Research Database (Denmark)

    Brok, Jesper; Greisen, Gorm; Madsen, Lars P

    2007-01-01

    OBJECTIVE: To assess agreement between Cochrane Neonatal Group reviews and clinical practice guidelines in Denmark. DESIGN: Retrospective analysis of clinical guidelines for newborn infants. Materials:All Cochrane neonatal reviews and Danish local clinical guidelines for newborn infants. MAIN OUT...

  7. Industry guidelines for the calibration of maximum anemometers

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, B.H. [AWS Scientific, Inc., Albany, NY (United States)

    1996-12-31

    The purpose of this paper is to report on a framework of guidelines for the calibration of the Maximum Type 40 anemometer. This anemometer model is the wind speed sensor of choice in the majority of wind resource assessment programs in the U.S. These guidelines were established by the Utility Wind Resource Assessment Program. In addition to providing guidelines for anemometers, the appropriate use of non-calibrated anemometers is also discussed. 14 refs., 1 tab.

  8. Assessing the HER2 status in mucinous epithelial ovarian cancer on the basis of the 2013 ASCO/CAP guideline update.

    Science.gov (United States)

    Chao, Wan-Ru; Lee, Ming-Yung; Lin, Wea-Lung; Koo, Chiew-Loon; Sheu, Gwo-Tarng; Han, Chih-Ping

    2014-09-01

    Her2 gene amplification and protein overexpression are important factors in predicting clinical sensitivity to anti-HER2 monoclonal antibody therapy in breast, gastric, or gastro-esophageal junction cancer patients. The purpose of this study was to evaluate the HER2 status in the mucinous epithelial ovarian cancer (EOC). Adopting the 2013 American Society for Clinical Oncology and the College of American Pathologists guideline update for HER2 testing, 49 tissue microarray samples of mucinous EOC were analyzed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests. The prevalence of HER2 positivity in Asian mucinous EOC was 9 of 49 Asian women (18.37%). The overall concordance was 100% between IHC and FISH results. Her2 gene copies before chromosome-17 correction increased significantly in a stepwise order through the negative, equivocal, and positive IHC result categories (PIHC and FISH tests for the Her2 gene copies per tumor cell either before or after correction of chromosome-17, and this can be applied as a potentially valuable tool to analyze the HER2 status. Polysomy-17 was absent under the CEP17 cutoff ≥3. The existence of HER2 heterogeneity can be discerned in certain HER2-expressed primary mucinous EOC in Taiwanese women.

  9. Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers' perspectives on relevance and challenges.

    Science.gov (United States)

    Hategeka, Celestin; Mwai, Leah; Tuyisenge, Lisine

    2017-04-07

    An emergency triage, assessment and treatment plus admission care (ETAT+) intervention was implemented in Rwandan district hospitals to improve hospital care for severely ill infants and children. Many interventions are rarely implemented with perfect fidelity under real-world conditions. Thus, evaluations of the real-world experiences of implementing ETAT+ are important in terms of identifying potential barriers to successful implementation. This study explored the perspectives of Rwandan healthcare workers (HCWs) on the relevance of ETAT+ and documented potential barriers to its successful implementation. HCWs enrolled in the ETAT+ training were asked, immediately after the training, their perspective regarding (i) relevance of the ETAT+ training to Rwandan district hospitals; (ii) if attending the training would bring about change in their work; and (iii) challenges that they encountered during the training, as well as those they anticipated to hamper their ability to translate the knowledge and skills learned in the ETAT+ training into practice in order to improve care for severely ill infants and children in their hospitals. They wrote their perspectives in French, Kinyarwanda, or English and sometimes a mixture of all these languages that are official in the post-genocide Rwanda. Their notes were translated to (if not already in) English and transcribed, and transcripts were analyzed using thematic content analysis. One hundred seventy-one HCWs were included in our analysis. Nearly all these HCWs stated that the training was highly relevant to the district hospitals and that it aligned with their work expectation. However, some midwives believed that the "neonatal resuscitation and feeding" components of the training were more relevant to them than other components. Many HCWs anticipated to change practice by initiating a triage system in their hospital and by using job aids including guidelines for prescription and feeding. Most of the challenges stemmed

  10. 561 SOURCE SPECIFIC QUANTIFICATION, CHARACTERISATION ...

    African Journals Online (AJOL)

    Osondu

    2013-09-02

    Sep 2, 2013 ... efficient and sustainable waste management. This study is the quantification, characterisation ... For efficient and sustainable solid waste management in Lapai it is recommended that Lapai Local Government Area Council .... a shop, a market stall, an eatery/restaurant, a hotel or any commercial enterprise.

  11. Towards the production of reliable quantitative microbiological data for risk assessment: Direct quantification of Campylobacter in naturally infected chicken fecal samples using selective culture and real-time PCR

    DEFF Research Database (Denmark)

    Garcia Clavero, Ana Belén; Vigre, Håkan; Josefsen, Mathilde Hasseldam

    2015-01-01

    and for the evaluation of control strategies implemented in poultry production. The aim of this study was to compare estimates of the numbers of Campylobacter spp. in naturally infected chicken fecal samples obtained using direct quantification by selective culture and by real-time PCR. Absolute quantification...... of Campylobacter by real-time PCR was performed using standard curves designed for two different DNA extraction methods: Easy-DNA™ Kit from Invitrogen (Easy-DNA) and NucliSENS® MiniMAG® from bioMérieux (MiniMAG). Results indicated that the estimation of the numbers of Campylobacter present in chicken fecal samples...... was partly dependent on the methodologies used. In general, the numbers of Campylobacter obtained by real-time PCR when extracting DNA using the MiniMAG method were in most cases higher than the numbers of Campylobacter obtained by selective culture and by real-time PCR when using the Easy-DNA method...

  12. Obstetric practice guidelines: labor's love lost?

    Science.gov (United States)

    Cohen, Wayne R; Friedman, Emanuel A

    2018-01-31

    Implementation of clinical practice guidelines may moderate health care costs, improve care, reduce medicolegal liability, and provide a uniformity in care allowing meaningful investigation of treatments and outcomes. However, new guidelines are often uncritically embraced by clinicians, risk management organizations, insurance companies, and the courts as the standard of care. Adoption of incompletely vetted recommendations can lead to patient harm. Recent recommendations made by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessment and management of labor provide an example of well-intended guidelines adopted uncritically. Ideally, but unattainably, each step in a practice guideline would be supported by results of prospective randomized trials. Usually, data from lower on the hierarchy of proof are included, and the personal or institutional preferences of the guideline developers influence the final product. These multiple resources help illuminate critical issues and balance competing perspectives, but can introduce biases that become embedded in our practice. The new labor management guidelines, which were never shown to be superior (or even equivalent) to current standards, have achieved widespread acceptance. Although they provide a formula for reducing the cesarean rate, they do so without concern for their potentially adverse effects on maternal or neonatal outcome. New guidelines should be outcome-based and address how to practice obstetrics to yield the best possible results for mother and baby.

  13. 3.8 Proposed approach to uncertainty quantification and sensitivity analysis in the next PA

    Energy Technology Data Exchange (ETDEWEB)

    Flach, Greg [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Wohlwend, Jen [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-10-02

    This memorandum builds upon Section 3.8 of SRNL (2016) and Flach (2017) by defining key error analysis, uncertainty quantification, and sensitivity analysis concepts and terms, in preparation for the next E-Area Performance Assessment (WSRC 2008) revision.

  14. Interpretation of biological and mechanical variations between the Lowry versus Bradford method for protein quantification

    National Research Council Canada - National Science Library

    Lu, Tzong-Shi; Yiao, Szu-Yu; Lim, Kenneth; Jensen, Roderick V; Hsiao, Li-Li

    2010-01-01

    .... We used the Lowry and Bradford methods- two most commonly used methods for protein quantification, to assess whether differential protein expressions are a result of true biological or methodical variations. MATERIAL #ENTITYSTARTX00026...

  15. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross......-sectional telephone survey. SETTING: All municipal health centres in Finland. SUBJECTS: Health centres where both the head physician and the senior nursing officer responded. MAIN OUTCOME MEASURES: Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p

  16. Adopting preoperative fasting guidelines.

    Science.gov (United States)

    Anderson, Megan; Comrie, Rhonda

    2009-07-01

    In 1999, the American Society of Anesthesiologists adopted preoperative fasting guidelines to enhance the quality and efficiency of patient care. Guidelines suggest that healthy, non-pregnant patients should fast six hours from solids and two hours from liquids. Although these guidelines are in place, studies suggest that providers are still using the blanket statement "NPO after midnight" without regard to patient characteristics, the procedure, or the time of the procedure. Using theory to help change provider's beliefs may help make change more successful. Rogers' Theory of Diffusion of Innovations can assist in changing long-time practice by laying the groundwork for an analysis of the benefits and disadvantages of proposed changes, such as changes to fasting orders, while helping initiate local protocols instead of additional national guidelines.

  17. EMI Messaging Guidelines

    CERN Document Server

    Cons, L.

    2011-01-01

    Guidelines for potential users of messaging within EMI. The goal is to provide enough practical information so that EMI product teams can start investigating whether using messaging in their products can be beneficial or not.

  18. Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

    Directory of Open Access Journals (Sweden)

    Perrier Lionel

    2012-03-01

    Full Text Available Abstract Background Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET comparing costs and outcomes when clinicians adhered to CPGs and when they did not. Methods Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006 or in the Veneto region of Italy (in 2007. Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach. All costs were expressed in euros (€ at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. Results A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%. Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. Conclusions Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of

  19. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....

  20. Electrical safety guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-01

    The Electrical Safety Guidelines prescribes the DOE safety standards for DOE field offices or facilities involved in the use of electrical energy. It has been prepared to provide a uniform set of electrical safety standards and guidance for DOE installations in order to affect a reduction or elimination of risks associated with the use of electrical energy. The objectives of these guidelines are to enhance electrical safety awareness and mitigate electrical hazards to employees, the public, and the environment.

  1. Verification& Validation (V&V) Guidelines and Quantitative Reliability at Confidence (QRC): Basis for an Investment Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Logan, R W; Nitta, C K

    2002-07-17

    This paper represents an attempt to summarize our thoughts regarding various methods and potential guidelines for Verification and Validation (V&V) and Uncertainty Quantification (UQ) that we have observed within the broader V&V community or generated ourselves. Our goals are to evaluate these various methods, to apply them to computational simulation analyses, and integrate them into methods for Quantitative Certification techniques for the nuclear stockpile. We describe the critical nature of high quality analyses with quantified V&V, and the essential role of V&V and UQ at specified Confidence levels in evaluating system certification status. Only after V&V has contributed to UQ at confidence can rational tradeoffs of various scenarios be made. UQ of performance and safety margins for various scenarios and issues are applied in assessments of Quantified Reliability at Confidence (QRC) and we summarize with a brief description of how these V&V generated QRC quantities fold into a Value-Engineering methodology for evaluating investment strategies. V&V contributes directly to the decision process for investment, through quantification of uncertainties at confidence for margin and reliability assessments. These contributions play an even greater role in a Comprehensive Test Ban Treaty (CTBT) environment than ever before, when reliance on simulation in the absence of the ability to perform nuclear testing is critical.

  2. CT quantification of central airway in tracheobronchomalacia

    Energy Technology Data Exchange (ETDEWEB)

    Im, Won Hyeong; Jin, Gong Yong; Han, Young Min; Kim, Eun Young [Dept. of Radiology, Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2016-05-15

    To know which factors help to diagnose tracheobronchomalacia (TBM) using CT quantification of central airway. From April 2013 to July 2014, 19 patients (68.0 ± 15.0 years; 6 male, 13 female) were diagnosed as TBM on CT. As case-matching, 38 normal subjects (65.5 ± 21.5 years; 6 male, 13 female) were selected. All 57 subjects underwent CT with end-inspiration and end-expiration. Airway parameters of trachea and both main bronchus were assessed using software (VIDA diagnostic). Airway parameters of TBM patients and normal subjects were compared using the Student t-test. In expiration, both wall perimeter and wall thickness in TBM patients were significantly smaller than normal subjects (wall perimeter: trachea, 43.97 mm vs. 49.04 mm, p = 0.020; right main bronchus, 33.52 mm vs. 42.69 mm, p < 0.001; left main bronchus, 26.76 mm vs. 31.88 mm, p = 0.012; wall thickness: trachea, 1.89 mm vs. 2.22 mm, p = 0.017; right main bronchus, 1.64 mm vs. 1.83 mm, p = 0.021; left main bronchus, 1.61 mm vs. 1.75 mm, p = 0.016). Wall thinning and decreased perimeter of central airway of expiration by CT quantification would be a new diagnostic indicators in TBM.

  3. Guidelines for accident prevention and emergency preparedness

    Energy Technology Data Exchange (ETDEWEB)

    Fthenakis, V.M.; Morris, S.C.; Moskowitz, P.D.

    1993-05-01

    This report reviews recent developments in the guidelines on chemical accident prevention, risk assessment, and management of chemical emergencies, principally in the United States and Europe, and discusses aspects of their application to developing countries. Such guidelines are either in the form of laws or regulations promulgated by governments, or of recommendations from international, professional, or non governmental organizations. In many cases, these guidelines specify lists of materials of concern and methods for evaluating safe usage of these materials and recommend areas of responsibility for different organizations; procedures to be included in planning, evaluation, and response; and appropriate levels of training for different classes of workers. Guidelines frequently address the right of communities to be informed of potential hazards and address ways for them to participate in planning and decision making.

  4. Japanese guidelines for allergic rhinitis 2017

    Directory of Open Access Journals (Sweden)

    Kimihiro Okubo

    2017-04-01

    To incorporate evidence based medicine (EBM introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2016. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA, this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

  5. Japanese Guideline for Allergic Rhinitis 2014

    Directory of Open Access Journals (Sweden)

    Kimihiro Okubo

    2014-01-01

    To incorporate evidence based medicine (EBM introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2013. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA, this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

  6. The changing Chinese SEA indicator guidelines

    DEFF Research Database (Denmark)

    Gao, Jingjing; Christensen, Per; Kørnøv, Lone

    2014-01-01

    general trends in the development of SEA and other environmental policies in a recent, Chinese context. Beside a more top-down, intentional approach specifying indicators for different sectors based on Chinese experiences from the preceding years, another significant change, following the new guidelines......In the last decades China has introduced a set of indicators to guide their Strategic Environmental Assessment (SEA) practice. The most recent indicator system, proposed in 2009, is based on sector-specific guidelines and it found its justification in past negative experiences with more general...... guidelines (from 2003), which were mostly inspired by, or copied from, international experiences. Based on interviews with practitioners, researchers and administrators, we map and analyse the change in the national guidelines. This analysis is based on a description of the indicators that makes it possible...

  7. EAU guidelines on penile curvature.

    Science.gov (United States)

    Hatzimouratidis, Konstantinos; Eardley, Ian; Giuliano, François; Hatzichristou, Dimitrios; Moncada, Ignacio; Salonia, Andrea; Vardi, Yoram; Wespes, Eric

    2012-09-01

    Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. To provide clinical guidelines on the diagnosis and treatment of penile curvature. A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction

  8. Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations.

    Science.gov (United States)

    Isma'eel, Hussain; Min, David; Al-Shaar, Laila; Hachamovitch, Rory; Halliburton, Sandra; Gentry, James; Griffin, Brian; Schoenhagen, Paul; Phelan, Dermot

    2016-11-15

    The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Assessment of hand functions in rheumatoid arthritis using SF-SACRAH (short form score for the assessment and quantification of chronic rheumatoid affections of the hands) and its correlation to disease activity.

    Science.gov (United States)

    Singh, Harpreet; Kumar, Suresh; Talapatra, Paulomi; Gupta, Vikas; Ray, Sucharita; Kumar, Harish

    2012-11-01

    Rheumatoid arthritis activity is generally evaluated by using DAS-28 score. But this does not reflect the extent of functional hand impairment, a decisive parameter for patient wellbeing as well as for work disability. Several questionnaires to quantify the hand involvement in RA have been elaborated, amongst which SACRAH has been popular since 2003. But this requires evaluating 23 questions on a visual analogue scale. The questions were reduced to 12 in modified-SACRAH (M-SACRAH) and to only five questions in short form SACRAH (SF-SACRAH) so as to make it easily applicable in daily clinical practice. A study was planned to compare M-SACRAH (already validated) to SF-SACRAH in Indian population as no Indian data are available on the same. A total of 100 patients of RA were evaluated for disease activity using DAS-28 score and hand functions using M-SACRAH and SF-SACRAH. The M-SACRAH and SF-SACRAH were then compared based on DAS-28 scores; also M-SACRAH was compared to SF-SACRAH using Spearman's correlation coefficient. The mean value of DAS-28 score was 3.15 ± 0.86. The mean value of SF-SACRAH was 8.065 ± 7.44, and mean value of M-SACRAH was 201.7 ± 201.1008. The correlation of DAS-28 score to SF-SACRAH and M-SACRAH was significant in moderate and high disease activity but insignificant in remission and low disease activity state. The correlation between M-SACRAH and SF-SACRAH showed a spearman's coefficient of 0.998 with a P value of disease activity states and for remission. The study suggests that the disease activity of rheumatoid arthritis (as assessed by DAS-28 score) has a poor correlation with hand functions (as assessed by M-SACRAH and SF-SACRAH) especially in low disease activity and remission states. Further, M-SACRAH and SF-SACRAH are significantly correlated. Therefore, it is suggested that RA patients should be assessed by SF-SACRAH (which includes five questions only) in addition to DAS-28 scoring for better evaluation of hand functions, a

  10. Primary care physician compliance with colorectal cancer screening guidelines.

    Science.gov (United States)

    Nodora, Jesse N; Martz, William D; Ashbeck, Erin L; Jacobs, Elizabeth T; Thompson, Patricia A; Martínez, María Elena

    2011-09-01

    To assess self-reported compliance to colorectal cancer (CRC) screening guidelines among primary care physicians (PCPs) and to assess physician and practice characteristics associated with reported compliance. Survey data from 984 PCPs in Arizona were used. Self-reported CRC screening practices, recommendations, and compliance with guidelines were assessed. Physician and practice characteristics associated with guideline compliance were also evaluated. While 77.5% of physicians reported using national screening guidelines, only 51.7% reported recommendations consistent with the guidelines. Younger physicians were significantly more likely to report compliance with screening guidelines (OR = 1.50, 95% CI = 1.07-2.10) as were female clinicians (OR = 1.46, 95% CI = 1.11-1.92). Physicians practicing in solo (OR = 0.33, 95% CI = 0.19-0.58), group (OR = 0.36, 95% CI = 0.21-0.62), or community health centers (OR = 0.37, 95% CI = 0.17-0.81) were significantly less likely to report following guidelines as compared to those in academic practice. Guideline compliance was higher for fecal occult blood test (FOBT) (65.0%) than colonoscopy (56.7%); overuse of screening for these modalities was reported among 34.4% of physicians. PCPs are not adequately following CRC screening guidelines. Further studies are needed to clarify the reasons for this lack of compliance, especially as guidelines become more complex.

  11. The wider use of fixed-dose combinations emphasizes the need for a global approach to regulatory guideline development

    DEFF Research Database (Denmark)

    Gautam, Yvonne; Bjerrum, Ole Jannik; Schmiegelow, Merete

    2015-01-01

    face the regulatory world: how to improve the role of regulatory science and provide clear quantification in assessment decisions; the role of guidelines and their impact on innovation; and, most important, the question of globalization and how to move toward a more harmonized regulatory system.......A fixed-dose combination (FDC) is a drug product in which two or more separate drug components (active pharmaceutical ingredients) are combined in a single-dosage form. Interest in developing FDCs is increasing in a range of diseases. This project investigated the regulatory environment for FDCs....... It was clear from the results that the current regulatory environment for FDCs lacks consistency. This may create a barrier to innovation moving from the laboratory to the clinic, as companies cannot clearly see the development path requirements. This project also highlighted certain challenges that currently...

  12. Guidelines on How to Read a Physics Textbook and the Assessment of the Readability of Recommended Physics Textbooks in Secondary Schools in Osun State of Nigeria

    Science.gov (United States)

    Akinbobola, Akinyemi Olufunminiyi

    2015-01-01

    This study assessed the readability of the four recommended physics textbooks in senior secondary schools in Osun State of Nigeria. A total of 25 physics teachers and 300 senior secondary three (SS3) physics students were randomly selected in the 12 secondary schools used for the study. A survey design was used for the study. Results showed that…

  13. Japanese Guideline for Atopic Dermatitis

    Directory of Open Access Journals (Sweden)

    Ichiro Katayama

    2011-01-01

    The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2009 (ADGL2009” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle.

  14. Development and Validation of a Stability-Indicating RP-HPLC Method by a Statistical Optimization Process for the Quantification of Asenapine Maleate in Lipidic Nanoformulations.

    Science.gov (United States)

    Managuli, Renuka S; Kumar, Lalit; Chonkar, Ankita D; Shirodkar, Rupesh K; Lewis, Shaila; Koteshwara, Kunnatur B; Reddy, Meka Sreenivasa; Mutalik, Srinivas

    2016-09-01

    A stability-indicating RP-HPLC method was developed for quantification of asenapine maleate (ASPM) in lipid nanoformulations. The proposed method was used to assess intrinsic stability of ASPM by conducting force degradation study. The results indicated no considerable degradation of ASPM on subjecting it to hydrolytic, oxidative, thermal and photolytic stresses. The method was validated according to ICH Q2(R1) guidelines by employing Full factorial design using Design-Expert(®) software. ASPM was precisely and accurately quantified in nanoparticles by separating it on Hyperclone BDS C18 using 80-20% v/v mixture of potassium phosphate solution containing 0.1% v/v triethylamine and acetonitrile. The effect of flow rate, pH, acetonitrile content and column temperature was assessed on method responses. The current method was linear in the range of 0.1-20 µg/mL with limit of detection (LOD) and limit of quantification (LOQ) of 29 and 89 ng/mL, respectively. The method was precise and accurate in the determination of ASPM with peak area RSD and recovery of ASPM content in bulk and lipid nanoformulations. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. A qualitative assessment of practitioner perspectives post-introduction of the first Continuous Professional Competence (CPC) guidelines for emergency medical technicians in Ireland.

    LENUS (Irish Health Repository)

    Knox, Shane

    2015-01-01

    In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)\\/continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement.

  16. Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study.

    Science.gov (United States)

    Hand, Rosa K; Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

    2016-11-15

    Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals' attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. The sample included 294 original tweets with the hashtag "#heartfailure." The most frequent message content codes were "HF awareness" (166/294, 56.5%) and "patient support" (97/294, 33.0%). The most frequent source codes were "professional, government, patient advocacy organization, or charity" (112/277, 40.4%) and "patient or family" (105/277, 37.9%). The most frequent target audience codes were "unable to identify" (111/277, 40.1%) and "other" (55/277, 19.9%). Significant differences were found in the popularity of

  17. Generalizing cell segmentation and quantification.

    Science.gov (United States)

    Wang, Zhenzhou; Li, Haixing

    2017-03-23

    In recent years, the microscopy technology for imaging cells has developed greatly and rapidly. The accompanying requirements for automatic segmentation and quantification of the imaged cells are becoming more and more. After studied widely in both scientific research and industrial applications for many decades, cell segmentation has achieved great progress, especially in segmenting some specific types of cells, e.g. muscle cells. However, it lacks a framework to address the cell segmentation problems generally. On the contrary, different segmentation methods were proposed to address the different types of cells, which makes the research work divergent. In addition, most of the popular segmentation and quantification tools usually require a great part of manual work. To make the cell segmentation work more convergent, we propose a framework that is able to segment different kinds of cells automatically and robustly in this paper. This framework evolves the previously proposed method in segmenting the muscle cells and generalizes it to be suitable for segmenting and quantifying a variety of cell images by adding more union cases. Compared to the previous methods, the segmentation and quantification accuracy of the proposed framework is also improved by three novel procedures: (1) a simplified calibration method is proposed and added for the threshold selection process; (2) a noise blob filter is proposed to get rid of the noise blobs. (3) a boundary smoothing filter is proposed to reduce the false seeds produced by the iterative erosion. As it turned out, the quantification accuracy of the proposed framework increases from 93.4 to 96.8% compared to the previous method. In addition, the accuracy of the proposed framework is also better in quantifying the muscle cells than two available state-of-the-art methods. The proposed framework is able to automatically segment and quantify more types of cells than state-of-the-art methods.

  18. Diffusion of CDC's Guidelines to Prevent Tobacco Use and Addiction.

    Science.gov (United States)

    McCormick, L; Tompkins, N O

    1998-02-01

    The Center for Disease Control and Prevention's School Guidelines to Prevent Tobacco Use and Addiction were developed, in part, to assist state and local education agencies in adopting and implementing effective school-based tobacco prevention and cessation programs. This project assessed state education agency awareness of and reaction to the Guidelines, and documented efforts to disseminate the Guidelines to local schools. Key informants in 15 state education agencies were interviewed. Respondents reported a fairly high level of receptivity to the Guidelines, numerous benefits and few barriers, and high commitment. Levels of use for the Guidelines varied. Dissemination strategies such as mass mailing or teleconferences are not sufficient to influence the use and integration of Guidelines for school health. The diffusion process requires planned change over time through numerous communication channels and should be monitored at the national, state, and local levels to assess effectiveness and impact.

  19. Towards objective quantification of the Tinetti test.

    Science.gov (United States)

    Panella, Lorenzo; Lombardi, Remo; Buizza, Angelo; Gandolfi, Roberto; Pizzagalli, Paola

    2002-01-01

    The Tinetti test is a widespread test for assessing motor control in the elderly, which could also be usefully applied in neurology. At present it uses a qualitative measurement scale. As a first step towards its objective quantification, trunk inclination was measured during the test by two inclinometers and quantified by descriptive parameters. The 95th or 5th percentiles of parameter distributions in normal subjects (no.=150) were taken as limits of normality, and parameters computed on 130 institutionalised elderly people were compared to these limits, to test the parameters' discriminatory power. The distributions of many parameters were statistically different in normal subjects and patients. These results suggest that this approach is a promising tool for objective evaluation of the Tinetti test.

  20. Translating Osteoporosis Prevention Guidelines.

    Science.gov (United States)

    Brennan-Olsen, Sharon L; Hosking, Sarah M; Dobbins, Amelia G; Pasco, Julie A

    2017-04-01

    In Australia, the social gradient of chronic disease has never been as prominent as in current times, and the uptake of preventive health messages appears to be lower in discrete population groups. In efforts to re-frame health promotion from addressing behavior change to empowerment, we engaged community groups in disadvantaged neighborhoods to translate published preventive guidelines into easy-to-understand messages for the general population. Our research team established partnerships with older aged community groups located in disadvantaged neighborhoods, determined by cross-referencing addresses with the Australian Bureau of Statistics, to translate guidelines regarding osteoporosis prevention. We developed an oversized jigsaw puzzle that we used to translate recommended osteoporosis prevention guidelines. Successful participatory partnerships between researchers, health promotion professionals, and community groups in disadvantaged neighborhoods build capacity in researchers to undertake future participatory processes; they also make the best use of expert knowledge held by specific communities.

  1. Guidelines for Project Management

    Science.gov (United States)

    Ben-Arieh, David

    2001-01-01

    Project management is an important part of the professional activities at Kennedy Space Center (KSC). Project management is the means by which many of the operations at KSC take shape. Moreover, projects at KSC are implemented in a variety of ways in different organizations. The official guidelines for project management are provided by NASA headquarters and are quite general. The project reported herein deals with developing practical and detailed project management guidelines in support of the project managers. This report summarizes the current project management effort in the Process Management Division and presents a new modeling approach of project management developed by the author. The report also presents the Project Management Guidelines developed during the summer.

  2. Exercise in Pregnancy: Guidelines.

    Science.gov (United States)

    Artal, Raul

    2016-09-01

    In recent years it has been recognized that in all phases of life, including pregnancy, physical activity promotes health benefits and precludes comorbidities, the scientific evidence is indisputable. Several organizations around the world have updated in recent years the guidelines and recommendations for exercise in pregnancy. The December 2015, updated guidelines of the American College of Obstetricians and Gynecologists emphasize that physical activity in pregnancy has minimal risk. Although recommending exercise in pregnancy, the anatomic/physiological changes, absolute and relative contraindications should be considered. Women who exercised regularly before pregnancy, in the absence of contraindications, can continue and engage in moderate to strenuous activities, although information on strenuous activities in pregnancy is still limited. This review summarizes the most recent published and recommended guidelines.

  3. ASVCP guidelines: allowable total error guidelines for biochemistry.

    Science.gov (United States)

    Harr, Kendal E; Flatland, Bente; Nabity, Mary; Freeman, Kathleen P

    2013-12-01

    As all laboratory equipment ages and contains components that may degrade with time, initial and periodically scheduled performance assessment is required to verify accurate and precise results over the life of the instrument. As veterinary patients may present to general practitioners and then to referral hospitals (both of which may each perform in-clinic laboratory analyses using different instruments), and given that general practitioners may send samples to reference laboratories, there is a need for comparability of results across instruments and methods. Allowable total error (TEa ) is a simple comparative quality concept used to define acceptable analytical performance. These guidelines are recommendations for determination and interpretation of TEa for commonly measured biochemical analytes in cats, dogs, and horses for equipment commonly used in veterinary diagnostic medicine. TEa values recommended herein are aimed at all veterinary settings, both private in-clinic laboratories using point-of-care analyzers and larger reference laboratories using more complex equipment. They represent the largest TEa possible without generating laboratory variation that would impact clinical decision making. TEa can be used for (1) assessment of an individual instrument's analytical performance, which is of benefit if one uses this information during instrument selection or assessment of in-clinic instrument performance, (2) Quality Control validation, and (3) as a measure of agreement or comparability of results from different laboratories (eg, between the in-clinic analyzer and the reference laboratory). These guidelines define a straightforward approach to assessment of instrument analytical performance. © 2013 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  4. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

    2015-01-01

    The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt...... diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...... of MRI in clinical practice for the diagnosis of MS....

  5. Guidelines for Urban Labs

    DEFF Research Database (Denmark)

    Scholl, Christian; Agger Eriksen, Mette; Baerten, Nik

    2017-01-01

    These guidelines are intended for team members and managers of urban labs and, more generally, for civil servants and facilitators in cities working with experimental processes to tackle complex challenges. They aim to support the everyday practice of collaboratively experimenting and learning how...... local conditions. Hence, the following guidelines do not provide a single definitive answer on ways to organize and run an urban lab or its experimental activities, but rather they offer, through frameworks and examples, guidance for ways to act in relation to, and reflect on, key issues. We hope...

  6. Strategy Guideline: Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Savage, C.; Hunt, A.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  7. Strategy Guideline. Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, A.; Savage, C.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  8. Introductional presentation of international guidelines for test-use

    Directory of Open Access Journals (Sweden)

    Staša Bučar Markič

    2000-09-01

    Full Text Available The causes for origin, the development the and main structure of the International Guidelines for test-use are presented. They were developed by Dave Bartram for the International Test Commission. The Guidelines should be considered as an aid for developing specific local standards, and to ensure consistency between different countries. The Guidelines are not relevant only for psychological testing, but also for testing in other fields (education, employment etc., as well as for other types of assessment.

  9. Reporting of financial conflicts of interest in clinical practice guidelines: a case study analysis of guidelines from the Canadian Medical Association Infobase.

    Science.gov (United States)

    Shnier, Adrienne; Lexchin, Joel; Romero, Mirna; Brown, Kevin

    2016-08-15

    Clinical practice guidelines are widely distributed by medical associations and relied upon by physicians for the best available clinical evidence. International findings report that financial conflicts of interest (FCOI) with drug companies may influence drug recommendations and are common among guideline authors. There is no comparable study on exclusively Canadian guidelines; therefore, we provide a case study of authors' FCOI declarations in guidelines from the Canadian Medical Association (CMA) Infobase. We also assess the financial relationships between guideline-affiliated organizations and drug companies. Using a population approach, we extracted first-line drug recommendations and authors' FCOI disclosures in guidelines from the CMA Infobase. We contacted the corresponding authors on guidelines when FCOI disclosures were missing for some or all authors. We also extracted guideline-affiliated organizations and searched each of their websites to determine if they had financial relationships with drug companies. We analyzed 350 authors from 28 guidelines. Authors were named on one, two, or three guidelines, yielding 400 FCOI statements. In 75.0 % of guidelines at least one author, and in 21.4 % of guidelines all authors, disclosed FCOI with drug companies. In 54.0 % of guidelines at least one author, and in 28.6 % of guidelines over half of the authors, disclosed FCOI with manufacturers of drugs that they recommended. Twenty of 48 authors on multiple guidelines reported different FCOI in their disclosures. Eight guidelines identified affiliated organizations with financial relationships with manufacturers of drugs recommended in those guidelines. This is the first study to systematically describe FCOI disclosures by authors of Canadian guidelines and financial relationships between guideline-affiliated organizations and pharmaceutical companies. These financial relationships are common. Because authoritative value is assigned to guidelines distributed by

  10. Japanese guidelines for atopic dermatitis 2017.

    Science.gov (United States)

    Katayama, Ichiro; Aihara, Michiko; Ohya, Yukihiro; Saeki, Hidehisa; Shimojo, Naoki; Shoji, Shunsuke; Taniguchi, Masami; Yamada, Hidekazu

    2017-04-01

    Given the importance of appropriate diagnosis and appropriate assessment of cutaneous symptoms in treatment of atopic dermatitis, the basics of treatment in this guideline are composed of (1) investigation and countermeasures of causes and exacerbating factors, (2) correction of skin dysfunctions (skin care), and (3) pharmacotherapy, as three mainstays. These are based on the disease concept that atopic dermatitis is an inflammatory cutaneous disease with eczema by atopic diathesis, multi-factorial in onset and aggravation, and accompanied by skin dysfunctions. These three points are equally important and should be appropriately combined in accordance with the symptoms of each patient. In treatment, it is important to transmit the etiological, pathological, physiological, or therapeutic information to the patient to build a favorable partnership with the patient or his/her family so that they may fully understand the treatment. This guideline discusses chiefly the basic therapy in relation to the treatment of this disease. The goal of treatment is to enable patients to lead an uninterrupted social life and to control their cutaneous symptoms so that their quality of life (QOL) may meet a satisfactory level. The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2015 (ADGL2015)" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2016" together with those for other allergic diseases. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  11. Assessing guidelines for burn referrals in a resource-constrained setting: Demographic and clinical factors associated with inter-facility transfer.

    Science.gov (United States)

    Klingberg, A; Wallis, L; Rode, H; Stenberg, T; Laflamme, L; Hasselberg, M

    2017-08-01

    The aim was to assess demographic and clinical factors associated with inter-facility referrals for patients with burns in a resource-constrained setting. This was a cross-sectional case review of patients presenting with a burn at the trauma unit at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, South Africa. Six hundred and eleven-(71%) children were referred to the burns or the intensive care unit and 253 children were treated and discharged from the trauma unit. Of those admitted as inpatients 94% fulfilled at least one of the criteria for referral and 80% of those treated and discharged fulfilled the criteria for referral. Almost three out of four children evaluated at the trauma unit were referred to the burns unit for further management. However, a large number of patients were treated and discharged from the trauma unit despite being eligible for referral. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  12. Quantification of myocardial perfusion by cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Jerosch-Herold Michael

    2010-10-01

    Full Text Available Abstract The potential of contrast-enhanced cardiovascular magnetic resonance (CMR for a quantitative assessment of myocardial perfusion has been explored for more than a decade now, with encouraging results from comparisons with accepted "gold standards", such as microspheres used in the physiology laboratory. This has generated an increasing interest in the requirements and methodological approaches for the non-invasive quantification of myocardial blood flow by CMR. This review provides a synopsis of the current status of the field, and introduces the reader to the technical aspects of perfusion quantification by CMR. The field has reached a stage, where quantification of myocardial perfusion is no longer a claim exclusive to nuclear imaging techniques. CMR may in fact offer important advantages like the absence of ionizing radiation, high spatial resolution, and an unmatched versatility to combine the interrogation of the perfusion status with a comprehensive tissue characterization. Further progress will depend on successful dissemination of the techniques for perfusion quantification among the CMR community.

  13. Comparison of coronary artery calcification scores and National Cholesterol Education program guidelines for coronary heart disease risk assessment and treatment paradigms in individuals with chronic traumatic spinal cord injury.

    Science.gov (United States)

    Lieberman, Jesse A; Hammond, Flora M; Barringer, Thomas A; Norton, H J; Goff, David C; Bockenek, William L; Scelza, William M

    2011-01-01

    To investigate the risk of coronary heart disease (CHD) in individuals with spinal cord injury (SCI) according to the National Cholesterol Educational Program (NCEP) guidelines and CT coronary artery calcium scores (CCS). Cross-sectional study of consecutive sample of males with SCI presenting to a single site for CHD risk assessment. Males age 45-70 with traumatic SCI (American Spinal Injury Association (ASIA) A, B, and C) injured for at least 10 years with no prior history of clinical CHD. Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD with the use of the Framingham risk score (FRS). Risk and treatment eligibility status was assessed based on NCEP/FRS recommendations and by presence and amount of CCS. Percent agreement (PA) and kappa were calculated between the two algorithms. Spearman correlations were calculated between CCS and FRS and individual risk factors. A total of 38 men were assessed; 18 (47.4%) had CCS > 0. The PA between NCEP/FRS assessment and CCS was 18% with a kappa of -0.03. 11 (28.9%) had CCS > 100 or >75th percentile for their age, sex, and race, which might qualify them for lipid-lowering treatment. Only 26 were placed into the same treatment category by NCEP/FRS and CCS, for a PA of 68% with a kappa of 0.35. In all, 20 (52.6%) were eligible for lipid-lowering treatment by either NCEP/FRS (n=9) or CCS (n = 11). Seven subjects were above the treatment threshold based on CCS, but not NCEP/FRS and five subjects were above the NCEP/FRS threshold, but not CCS. Just four subjects were eligible by both algorithms. CCS only correlated with FRS (r = 0.508, P = 0.001) and age (r = 0.679, P < 0.001).

  14. Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Carter, R.J.

    1997-07-01

    This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

  15. Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal.

    Science.gov (United States)

    Hennessy, Kym; Woodburn, James; Steultjens, Martijn

    2016-01-01

    Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain. Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines.

  16. Instructional Guidelines. Welding.

    Science.gov (United States)

    Fordyce, H. L.; Doshier, Dale

    Using the standards of the American Welding Society and the American Society of Mechanical Engineers, this welding instructional guidelines manual presents a course of study in accordance with the current practices in industry. Intended for use in welding programs now practiced within the Federal Prison System, the phases of the program are…

  17. Guidelines on testicular cancer

    NARCIS (Netherlands)

    Albers, Peter; Albrecht, Walter; Algaba, Ferran; Bokemeyer, Carsten; Cohn-Cedermark, Gabriella; Horwich, Alan; Klepp, Olbjoern; Laguna, M. Pilar; Pizzocaro, Giorgio

    2005-01-01

    To up-date the 2001 version of the EAU testicular cancer guidelines. A non-structured literature review until January 2005 using the MEDLINE database has been performed. Literature has been classified according to evidence-based medicine levels. Testicular cancer is a highly curable disease.

  18. Guidelines for Authors

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 1. Guidelines for Authors. Information and Announcements Volume 19 Issue 1 January 2014 pp 99-103. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/019/01/0099-0103. Resonance – Journal of ...

  19. Record Keeping Guidelines

    Science.gov (United States)

    American Psychologist, 2007

    2007-01-01

    These guidelines are designed to educate psychologists and provide a framework for making decisions regarding professional record keeping. State and federal laws, as well as the American Psychological Association's "Ethical Principles of Psychologists and Code of Conduct," generally require maintenance of appropriate records of psychological…

  20. Tinnitus guidelines and treatment

    DEFF Research Database (Denmark)

    Larsen, Dalia Gustaityté; Ovesen, Therese

    2014-01-01

    In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation, and validated questionnaires, oto-neurological examination, audiometry tests, MRI and angiography are necessary...

  1. Space Guidelines for Libraries.

    Science.gov (United States)

    Wisconsin Coordinating Committee for Higher Education, Madison.

    The following guidelines are recommended: stack space--for each 10 volumes, one square foot of space; reading room--25 square feet per station x 20% of the total undergraduate population; carrel space--25% of the graduate enrollment x 45 square feet; office and auxilliary space--135 square feet x full time equivalent staff. (NI)

  2. AACE hyperandrogenism guidelines.

    Science.gov (United States)

    Goolsby, M J

    2001-11-01

    The problems associated with hyperandrogenism are not uncommon in primary care settings. In fact, polycystic ovary syndrome, a common cause of androgen excess, exists in 5% to 10% of women during their reproductive years, with onset typically in adolescence. The subject of this column is the AACE's Hyperandrogenism Guidelines, which review the evaluation and treatment of the disorders causing androgenic excess.

  3. Training Guidelines: Bricks Operatives.

    Science.gov (United States)

    Ceramics, Glass, and Mineral Products Industry Training Board, Harrow (England).

    This manual offers guidelines for training of personnel involved in the manufacture of bricks, including employment practices; handling and preparation of raw materials; making, drying, firing, sorting, packing, and loading of bricks. A major emphasis is placed on industrial safety. (MF)

  4. ADULT INFLUENZA VACCINATION GUIDELINE

    African Journals Online (AJOL)

    meeting to consider the draft guideline. Financial sponsor. Development supported by an ... respiratory vaccinations consensus meeting was held in. Gauteng (see below). Participants were invited ..... Boorman D. Influenza vaccine and its relationship to absenteeism in the workplace. Occupational Health SA 1997; 3: 29-30.

  5. Human milk banking guidelines.

    Science.gov (United States)

    Bharadva, Ketan; Tiwari, Satish; Mishra, Sudhir; Mukhopadhyay, Kanya; Yadav, Balraj; Agarwal, R K; Kumar, Vishesh

    2014-06-01

    WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively concerned about the compelling use of formula feeds in the infants because of the non availability of human breast milk banks. A National Consultative Meet for framing guidelines was summoned by the IYCF Chapter and the Ministry of Health and Family Welfare, Government of India on 30th June, 2013, with representations from various stakeholders. The guidelines were drafted after an extensive literature review and discussions. Though these guidelines are based on the