WorldWideScience

Sample records for bicameral appropriations politics1

  1. Modele bicamerale comparate. Romania: Monocameralism versus bicameralism

    Directory of Open Access Journals (Sweden)

    Cynthia Carmen CURT

    2007-06-01

    Full Text Available The paper attempts to evaluate the Romanian bicameral model as well as to identify and critically asses which are the options our country has in choosing between unicameral and bicameral system. The analysis attempts to observe the characteristics of some Second Chambers that are related to Romanian bicameralism by influencing the configuration of the Romanian bicameral legislature, or which devised constitutional mechanisms can be used in order to preserve an efficient bicameral formula. Also the alternative of giving up the bicameral formula due to some arguments related to the simplification and the efficiency of the legislative procedure is explored.

  2. Considerations on the bicameral parliamentary system in Romania

    Directory of Open Access Journals (Sweden)

    Mihaela Adina APOSTOLACHE

    2014-12-01

    Full Text Available The study approaches the way Romanian bicameralism functions, considering both its strengths and weaknesses. In addition, the unicameral parliamentary system is presented in relation to the bicameral one. In the doctrine, there are several opinions according to which bicameralism is preferred to unicameralism, because the two Houses provide increased safety, as the concentration of legislative power in one place could be both dangerous and, often, unjustified. But the two Chambers should not be similar, as this would not serve their guaranteeing purpose. Furthermore, bicameralism consolidates the balance and solidity of democratic regimes, providing a better separation of powers.

  3. Quiet Grove in a Savage Garden: A Composer's Bicameral Reality

    Science.gov (United States)

    Bohlen, Donald

    2004-01-01

    This author, a composer, states that music has been the primal generator of his existence and the definition of living creatively; and that understanding the bicameral reality of creativity through a study of the nature of consciousness involves a symbiotic host of disciplines. In the study of the occurrence of "creativity," consciousness as well…

  4. Federalism, Bicameralism, and Institutional Change: General Trends and One Case-study

    Directory of Open Access Journals (Sweden)

    Marta Arretche

    2010-12-01

    Full Text Available The article distinguishes federal states from bicameralism and mechanisms of territorial representation in order to examine the association of each with institutional change in 32 countries by using constitutional amendments as a proxy. It reveals that bicameralism tends to be a better predictor of constitutional stability than federalism. All of the bicameral cases that are associated with high rates of constitutional amendment are also federal states, including Brazil, India, Austria, and Malaysia. In order to explore the mechanisms explaining this unexpected outcome, the article also examines the voting behavior of Brazilian senators constitutional amendments proposals (CAPs. It shows that the Brazilian Senate is a partisan Chamber. The article concludes that regional influence over institutional change can be substantially reduced, even under symmetrical bicameralism in which the Senate acts as a second veto arena, when party discipline prevails over the cohesion of regional representation.

  5. The Dilemma Unicameralism-Bicameralism in the Spanish Second Republic

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Giménez Martínez

    2016-11-01

    Full Text Available One of the essential characteristics of the Spanish constitutionalism is the duality of Assemblies in the Cortes, uninterrupted since the promulgation of the Royal Statute in 1834. Nevertheless, the 1931 Constitution came to break this tradition and became, along with the 1812 Constitution, the only one in our history that has created a unicameral Parliament. The aim of this paper is to analyse the causes which led to establish a single Chamber, which was one of the main novelties the Second Republic offered regarding the State’s organic structure. To do so, we start from a multidisciplinary scientific approach that combines the exegesis of legal texts, the analysis of parliamentary sources (the Journal of Debates and the contrast with the doctrinal contributions. The study focuses first on the process of constitutional elaboration; revises next the dialectical dispute between the supporters of unicameralism and those who leaned towards maintaining the bicameral structure of the Cortes, and concludes with a final assessment about the consequences the elected model had for the consolidation of the republican regime and the potential benefits the conservation of the Senate would have provided.

  6. Endocytic activity of Sertoli cells grown in bicameral culture chambers

    International Nuclear Information System (INIS)

    Dai, R.X.; Djakiew, D.; Dym, M.

    1987-01-01

    Immature rat Sertoli cells were cultured for 7 to 14 days on Millipore filters impregnated with a reconstituted basement membrane extract in dual-environment (bicameral) culture chambers. Electron microscopy of the cultured cells revealed the presence of rod-shaped mitochondria, Golgi apparatus, rough endoplasmic reticulum, and Sertoli-Sertoli tight junctions, typical of these cells in vivo. The endocytic activity of both the apical and basal surfaces of the Sertoli cells was examined by either adding alpha 2-macroglobulin (alpha 2-M) conjugated to 20 nm gold particles to the apical chamber or by adding 125 I labeled alpha 2-M to the basal chamber. During endocytosis from the apical surface of Sertoli cells, the alpha 2-M-gold particles were bound initially to coated pits and then internalized into coated vesicles within 5 minutes. After 10 minutes, the alpha 2-M-gold was found in multi-vesicular bodies (MVBs) and by 30 minutes it was present in the lysosomes. The proportion of alpha 2-M-gold found within endocytic cell organelles after 1 hour of uptake was used to estimate the approximate time that this ligand spent in each type of organelle. The alpha 2-M-gold was present in coated pits, coated vesicles, multivesicular bodies, and lysosomes for approximately 3, 11, 22, and 24 minutes, respectively. This indicates that the initial stages of endocytosis are rapid, whereas MVBs and lysosomes are relatively long-lived

  7. Sub-state interests in bi-cameral legislatures: inter-institutional cooperation in decentralised government

    Directory of Open Access Journals (Sweden)

    Marc NAVARRO

    2013-10-01

    Full Text Available The aim of this article is to study the role of the second chamber in the vertical coordination of interests between national and subnational levels. Firstly, we specify the legislative governance variables which must be analyzed in bicameral countries in order to measure incentives and restrictions to strengthen vertical inter-institutional coordination, deepening political decentralization. Secondly, these variables –symmetry, congruence and political particularism– are broken down and ranked to be tested empirically in the nine bicameral countries existing in Latin America. Finally, with the results obtained, we are in a position to develop a bicameralism index that measures the role of second chambers as the institutional space where subnational interests are taken into the national Legislative body, encouraging vertical relations among institutions.

  8. Análisis del Informe de la Comisión Bicameral Investigadora de las Violaciones de los Derechos Humanos en la provincia de Tucumán (1974-1983

    Directory of Open Access Journals (Sweden)

    Rubén Kotler

    2007-12-01

    Full Text Available El informe de la CONADEP sostiene que a "la provincia de Tucumán le cupo el siniestro privilegio de haber inaugurado la institución centro clandestino de detención.". El presente trabajo se propone analizar el Informe elaborado por la Comisión Bicameral Investigadora de las Violaciones de los Derechos Humanos en la provincia de Tucumán, que da cuenta de cómo la represión ilegal en el "Jardín de la República" comenzó mucho antes de producirse el golpe de Estado el 24 de marzo de 1976. Un informe que no ha sido lo suficientemente difundido y que arroja datos fundamentales para saber qué ha sucedido en dicha provincia.The inform CONADEP says that in Tucumán began the repression with the installation of the illegal detention center. Through this article I want to analyze de inform made by the Bicameral Commission that investigated the violation of the human rights in Tucumán. These inform proof how it began the illegal repression in Tucumán, before the last dictatorship in 24 of March 1976. This inform wasn't enough spread and give us fundamental pieces of information about what happened in the Argentina recently pass.

  9. Appropriate strategies.

    Science.gov (United States)

    Halty, M

    1979-01-01

    Technology strategies are concerned with the production, distribution, and consumption of technology. Observation of less developed countries (LDCs) and international organizations shows that little attention is given to the development of a technology strategy. LDCs need to formulate a strategy of self-reliant technological development for the next decade. They should no longer be content to stand in a technologically dependent relationship to the developed countries. Such strategies must balance the ratio between investment in indigenous technologies and expenditure for foreign technology. The strategies change according to the level of industrialization achieved. The following considerations come into development of technology strategies: 1) determination of an appropriate balance among the accumulation, consumption, and distribution of technology; 2) the amount and level of government support; and 3) the balance between depth and breadth of technology to be encouraged.

  10. Análisis del Informe de la Comisión Bicameral Investigadora de las Violaciones de los Derechos Humanos en la provincia de Tucumán (1974-1983

    Directory of Open Access Journals (Sweden)

    Rubén Kotler

    2007-12-01

    Full Text Available El informe de la CONADEP sostiene que a "la provincia de Tucumán le cupo el siniestro privilegio de haber inaugurado la institución centro clandestino de detención.". El presente trabajo se propone analizar el Informe elaborado por la Comisión Bicameral Investigadora de las Violaciones de los Derechos Humanos en la provincia de Tucumán, que da cuenta de cómo la represión ilegal en el "Jardín de la República" comenzó mucho antes de producirse el golpe de Estado el 24 de marzo de 1976. Un informe que no ha sido lo suficientemente difundido y que arroja datos fundamentales para saber qué ha sucedido en dicha provincia.

  11. Appropriability, services and reputation

    NARCIS (Netherlands)

    Dolfsma, W.A.

    2011-01-01

    The appropriability regime (Teece 1986) that innovating service firms face is generally weaker than what firms in manufacturing sectors face. An important means to appropriate benefits from innovation that service firms can use is their reputation. This conceptual paper offers insights into how a

  12. Libertarianism and Original Appropriation

    OpenAIRE

    Dominiak, Łukasz

    2017-01-01

    The article is devoted to the problem of the structure of libertarian theory of justice. It tries to present a map of the main concepts and principles of this theory and to investigate its possible justifications. It explains such fundamental concepts as original appropriation, homesteading, labour theory of property or first possession theory of original appropriation. The article shows merits and drawbacks of alternative libertarian principles of justice in first acquisition and proposes a ...

  13. Appropriering, system, bogobjekt

    DEFF Research Database (Denmark)

    Kromann, Thomas Hvid

    og en afpersonaliseringens poetik bliver konstrueret og typologiseret ud fra et heterogent og spredt tekstmateriale. En poetik, der er kendetegnet af en vidtdreven afmytologisering og afpersonalisering af kunstnerrollen og værket. I kapitel 2, Appropriering, analyseres approprieringsteknikker som...... værker af Bjørn Nørgaard, Hans-Jørgen Nielsen, Henning Christiansen, Vagn Steen og Per Kirkeby (i kap. 2, 3 og 4) analyseres eksempler på appropriering, systemer og bogobjekter. Afpersonalisering er som strategi ikke en homogen metode, men derimod en heterogen og individuel praksis, der spænder fra...

  14. Crowding as appropriation

    DEFF Research Database (Denmark)

    Thelle, Mikkel

    2016-01-01

    This article seeks to address the relation between crowds andpublic space as a question of appropriation. With the newliberal constitutions in Europe, several phenomena of crowdingemerge in major cities, of which Copenhagen is taken as anexample. By focusing on the crowd as an agglomeration...... ofbodies, it is assessed how the agency of the crowd works on animmediate level and in its more lasting effects on urban space.The notion of appropriation is related to the crowd’s claim,formal and informal, as resulting from a negotiation of this,mostly public, space, and articulated in empirical cases...

  15. Appropriation of Information Systems

    DEFF Research Database (Denmark)

    Kjærgaard, Annemette Leonhardt; Jensen, Tina Blegind

    2008-01-01

    This paper explores the use of cognitive mapping for eliciting users' sensemaking during information system (IS) appropriation. Despite the potential usefulness of sensemaking, few studies in IS research use it as a theoretical lens to address IS appropriation. A possible reason for this may...... be that sensemaking does not easily lend itself to be used in practice. We introduce cognitive mapping as a way to elicit users' sensemaking and illustrate its value by reporting on findings from an empirical study of the introduction of an Electronic Patient Record (EPR) system. The contribution of the paper...

  16. Narrative self-appropriation

    DEFF Research Database (Denmark)

    Køster, Allan

    2017-01-01

    is profoundly saturated by an alienness regarding the person’s own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through e.g. psychotherapy. Following this line of thought, I present the idea that narrativising experiences can play an important...... role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing...

  17. Special Appropriation Act Projects

    Science.gov (United States)

    EPA is sometimes directed to provide funding to a specific entity for study, purpose, or activity.This information will be of interest to a community or other entity that has been identified in one of EPA's appropriations acts to receive such funding.

  18. Choosing Appropriate Business Models

    OpenAIRE

    UNCTAD; World Bank

    2018-01-01

    This note provides guidance on considerations in the selection of an appropriate business model through which to conduct an agricultural investment. Agricultural investments have a wide range of impacts, positive and negative. The choice of business model is one, but by no means the only, determining factor of the financial success of the investment, as well as its socioeconomic and enviro...

  19. Workspace appropriation and attachment

    Directory of Open Access Journals (Sweden)

    M. PAVALACHE-ILIE

    2016-11-01

    Full Text Available This literature synthesis presents a short history of the evolution of the concepts of space appropriation and place attachment, highlighting the difficulty of their operationalisation from a cultural point of view. The next subject brought into discussion is the relation between the affective dimension of the connection between a person and the work place and the behaviours which are prone to insure the proper functioning of organizations, such as the organizational civism and the organizational commitment.

  20. ACR appropriateness criteria jaundice.

    Science.gov (United States)

    Lalani, Tasneem; Couto, Corey A; Rosen, Max P; Baker, Mark E; Blake, Michael A; Cash, Brooks D; Fidler, Jeff L; Greene, Frederick L; Hindman, Nicole M; Katz, Douglas S; Kaur, Harmeet; Miller, Frank H; Qayyum, Aliya; Small, William C; Sudakoff, Gary S; Yaghmai, Vahid; Yarmish, Gail M; Yee, Judy

    2013-06-01

    A fundamental consideration in the workup of a jaundiced patient is the pretest probability of mechanical obstruction. Ultrasound is the first-line modality to exclude biliary tract obstruction. When mechanical obstruction is present, additional imaging with CT or MRI can clarify etiology, define level of obstruction, stage disease, and guide intervention. When mechanical obstruction is absent, additional imaging can evaluate liver parenchyma for fat and iron deposition and help direct biopsy in cases where underlying parenchymal disease or mass is found. Imaging techniques are reviewed for the following clinical scenarios: (1) the patient with painful jaundice, (2) the patient with painless jaundice, and (3) the patient with a nonmechanical cause for jaundice. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. Unauthorized Appropriations and Expiring Authorizations

    Science.gov (United States)

    2015-01-15

    Unauthorized FY 2015 Appropriations: Not Available Organ Donation and Recovery Improvement ActP.L. 108-216 Reimbursement of travel and subsistence...FY 2013 Appropriation Authorized: Indefinite Unauthorized FY 2015 Appropriations: Not Available Capital investment grants to support intercity ...priority rail corridor projects necessary to reduce congestion or facilitate ridership growth in intercity rail passenger transportation * FY 2013

  2. Appropriate Technology as Indian Technology.

    Science.gov (United States)

    Barry, Tom

    1979-01-01

    Describes the mounting enthusiasm of Indian communities for appropriate technology as an inexpensive means of providing much needed energy and job opportunities. Describes the development of several appropriate technology projects, and the goals and activities of groups involved in utilizing low scale solar technology for economic development on…

  3. Value Appropriation in Business Exchange

    DEFF Research Database (Denmark)

    Ellegaard, Chris; Medlin, Christopher J.; Geersbro, Jens

    2014-01-01

    value creation. Originality/value – To the authors’ knowledge, this paper represents the first attempt at reviewing the management literature on value appropriation in business exchange. The authors provide overview, details, comparisons, and frame a research agenda as a first step towards establishing......Purpose – Value appropriation is a central, yet neglected aspect in business exchange research. The purpose of the paper is to generate an overview of research on active value appropriation in business exchange and provide the foundation for further research into value appropriation, as well...... as some initial guidance for managers. Design/methodology/approach – Literatures investigating value appropriation were identified by the means of a systematic review of the overall management literature. Findings – The authors provide an overview and comparison of the literatures and find that they apply...

  4. Appropriate roads for rural access

    CSIR Research Space (South Africa)

    Paige-Green, P

    2006-03-01

    Full Text Available be reduced, the result remains environmentally unsustainable. Low cost but appropriate techniques for upgrading these roads cost-effectively to sealed standards have been implemented in many countries recently. These techniques optimize the use of local...

  5. Appropriate use of diagnostic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Palmer, P.E.S.; Cockshott, W.P.

    1984-11-16

    This article discusses ways in which more appropriate use can be made of roentgenography with a resulting decrease in radiation doses to the patient population. The authors recommend that fewer films be made and that traditional roentgenography be replaced with endoscopy, ultrasound, computerized tomography, or angiography where appropriate. They also recommend that medical schools and medical subspecialty groups study the World Health Organization document which provides indications for diagnostic imaging, the choice of procedure and the limitations of each.

  6. The moral appropriateness of shame

    Directory of Open Access Journals (Sweden)

    M. Ally

    2005-07-01

    Full Text Available In this article I explore the much neglected moral emotion of shame and consider the senses in which it may be regarded as morally appropriate. I argue that there is a connection between coming to terms with shame for those who feel ashamed, and judgments concerning its moral appropriateness. The elucidation of normative connections between shame, self-respect and autonomy implies the need to accept certain aspects of shame as regrettable yet, sometimes, as valuable.

  7. Military Construction: FY2017 Appropriations

    Science.gov (United States)

    2016-10-04

    Appropriations Act (H.R. 4974, S. 2806, H.R. 2577, H.R. 5325) Committee Markup (H.R. 4974, S. 2806) House Report H.R. 4974 House Passage H.R...List (UPL), has had the UPL extracted to indicate the budget authority not requested by the President:  Active Components (Army, Navy and Marine

  8. Academic appropriation and Impact Indicators

    Directory of Open Access Journals (Sweden)

    Wilson López López

    2012-06-01

    Full Text Available The role of appropriation of scientific knowledge and the indicators designed to measure its impact is being hotly debated in Iberoamerica right now. I will separate what I call academic appropriation of knowledge from what many authors have called social appropriation of knowledge. The former isrelated to knowledge communication and transference practices in scientific communities, and the latter has to do with the multiple ways in which knowledge goes to society. This editorial will address academic appropriation.Academic appropriations are found in many levels: the first is that performed by colleagues (peers who use this knowledge, and citations are the indicators of usage. This is a sensitive indicator, and thus vulnerable to citation dynamics in academic communities. For example, communities with low levels of knowledge use are generally endogamic and have low international collaboration.They are also characterised by not easily modifying their citation habits. In this sense, a part of these citations generally make themselves invisible, this is, they do not acknowledge neither their own efforts, not those made by local peer groups (regional, and are negatively paradoxical, even when proclaimed in an anti-mainstream science discourse. At the same time, they downplay their own production or the regional production, and ground their work on the production that they claim to go beyond.On the other hand, research groups with an important output can improve or decrease the visibility of other groups and journals, since the amount of work ends up concentrating citations in particular works or journals, which affects themeasures derived from citation-expressed impacts. In this sense, and as a response with additional elements for assessing academic production, it is suggested that: 1. The quartile of the journal be used, since it gives a more accurate idea of its dynamics and shows the journal in relation to other journals with its variability

  9. 32 CFR 3.5 - Appropriate use.

    Science.gov (United States)

    2010-07-01

    ... CONTRACTS, GRANTS, OR COOPERATIVE AGREEMENTS FOR PROTOTYPE PROJECTS § 3.5 Appropriate use. In accordance... 32 National Defense 1 2010-07-01 2010-07-01 false Appropriate use. 3.5 Section 3.5 National... is participating to a significant extent in the prototype project; or (b) No nontraditional Defense...

  10. Ghost-Story Telling: Keeping It Appropriate.

    Science.gov (United States)

    Weintraub, Jeff

    1996-01-01

    Guidelines for telling ghost stories at camp involve considering children's fears at different ages, telling age appropriate stories, determining appropriate times for telling ghost stories, and minimizing fear when a child becomes frightened by a ghost story. Includes tips on the selection, preparation, and presentation of ghost stories. (LP)

  11. 7 CFR 457.9 - Appropriation contingency.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Appropriation contingency. 457.9 Section 457.9 Agriculture Regulations of the Department of Agriculture (Continued) FEDERAL CROP INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.9 Appropriation contingency...

  12. 22 CFR 710.13 - Appropriate action.

    Science.gov (United States)

    2010-04-01

    ... communication to, OPIC on any matter or business for a period not to exceed five years, which may be... communication. (b) Taking other appropriate disciplinary action. [45 FR 5685, Jan. 24, 1980; 49 FR 18295, Apr...

  13. ACR Appropriateness Criteria on Resectable Rectal Cancer

    International Nuclear Information System (INIS)

    Suh, W. Warren; Blackstock, A. William; Herman, Joseph; Konski, Andre A.; Mohiuddin, Mohammed; Poggi, Matthew M.; Regine, William F.; Cosman, Bard C.; Saltz, Leonard; Johnstone, Peter A.S.

    2008-01-01

    The American College of Radiology (ACR) Appropriateness Criteria on Resectable Rectal Cancer was updated by the Expert Panel on Radiation Oncology-Rectal/Anal Cancer, based on a literature review completed in 2007

  14. Appropriate flow forecasting for reservoir operation

    NARCIS (Netherlands)

    Dong, Xiaohua

    2005-01-01

    The aim of the study presented in this thesis is to develop and apply a methodology to determine the appropriate model application by including the water management objective explicitly, and to demonstrate its benefits.

  15. Appropriateness of Referrals for Upper Gastrointestinal Endoscopy ...

    African Journals Online (AJOL)

    Appropriateness of Referrals for Upper Gastrointestinal Endoscopy. ... Accra between January and December, 2008 were interviewed and evaluated for this study. ... Presentations with bleeding and suspicion of malignancy showed statistical ...

  16. Ways of art appropriation by the advertising

    Directory of Open Access Journals (Sweden)

    Roberta Fernandes Esteves

    2013-09-01

    Full Text Available Based on the different ways of appropriation of the artistic visualrepresentations by the advertising communication, proposed by Lucia Santaella (2005 – imitation of the ways of composing and incorporation of the artistic image – this article presents, as of the examination of advertisements broadcast in different countries, seven new categories outlined on the basis of partial or total use of the appropriated image and the interference performed in them.

  17. Chautauqua notebook: appropriate technology on radio

    Energy Technology Data Exchange (ETDEWEB)

    Renz, B.

    1981-01-01

    Experiences in establishing and maintaining a regional call-in information-exchange radio show (Chautauqua) on energy conservation, appropriate technology, renewable energy sources, and self-reliance are discussed. Information is presented on: appropriate technology; the Chautauquaa concept; topics discussed; research performed; guests; interviewing tips; types of listeners; program features; where to find help; promotion and publicity; the technical and engineering aspects; the budget and funding; and station policies. (MCW)

  18. ASP Strategies and Appropriate Antibiotic Use

    Science.gov (United States)

    Lee, Brian R; Tribble, Alison; Handy, Lori; Gerber, Jeffrey S; Hersh, Adam L; Kronman, Matthew; Terrill, Cindy; Newland, Jason

    2017-01-01

    Abstract Background The Infectious Diseases Society of America (IDSA) recommends hospitals implement antimicrobial stewardship programs (ASP) in order to decrease inappropriate antibiotic use due to the rise in antibiotic-resistant infections. Data are limited on the extent to which different ASP strategies influence appropriate antibiotic use. Methods We conducted an online survey in 2016 of U.S. Children’s Hospitals to collect hospital-level information on dedicated ASP effort, ASP monitoring activities, use of audit-feedback, formulary restrictions, rapid diagnostics, etc. During the same period the ASP teams at these hospitals completed 3 point prevalence surveys that documented details on all admitted patients 0–17 years receiving any antibiotics, determined what ASP modifications could be made, and if the antibiotic was appropriate. We employed hierarchical, multivariable logit models to examine which ASP-related, hospital-level strategies were associated with appropriate antibiotic use. Results Thirty hospitals participated. A total of 6,921 patients were included, representing 10,068 total antibiotics. Of these orders, 8,554 (85.0%) were categorized as appropriate, though this varied across sites (range: 68-92%). Additionally, 78.2% of antibiotics did not have recommended modifications. Appropriate antibiotic use was significantly higher for hospitals that relied on rapid diagnostics (aOR: 1.6; P Terrill, Merck: Grant Investigator, Research grant Allergan: Grant Investigator, Research grant. J. Newland, Merck: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant

  19. ACR Appropriateness Criteria® Tinnitus.

    Science.gov (United States)

    Kessler, Marcus M; Moussa, Marwan; Bykowski, Julie; Kirsch, Claudia F E; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fife, Terry D; Germano, Isabelle M; Kendi, A Tuba; Kim, Jeffrey H; Luttrull, Michael D; Nunez, Diego; Shah, Lubdha M; Sharma, Aseem; Shetty, Vilaas S; Symko, Sophia C; Cornelius, Rebecca S

    2017-11-01

    Tinnitus is the perception of sound in the absence of an external source. It is a common symptom that can be related to hearing loss and other benign causes. However, tinnitus may be disabling and can be the only symptom in a patient with a central nervous system process disorder. History and physical examination are crucial first steps to determine the need for imaging. CT and MRI are useful in the setting of pulsatile tinnitus to evaluate for an underlying vascular anomaly or abnormality. If there is concomitant asymmetric hearing loss, neurologic deficit, or head trauma, imaging should be guided by those respective ACR Appropriateness Criteria ® documents, rather than the presence of tinnitus. Imaging is not usually appropriate in the evaluation of subjective, nonpulsatile tinnitus that does not localize to one ear. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Technological transfer. 1. Appropriateness for developing countries

    Energy Technology Data Exchange (ETDEWEB)

    Berrie, T W

    1978-12-01

    Capital-intensive projects dominate the technology transferred to developing countries in spite of the need to serve a pool of unskilled labor and small capital reserves. Recent doubts about the appropriateness of large industrialization projects have questioned the social and economic benefits of this approach and led to an emphasis on innovative planning for the benefit of the urban and rural poor. This shift assumed that direct attacks on the roots of poverty will be more effective than the trickle-down approach, but development planners now see that technologies can be planned that are not limited to single groups. Official policies, often working against the adoption of appropriate technologies, must consider local needs and local resources. Farm equipment, for example, must minimize the need for skilled labor and maintenance. Planners for appropriate urban technology should emphasize local capability, but should also risk occasional failure in the effort to improve the efficiency of labor.

  1. An appropriate level for reactor regulatory research

    International Nuclear Information System (INIS)

    Budnitz, R.J.; Kouts, H.J.C.

    1986-01-01

    In this brief paper the appropriate role for NRC's research program is set down, based on the experience of the last decade; and the broad outlines of an appropriate research program for the next decade are discussed. The two authors bring to this topic direct personal experience: they are two of only three former directors of NRC's research program in its history (the other was the last Saul Levine). The discussion considers only reactor safety research, although NRC's research program covers several other areas as well. Safeguards, environmental and health studies, waste management, and transportation are not covered

  2. Rediscovering Enterprise: Developing Appropriate University Entrepreneurship Education

    Science.gov (United States)

    Bridge, Simon; Hegarty, Cecilia; Porter, Sharon

    2010-01-01

    Purpose: Entrepreneurship can refer to business start-up, but now sometimes has wider connotations. This paper aims to explore what entrepreneurship means for the promoters of entrepreneurship education and what might be appropriate for the students who consume it. Design/methodology/approach: The paper assesses the work of NICENT (The Northern…

  3. Desktop Publishing Choices: Making an Appropriate Decision.

    Science.gov (United States)

    Crawford, Walt

    1991-01-01

    Discusses various choices available for desktop publishing systems. Four categories of software are described, including advanced word processing, graphics software, low-end desktop publishing, and mainstream desktop publishing; appropriate hardware is considered; and selection guidelines are offered, including current and future publishing needs,…

  4. Appropriate administrative structures in harnessing water resources ...

    African Journals Online (AJOL)

    Appropriate administrative structures in harnessing water resources for sustainable growth in Nigeria. Lekan Oyebande. Abstract. No Abstract. Journal of Mining and Geology Vol. 42(1) 2006: 21-30. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  5. Audit incorporating avoidability and appropriate intervention can ...

    African Journals Online (AJOL)

    Audit incorporating avoidability and appropriate intervention can significantly decrease perinatal mortality. H. R. G. Ward, G. R. Howarth, O. J. N. Jennings,. R. C. Pattinson .... 6 months) and seven interns. The study was .... maternity care notes study: a randomized control trial to assess the effects of giving expectant mothers ...

  6. Using Appropriate Strategies to Improve Students' Comprehension ...

    African Journals Online (AJOL)

    Using Appropriate Strategies to Improve Students' Comprehension of Chemistry Texts: A Guide for Chemistry Teachers. ... African Research Review ... Unfortunately, contemporary research insight into science reading is lacking and science educators tend to focus on methods of teaching specific subject matter and ...

  7. Perspectives on Conceptualizing Developmentally Appropriate Sexuality Education

    Science.gov (United States)

    Silvério Marques, Sara; Goldfarb, Eva S.; Deardorff, Julianna; Constantine, Norman A.

    2017-01-01

    Despite recognition of the importance of a developmentally appropriate approach to sexuality education, there is little direct guidance on how to do this. This study employed in-depth interviews with experienced sexuality educators and developers of sexuality education materials to identify how this concept is understood and applied in the field.…

  8. Nationally Appropriate Mitigation Action: Understanding NAMA Cycle

    DEFF Research Database (Denmark)

    Sharma, Sudhir; Desgain, Denis DR

    There is no internationally defined or agreed Nationally Appropriate Mitigation Action(NAMA) cycle, as was the case, for example, with the Clean Development Mechanisms (CDM) project cycle. However, there are some common steps that NAMA identification, formulation, and implementation will all go...

  9. ACR Appropriateness Criteria® Multiple Gestations.

    Science.gov (United States)

    Glanc, Phyllis; Nyberg, David A; Khati, Nadia J; Deshmukh, Sandeep Prakash; Dudiak, Kika M; Henrichsen, Tara Lynn; Poder, Liina; Shipp, Thomas D; Simpson, Lynn; Weber, Therese M; Zelop, Carolyn M

    2017-11-01

    Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Chorionicity and amnionicity should be determined as early as possible when a twin pregnancy is identified to permit triage of the monochorionic group into a closer surveillance model. Screening for congenital heart disease is warranted in monochorionic twins because they have an increased rate of congenital cardiac anomalies. In addition, monochorionic twins have a higher risk of developing cardiac abnormalities in later gestation related to right ventricular outflow obstruction, in particular the subgroups with twin-twin transfusion syndrome or selective intrauterine growth restriction. Monochorionic twins have unique complications including twin-to-twin transfusion syndrome, twin embolization syndrome, and acardius, or twin-reversed arterial perfusion sequence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or

  10. Selection of appropriate greenhouse gas mitigation options

    Energy Technology Data Exchange (ETDEWEB)

    Ramanathan, R. [Indira Ghandi Institute of Development Research, Mumbai (India)

    1999-10-01

    Greenhouse gas mitigation options help in reducing greenhouse gas emissions so as to avoid the adverse environmental impacts due to global warming/climate change. They have different characteristics when evaluated using different criteria. For example, some options may be very cost effective, while some may have an additional advantage of reducing local pollution. Hence, selection of these options, for consideration by a national government or by a funding agency, has to incorporate multiple criteria. In this paper, some important criteria relevant to the selection are discussed, and a multi-criteria methodology is suggested for making appropriate selection. The methodology, called the Analytic Hierarchy Process, is described using two illustrations. (author)

  11. ACR Appropriateness Criteria® rib fractures.

    Science.gov (United States)

    Henry, Travis S; Kirsch, Jacobo; Kanne, Jeffrey P; Chung, Jonathan H; Donnelly, Edwin F; Ginsburg, Mark E; Heitkamp, Darel E; Kazerooni, Ella A; Ketai, Loren H; McComb, Barbara L; Parker, J Anthony; Ravenel, James G; Restrepo, Carlos Santiago; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D; Mohammed, Tan-Lucien H

    2014-11-01

    Rib fracture is the most common thoracic injury, present in 10% of all traumatic injuries and almost 40% of patients who sustain severe nonpenetrating trauma. Although rib fractures can produce significant morbidity, the diagnosis of associated complications (such as pneumothorax, hemothorax, pulmonary contusion, atelectasis, flail chest, cardiovascular injury, and injuries to solid and hollow abdominal organs) may have a more significant clinical impact. When isolated, rib fractures have a relatively low morbidity and mortality, and failure to detect isolated rib fractures does not necessarily alter patient management or outcome in uncomplicated cases. A standard posteroanterior chest radiograph should be the initial, and often the only, imaging test required in patients with suspected rib fracture after minor trauma. Detailed radiographs of the ribs rarely add additional information that would change treatment, and, although other imaging tests (eg, computed tomography, bone scan) have increased sensitivity for detection of rib fractures, there are little data to support their use. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review process include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  12. Food appropriation through large scale land acquisitions

    International Nuclear Information System (INIS)

    Cristina Rulli, Maria; D’Odorico, Paolo

    2014-01-01

    The increasing demand for agricultural products and the uncertainty of international food markets has recently drawn the attention of governments and agribusiness firms toward investments in productive agricultural land, mostly in the developing world. The targeted countries are typically located in regions that have remained only marginally utilized because of lack of modern technology. It is expected that in the long run large scale land acquisitions (LSLAs) for commercial farming will bring the technology required to close the existing crops yield gaps. While the extent of the acquired land and the associated appropriation of freshwater resources have been investigated in detail, the amount of food this land can produce and the number of people it could feed still need to be quantified. Here we use a unique dataset of land deals to provide a global quantitative assessment of the rates of crop and food appropriation potentially associated with LSLAs. We show how up to 300–550 million people could be fed by crops grown in the acquired land, should these investments in agriculture improve crop production and close the yield gap. In contrast, about 190–370 million people could be supported by this land without closing of the yield gap. These numbers raise some concern because the food produced in the acquired land is typically exported to other regions, while the target countries exhibit high levels of malnourishment. Conversely, if used for domestic consumption, the crops harvested in the acquired land could ensure food security to the local populations. (letter)

  13. Designing appropriate blended courses: a students' perspective.

    Science.gov (United States)

    Tsai, Chia-Wen

    2010-10-01

    The computing education in Taiwan's vocational schools usually focuses on how to help students enhance their professional skills and pass certified examinations. In addition, due to national education policy and universities' regulations, pure online courses are not permitted in Taiwan. In order to design appropriate blended learning (BL) courses, the author explored the effects of web-mediated self-regulated learning (SRL) with variations in online class frequency on enhancing students' computing skills and their perspective of the blended courses. A total of 172 students, divided into four groups, participated in the experiment. The results showed that students in the SRL and BL group with five online classes had the highest scores for using a database management system (DBMS), and the highest pass rate on certified examinations. Students in this group also expressed their positive perspective on the arrangement of their blended course with the intervention of web-mediated SRL.

  14. Shoosing the appropriate size wind turbine

    Energy Technology Data Exchange (ETDEWEB)

    Lynette, R. [FloWind Corp., San Rafael, CA (United States)

    1996-12-31

    Within the past several years, wind turbines rated at 400 kW and higher have been introduced into the market, and some manufacturers are developing machines rated at 750 - 1,000+ kW. This raises the question: What is the appropriate size for utility-grade wind turbines today? The answer depends upon the site where the machines will be used and the local conditions. The issues discussed in the paper are: (1) Site-Related (a) Visual, noise, erosion, television interference, interference with aviation (b) Siting efficiency (2) Logistics (a) Adequacy of roads and bridges to accept large vehicles (b) Availability and cost of cranes for erection and maintenance (c) Capability of local repair/overhauls (3) Cost Effectiveness (a) Capital costs (1) Wind Turbine (2) Infrastructure costs (b) Maintenance costs (4) Technical/Financial Risk. 1 fig., 1 tab.

  15. Selecting appropriate cases when tracing causal mechanisms

    DEFF Research Database (Denmark)

    Beach, Derek; Pedersen, Rasmus Brun

    2016-01-01

    The last decade has witnessed resurgence in the interest in studying the causal mechanisms linking causes and outcomes in the social sciences. This article explores the overlooked implications for case selection when tracing mechanisms using in-depth case studies. Our argument is that existing case...... selection guidelines are appropriate for research aimed at making cross-case claims about causal relationships, where case selection is primarily used to control for other causes. However, existing guidelines are not in alignment with case-based research that aims to trace mechanisms, where the goal...... is to unpack the causal mechanism between X and Y, enabling causal inferences to be made because empirical evidence is provided for how the mechanism actually operated in a particular case. The in-depth, within-case tracing of how mechanisms operate in particular cases produces what can be termed mechanistic...

  16. ACR appropriateness criteria blunt chest trauma.

    Science.gov (United States)

    Chung, Jonathan H; Cox, Christian W; Mohammed, Tan-Lucien H; Kirsch, Jacobo; Brown, Kathleen; Dyer, Debra Sue; Ginsburg, Mark E; Heitkamp, Darel E; Kanne, Jeffrey P; Kazerooni, Ella A; Ketai, Loren H; Ravenel, James G; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Suh, Robert D

    2014-04-01

    Imaging is paramount in the setting of blunt trauma and is now the standard of care at any trauma center. Although anteroposterior radiography has inherent limitations, the ability to acquire a radiograph in the trauma bay with little interruption in clinical survey, monitoring, and treatment, as well as radiography's accepted role in screening for traumatic aortic injury, supports the routine use of chest radiography. Chest CT or CT angiography is the gold-standard routine imaging modality for detecting thoracic injuries caused by blunt trauma. There is disagreement on whether routine chest CT is necessary in all patients with histories of blunt trauma. Ultimately, the frequency and timing of CT chest imaging should be site specific and should depend on the local resources of the trauma center as well as patient status. Ultrasound may be beneficial in the detection of pneumothorax, hemothorax, and pericardial hemorrhage; transesophageal echocardiography is a first-line imaging tool in the setting of suspected cardiac injury. In the blunt trauma setting, MRI and nuclear medicine likely play no role in the acute setting, although these modalities may be helpful as problem-solving tools after initial assessment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

    Directory of Open Access Journals (Sweden)

    Hossein Yousefi Manesh

    2013-01-01

    Full Text Available MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM criteria. Methods This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56% were considered inappropriate, 72 (24% were uncertain, and 61 (20% were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA and Clinical Practice Guidelines (CPGs. As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement.

  18. Exploring voices, exploring appropriate education. A practitioners’ discourse'

    NARCIS (Netherlands)

    Grol, C.E.J.

    2012-01-01

    My thesis describes an exploratory process into a practitioners’ discourse on appropriate education. Chapter one: Appropriate Education is about the Dutch educational policy called Passend onderwijs. The chapter positions the appropriate education in national and international educational and

  19. Searching for an Appropriate Exchange Rate Regime

    Directory of Open Access Journals (Sweden)

    Yunjong Wang

    2001-06-01

    Full Text Available This paper attempts to survey current debates on the choice of exchange rate regime in emerging market economies. The issue of choosing an appropriate exchange rate regime is being actively discussed since the recent Asian crisis. As a lesson from the recent crises, one widely shared conclusion is that soft peg exchange rate regimes are extremely vulnerable in a world of volatile capital movements. Consequently, new orthodoxy based on the impossible trinity hypothesis favours two corner solutions ― greater flexibility or credible institutional assurance, like a currency board system or dollarization. Nevertheless, questions whether such corner solutions are adequate for developing countries are rising of late. "Fear of floating" is still conspicuous in many developing countries having adopted nominally a free-floating exchange rate regime. Developing countries are sensitive to exchange rate fluctuations because the cost of exchange rate volatility is greater than the benefit when compared to developed countries. Monitoring bands is a compromise solution, but it still needs further enhancement of estimation techniques for fundamental equilibrium exchange rates in order to make those estimation results more workable in practice. Other alternatives include the creation of soft peg of the G-3 currencies. Despite counterarguments, the stability of G-3 currencies could prove to be beneficial to emerging market economies.

  20. Public Library Representations and Internet Appropriations

    Directory of Open Access Journals (Sweden)

    Paula Sequeiros

    2013-11-01

    Full Text Available May the changes in the representations of the public library be propitiated by readers' appropriations of the Internet? To answer this question, a theoretically-driven and empirically-based research was developed in a public library in Portugal, combining the analysis of documents uses, the ethnography of space and Internet use, of social relations developed while reading, with the analysis of representations of the public library. No clear-cut association emerged between social-demographics or user profiles, and representations, in general. No disruptive Internet "impact" was found: Internet use may contribute to reinforce traditional representations of the library, while it may also update and democratise other representations. If the library and the Internet are represented as synonymous, the former does not make sense without the latter; but an Internet widespread and intensive use conflicts with the image of an institution dedicated to high-brow culture. Changes in uses of the public library are, instead, clearly associated with new types of readers, which in their turn reflect changes in urban social composition. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1401141

  1. Gender Inequality Index Appropriateness for Measuring Inequality.

    Science.gov (United States)

    Amin, Elham; Sabermahani, Asma

    2017-01-01

    Gender inequality means unequal distribution of wealth, power, and benefits among women and men. The gender inequality index (GII) measures the lost human development in three important dimensions: reproductive health, political empowerment, and economic status. The first purpose of this study was to calculate the index for provinces of Iran, and the second purpose was to survey the appropriateness of that, for comparing different regions, through regression estimations. In this study, GII has been calculated for Iran between the years 2006-2011 and provinces have been ranked based on it. Then, a panel composed of 30 sections was estimated for five years to determine the most important factor affecting level of index. Some changes have been made to analyze values of the index and the ranking of provinces. Based on panel model, share of parliamentary seats was the most effective factor for determination of the index. After applying adjustments, some differences were seen in the ranking of provinces and general level of index. Weighing of dimensions of the index and considering an overall variable, such as life expectancy in the field of health, will give a more accurate comparison of the GII among different regions though concurrent attention to non-discriminatory cultural dimensions of political participation of women; therefore, making more analyses possible for a more correct comparison of the extensive geographical regions, such as countries.

  2. Appropriate fluid regimens to prevent bronchopulmonary dysplasia.

    Science.gov (United States)

    Tammela, O K

    1995-01-01

    Pulmonary oedema is an important problem in premature neonates with surfactant deficiency because of fluid accumulation in the lung interstitium and reduced urine output. Some retrospective reports suggest that excessive early hydration might increase the risk of bronchopulmonary dysplasia (BPD). Only three prospective studies evaluating low or conventional fluid administration regimens to very low birth weight infants have been published. According to their results no significant differences in the incidence of BPD have been shown. However, fluid restriction seems to improve the outcome of the infants because of decreased incidence of haemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, pulmonary air leaks and decreased mortality. The appropriate amount of sodium in the intravenous fluids during the first days of life needs further evaluation. In tiny infants with birth weights from 500 to 800g intensive monitoring of fluid balance is essential to control the extremely high fluid losses due to evaporation. Undernutrition is a risk factor of BPD and therefore it is important to start parenteral nutrition early. The benefit of the use of colloids as volume expanders is controversial. According to some retrospective reports there might be an association with increased use of colloidal fluids during the first days of life and the development of BPD. Early excessive fluid administration might constitute a potential risk for low birth weight infants with hyaline membrane disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Neurophysiological appropriateness of ionizing radiation effects

    International Nuclear Information System (INIS)

    Nyagu, A.I.; Loganovsky, K.N.

    1997-01-01

    The goal of this study was to compare bioelectrical activity of the brain in remote period of acute radiation sickness (ARS), chronic and prenatal irradiation as a result of the Chernobyl disaster. Registration of computerized 19-channel EEG, visual and somato-sensory evoked potentials have been carried out for 70 patients who had a verified ARS, 100 Chernobyl disaster survivors, who have been working in the Chernobyl exclusion zone since 1986-87 during 5 and more years, 50 prenatally irradiated children, and relevant controls. The relative risks of neurophysiological abnormalities are 4.5 for the ARS-patients, 3.6 for the chronically irradiated persons and 3.7 for the prenatally irradiated children. The data obtained testify to possibility of radiation-induced neurophysiological abnormalities in examined Chernobyl accident survivors which seems to be non-stochastic effects of ionizing radiation. For all examined irradiated patients it was typically an increasing of δ- and β- powers of EEG, particularly, in the frontal lobe shifted to the left fronto-temporal region, but spectral power of both θ- and α-range was significantly depressed. Aforesaid signs together with data of evoked potentials reflect the structural and functional abnormalities of limbic system and the left hemisphere as the first revealed neurophysiological appropriateness of ionizing radiation effects. (author)

  4. Neurophysiological appropriateness of ionizing radiation effects

    Energy Technology Data Exchange (ETDEWEB)

    Nyagu, A I; Loganovsky, K N [Department of Neurology, Inst. of Clinical Radiology, Scientific Centre for Radiation Medicine of Academy of Medical Sciences of Ukraine, Kiev (Ukraine)

    1997-11-01

    The goal of this study was to compare bioelectrical activity of the brain in remote period of acute radiation sickness (ARS), chronic and prenatal irradiation as a result of the Chernobyl disaster. Registration of computerized 19-channel EEG, visual and somato-sensory evoked potentials have been carried out for 70 patients who had a verified ARS, 100 Chernobyl disaster survivors, who have been working in the Chernobyl exclusion zone since 1986-87 during 5 and more years, 50 prenatally irradiated children, and relevant controls. The relative risks of neurophysiological abnormalities are 4.5 for the ARS-patients, 3.6 for the chronically irradiated persons and 3.7 for the prenatally irradiated children. The data obtained testify to possibility of radiation-induced neurophysiological abnormalities in examined Chernobyl accident survivors which seems to be non-stochastic effects of ionizing radiation. For all examined irradiated patients it was typically an increasing of {delta}- and {beta}- powers of EEG, particularly, in the frontal lobe shifted to the left fronto-temporal region, but spectral power of both {theta}- and {alpha}-range was significantly depressed. Aforesaid signs together with data of evoked potentials reflect the structural and functional abnormalities of limbic system and the left hemisphere as the first revealed neurophysiological appropriateness of ionizing radiation effects. (author). 25 refs.

  5. Financial Audit and Spending of Appropriations

    Directory of Open Access Journals (Sweden)

    Ivo Mijoč

    2013-07-01

    Full Text Available Local and district (regional governments receive various forms of revenue. The entitlement to and purpose of this income is determined by law. Likewise for companies owned by local government there are revenues with allocated use, which are also associated with the budget of the local unit. The importance of proper recording of the revenue collected, as well as claims for different types of income is significant because it affects the proper presentation of the financial statements. The presented data are the basis for making decisions, which result in opportunities to meet the needs of local communities. When it comes to the disposal of revenue collected, misconduct or even illegal activities might occur. It is crucial to spot them early on, and here the internal control system and the accounting system have a key role, as they examine the financial and other information for management purposes. The aim of the paper was to investigate irregularities in the use of local funds by examining the data obtained by Financial Audits and to show the movement of appropriations (allocated funds at the county level.

  6. Methylphenidate: increased abuse or appropriate use?

    Science.gov (United States)

    Llana, M E; Crismon, M L

    1999-01-01

    To address the question of the significant increase in methylphenidate (MPD) prescriptions being written and to make recommendations for health care providers involved in providing care for patients with attention deficit hyperactivity disorder (ADHD) and their families. Medline search 1966-1998 for professional articles using the following search terms--methylphenidate, children, adolescents, abuse; Internet search using MPD, Ritalin, and ADHD; and Paper Chase search using methylphenidate. The available literature regarding potential abuse or diversion of MPD consists of case reports, review articles, newspaper articles, and a Drug Enforcement Administration (DEA) publication. All available literature sources were used. Although the media and DEA report significant abuse and diversion of prescribed MPD, a review of the available literature did not reveal data to substantiate these claims. Nonetheless, there are reasons to suspect that abuse and diversion occur. A potential contributing factor to abuse is the reported similarities in pharmacodynamics and pharmacokinetics between MPD and cocaine. Recommendations are made to decrease the possibility of abuse and diversion of prescribed MPD. A balanced middle ground must be found regarding the benefits of MPD and its abuse potential. Education of clinicians, patients, and family members is key in ensuring that MPD is used appropriately.

  7. Correlation Coefficients: Appropriate Use and Interpretation.

    Science.gov (United States)

    Schober, Patrick; Boer, Christa; Schwarte, Lothar A

    2018-05-01

    Correlation in the broadest sense is a measure of an association between variables. In correlated data, the change in the magnitude of 1 variable is associated with a change in the magnitude of another variable, either in the same (positive correlation) or in the opposite (negative correlation) direction. Most often, the term correlation is used in the context of a linear relationship between 2 continuous variables and expressed as Pearson product-moment correlation. The Pearson correlation coefficient is typically used for jointly normally distributed data (data that follow a bivariate normal distribution). For nonnormally distributed continuous data, for ordinal data, or for data with relevant outliers, a Spearman rank correlation can be used as a measure of a monotonic association. Both correlation coefficients are scaled such that they range from -1 to +1, where 0 indicates that there is no linear or monotonic association, and the relationship gets stronger and ultimately approaches a straight line (Pearson correlation) or a constantly increasing or decreasing curve (Spearman correlation) as the coefficient approaches an absolute value of 1. Hypothesis tests and confidence intervals can be used to address the statistical significance of the results and to estimate the strength of the relationship in the population from which the data were sampled. The aim of this tutorial is to guide researchers and clinicians in the appropriate use and interpretation of correlation coefficients.

  8. Developing appropriate criteria for Benign Prostatic Hyperplasia Surgery Using RAND Appropriateness Method (RAM

    Directory of Open Access Journals (Sweden)

    R Ostovar

    2009-07-01

    Full Text Available ABSTRACT: Introduction & Objective: Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. Materials & Methods: In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient’s condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal (AGREE were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Results: Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases (25.9% were considered as appropriate, 14 cases (5% as equivocal and 7 cases (2

  9. 43 CFR 20.506 - Appropriations, legislation and lobbying.

    Science.gov (United States)

    2010-10-01

    ... money appropriated by any enactment of Congress to pay for any personal service, advertisement, telegram... appropriations which they deem necessary for the efficient conduct of the public business (18 U.S.C. 1913). (b...

  10. 17 CFR 256.215 - Appropriated retained earnings.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Appropriated retained earnings... UTILITY HOLDING COMPANY ACT OF 1935 Liabilities and Other Credit Accounts § 256.215 Appropriated retained earnings. This account shall include the amount of retained earnings which has been appropriated or set...

  11. 45 CFR 84.33 - Free appropriate public education.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Free appropriate public education. 84.33 Section..., Elementary, and Secondary Education § 84.33 Free appropriate public education. (a) General. A recipient that operates a public elementary or secondary education program or activity shall provide a free appropriate...

  12. 7 CFR 15b.22 - Free appropriate public education.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Free appropriate public education. 15b.22 Section 15b... Extension Education § 15b.22 Free appropriate public education. (a) General. A recipient that operates a public elementary or secondary education program or activity shall provide a free appropriate public...

  13. 45 CFR 605.33 - Free appropriate public education.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Free appropriate public education. 605.33 Section... Preschool, Elementary, and Secondary Education § 605.33 Free appropriate public education. (a) General. A recipient that operates a public elementary or secondary education program shall provide a free appropriate...

  14. Defense Authorization and Appropriations Bills: FY1970-FY2017

    Science.gov (United States)

    2017-01-18

    textbooks on legislative procedure. Tracking DOD authorization or appropriation bills can be confusing and time-consuming. This has been particularly...by the President through the White House Office of Management and Budget) to the defense authorizing and appropriations committees. Then, for...maintain operations . 3 This might be considered a “line of credit” against the enactment of the relevant appropriations for the new fiscal year

  15. Sandy PMO Disaster Relief Appropriations Act of 2013 Financial Data

    Data.gov (United States)

    Department of Homeland Security — Sandy PMO: Disaster Relief Appropriations Act of 2013 (Sandy Supplemental Bill) Financial Data. This is the Sandy Supplemental Quarterly Financial Datasets that are...

  16. Appropriate Technology and Journal Writing: Structured Dialogues that Enhance Learning

    Science.gov (United States)

    Longhurst, James; Sandage, Scott A.

    2004-01-01

    Of the many available options, instructors should choose "appropriate technology" that meets pedagogical goals with minimum disruption. Student journal assignments follow many teaching "best practices" but consume time and energy; we recommend e-mail as the most appropriate choice for journal assignments. E-mail encourages fast and personalized…

  17. 18 CFR 367.2150 - Account 215, Appropriated retained earnings.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 215, Appropriated retained earnings. 367.2150 Section 367.2150 Conservation of Power and Water Resources FEDERAL... retained earnings. This account must include the amount of retained earnings that has been appropriated or...

  18. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  19. 16 CFR 614.1 - Appropriate proof of identity.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Appropriate proof of identity. 614.1 Section... IDENTITY § 614.1 Appropriate proof of identity. (a) Consumer reporting agencies shall develop and implement reasonable requirements for what information consumers shall provide to constitute proof of identity for...

  20. 38 CFR 18.433 - Free appropriate public education.

    Science.gov (United States)

    2010-07-01

    ... education. 18.433 Section 18.433 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS..., Secondary, and Adult Education § 18.433 Free appropriate public education. (a) General. A recipient that operates a public elementary or secondary education program shall provide a free appropriate public...

  1. Army Corps of Engineers: Water Resource Authorizations, Appropriations, and Activities

    Science.gov (United States)

    2017-02-27

    eight divisions that are further divided into 38 districts.2 This report provides an overview of the Corps water resource activities , including...rules associated with authorization and appropriation earmarks, individual Members often brought attention to similar activities for congressional...Army Corps of Engineers: Water Resource Authorizations, Appropriations, and Activities Nicole T. Carter Specialist in Natural Resources Policy

  2. Wastes to Resources: Appropriate Technologies for Sewage Treatment and Conversion.

    Science.gov (United States)

    Anderson, Stephen P.

    Appropriate technology options for sewage management systems are explained in this four-chapter report. The use of appropriate technologies is advocated for its health, environmental, and economic benefits. Chapter 1 presents background information on sewage treatment in the United States and the key issues facing municipal sewage managers.…

  3. 34 CFR 300.101 - Free appropriate public education (FAPE).

    Science.gov (United States)

    2010-07-01

    ... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Fape Requirements § 300.101 Free appropriate... ensure that FAPE is available to any individual child with a disability who needs special education and... 34 Education 2 2010-07-01 2010-07-01 false Free appropriate public education (FAPE). 300.101...

  4. Primary to comprehensive stroke center transfers: Appropriateness, not futility.

    Science.gov (United States)

    Goyal, Mayank; Menon, Bijoy K; Wilson, Alexis T; Almekhlafi, Mohammed A; McTaggart, Ryan; Jayaraman, Mahesh; Demchuk, Andrew M; Hill, Michael D

    2018-01-01

    Background and purpose Ischemic stroke patients must be transferred to comprehensive stroke centers for endovascular treatment, but this transfer can be interpreted post hoc as "futile" if patients do not ultimately undergo the procedure or have a poor outcome. We posit that transfer decisions must instead be evaluated in terms of appropriateness at the time of decision-making. Methods We propose a classification schema for Appropriateness of Transfer for Endovascular Thrombectomy based on patient, logistic, and center characteristics. Results The classification outline characteristics of patients that are 1. Appropriate for transfer for endovascular treatment; 2. Inappropriate for transfer; and 3. Appropriate for transfer for higher level of care. Conclusions Appropriate transfer decisions for endovascular treatment are significant for patient outcomes. A more nuanced understanding of transfer decision-making and a classification for such transfers can help minimize inappropriate transfers in acute stroke.

  5. APPROPRIATING CREATIVE WORKS PROTECTED BY INTELLECTUAL PROPERTY RIGHTS

    Directory of Open Access Journals (Sweden)

    Cornelia DUMITRU

    2015-07-01

    Full Text Available The ownership, either public or private, is an expression for appropriating goods. Consequently, the appropriation takes the form of private (i.e. private property and common forms (i.e. public property. The common law property defines appropriation as „a deliberate act of acquisition of something, often without the permission of the owner”, but the intellectual property rights do not protect goods. Particularly in this case „the object” of appropriation does not represent a „res nullius” simply because the intellectual property right arises from the act of creation, therefore the appropriation of somebody else’s creation becomes equivalent with stealing (plagiarism. Consequently, if we are to admit that the authors have a right of ownership over them, then ownership in intellectual property law has (it must have other manifestations than those known and accepted in the common law of property.

  6. Budget estimates fiscal year 1989: Appropriation, Salaries and expenses

    International Nuclear Information System (INIS)

    1988-02-01

    The budget estimates for Salaries and Expenses for FY 1989 provide for obligations of $450,000,000 to be funded in total by a new appropriation. The sum appropriated shall be reduced by the amount of revenues received during fiscal year 1989 from licensing fees, inspection services, and other services and collections, excluding those monies received for the cooperative nuclear safety research program, services rendered to foreign governments and international organizations, and the material and information access authorization programs, so as to result in a final fiscal year 1989 appropriation estimated at not more than $247,500,000

  7. Interior, Environment, and Related Agencies: FY2007 Appropriations

    National Research Council Canada - National Science Library

    Vincent, Carol H; Bearden, David M; Corn, M. L; Gorte, Ross W; Humphries, Marc; Sheikh, Pervaze A; Whiteman, David L; Boren, Susan; Walke, Roger; Bea, Keith

    2007-01-01

    ... of Health and Human Services. It also includes funding for arts and cultural agencies; the Environmental Protection Agency, which was recently transferred to the appropriations subcommittees that deal with Interior and Related Agencies...

  8. Appropriate technology: Often, the best answers can be found right ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-10-28

    Oct 28, 2010 ... In each case, however, the technologies have done their job – they have led to lasting solutions ... Appropriate technology: Often, the best answers can be found right at home ... In a Bookless Society, Why Start With Books?

  9. Appropriate models for estimating stresses and strains in asphalt layers

    CSIR Research Space (South Africa)

    Jooste, FJ

    1998-09-01

    Full Text Available The broad objective is to make recommendations for appropriate modelling procedures to be used in the structural design of asphalt layers. Findings of this investigation are intended to be used in refining and validating existing asphalt pavement...

  10. Financial Status of Air Force Expired Year Appropriations

    National Research Council Canada - National Science Library

    1994-01-01

    ... Procurement appropriations. In our report on that audit, we found that the Air Force experienced deficits and accounting problems relating to funding upward cost adjustments to obligations when such costs were charged...

  11. Determining the appropriate code in a South African business ...

    African Journals Online (AJOL)

    Determining the appropriate code in a South African business environment. ... Southern African Linguistics and Applied Language Studies ... would be perceived to enhance the quality of the interaction between client and service provider.

  12. The application of appropriate technologies and systems for sustainable sanitation

    CSIR Research Space (South Africa)

    Duncker, Louiza C

    2014-11-01

    Full Text Available and environmental factors into planning, implementation and decision-making so as to ensure that development serves present and future generations. The chapter discusses the use of appropriate technologies and systems to render sanitation technologies and services...

  13. Appropriate tools and methods for tropical microepidemiology: a ...

    African Journals Online (AJOL)

    Appropriate tools and methods for tropical microepidemiology: a case-study of malaria clustering in Ethiopia. Tedros A Ghebreyesus, Peter Byass, Karen H Witten, Asfaw Getachew, Mitiku Haile, Mekonnen Yohannes, Steven W Lindsay ...

  14. Age-Appropriate Immunization (AAI) as an Intractable Issue ...

    African Journals Online (AJOL)

    Dinesh Kumar

    ) approved. 30 cluster ... As FI measures coverage for services, but age appropriate ..... providers need to be effectively oriented towards importance of ... planning and management interventions for improving age- ... BMC Health Serv Res.

  15. ACR Appropriateness Criteria® Colorectal Cancer Screening.

    Science.gov (United States)

    Moreno, Courtney; Kim, David H; Bartel, Twyla B; Cash, Brooks D; Chang, Kevin J; Feig, Barry W; Fowler, Kathryn J; Garcia, Evelyn M; Kambadakone, Avinash R; Lambert, Drew L; Levy, Angela D; Marin, Daniele; Peterson, Christine M; Scheirey, Christopher D; Smith, Martin P; Weinstein, Stefanie; Carucci, Laura R

    2018-05-01

    This review summarizes the relevant literature regarding colorectal screening with imaging. For individuals at average or moderate risk for colorectal cancer, CT colonography is usually appropriate for colorectal cancer screening. After positive results on a fecal occult blood test or immunohistochemical test, CT colonography is usually appropriate for colorectal cancer detection. For individuals at high risk for colorectal cancer (eg, hereditary nonpolyposis colorectal cancer, ulcerative colitis, or Crohn colitis), optical colonoscopy is preferred because of its ability to obtain biopsies to detect dysplasia. After incomplete colonoscopy, CT colonography is usually appropriate for colorectal cancer screening for individuals at average, moderate, or high risk. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Analysis of databases appropriation in the academic staffs of Iranian Universities of Medical Sciences according to the social appropriation approach.

    Science.gov (United States)

    Keyvanara, Mahmoud; Sohrabi, Mozaffar Cheshmeh; Zare, Firoozeh; Hassnazadeh, Akbar; Malekahmadi, Parisa

    2014-01-01

    Numerous researches conducted on about the quality of perception of media messages shows that the people are not passive receivers but they have the ability of understanding, interpreting and accepting or rejecting messages. In order to make clear the relationship of information and communication technologies with social changes and to gain a broader vision from this scope, sociological theories about information and communication technologies' usage, especially appropriation approach can be very useful. So, keeping in mind the important role of Databases in the qualitative expansion of education, research, diagnosis, remedy and medical services presentation, this research was carried out with the aim of status determination of databases appropriation in the academic staffs of Iranian Universities of Medical Sciences according to the social appropriation approach in 2012. This is an applicative research of an analytical-descriptive type, which was carried out by measurement approach. The statistical society of this research was composed of the academic staffs of the Iranian Universities of Medical Sciences in 2012 and finally 390 academic staffs were selected according to the Cochran's formula were selected. The research tool are searcher's made questionnaire, which was composed of nine separate parts. Its validity was accepted by the specialists and its reliability was calculated and found to be 0.961 by Cronbakh's alpha. Database appropriation score in the academic staffs of Iranian Universities of Medical Sciences with 65.020% was in a good status and data bases dis appropriation score with 71.484 was in a high status. According to the findings of this research, Librarians and politicians in this scope-with determination of the academic staff's positive and negative points in usage and appropriation would be capable of accurately diagnozing and analyzing the chances and challenges of the academic staffs members in using databases and would also be capable of

  17. Beyond Brazilian Coalition Presidentialism: the Appropriation of the Legislative Agenda

    Directory of Open Access Journals (Sweden)

    Rafael Silveira e Silva

    2014-12-01

    Full Text Available Even though they possess several power resources, Brazilian Presidents also elaborate their legislative proposals based upon bills already being processed in Congress through a phenomenon called Appropriation of the legislative agenda. In this paper I examine the conditions under which this phenomenon occurs by means of a typology and a qualitative comparative analysis (QCA. I conclude that Appropriation provides the President with the expansion of the formal support base by controlling the agenda of allied and opposition parties as well as obtaining the "paternity" of several policies already in motion in Congress, thus enabling a public association of the President's actions and his or her party with the possibility of social benefits. Be it in the pursuit of promising agendas or for the maintenance of their own dominance, Appropriation shows that Brazilian Presidents must go beyond coalition presidentialism.

  18. Korean guidelines for the appropriate use of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Jin [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul(Korea, Republic of); Yong, Hwan Seok [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul(Korea, Republic of); Kim, Sung Mok [Dept. of Radiology, amsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jung A [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of); Hong, Yoo Jin [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.

  19. Appropriate selection for omalizumab treatment in patients with severe asthma?

    DEFF Research Database (Denmark)

    Nygaard, Leo; Henriksen, Daniel Pilsgaard; Madsen, Hanne

    2017-01-01

    Background: Omalizumab improves asthma control in patients with uncontrolled severe allergic asthma; however, appropriate patient selection is crucial. Information in this field is sparse. Objective: We aimed to estimate whether potential omalizumab candidates were appropriately selected according...... to guidelines, and the clinical effect of omalizumab treatment over time. Design: We performed a retrospective observational study on adult patients with asthma treated with omalizumab during 2006-2015 at the Department of Respiratory Medicine at Odense University Hospital (OUH), Denmark. Data were obtained...... from the Electronic Patient Journal of OUH and Odense Pharmaco-Epidemiological Database. Guideline criteria for omalizumab treatment were used to evaluate the appropriateness of omalizumab candidate selection, and the Asthma Control Test (ACT) to assess the clinical effects of omalizumab at weeks 16...

  20. Evaluation of appropriate technologies for grey water treatments and reuses.

    Science.gov (United States)

    Li, Fangyue; Wichmann, Knut; Otterpohl, Ralf

    2009-01-01

    As water is becoming a rare resource, the onsite reuse and recycling of grey water is practiced in many countries as a sustainable solution to reduce the overall urban water demand. However, the lack of appropriate water quality standards or guidelines has hampered the appropriate grey water reuses. Based on literature review, a non-potable urban grey water treatment and reuse scheme is proposed and the treatment alternatives for grey water reuse are evaluated according to the grey water characteristics, the proposed standards and economical feasibility.

  1. The Appropriation of Fine Art into Contemporary Narrative Picturebooks

    Science.gov (United States)

    Serafini, Frank

    2015-01-01

    Many picturebook artists have been formally trained in specific artistic styles, movements, and techniques. These artists appropriate and transform works of fine art to varying degrees to fit the themes and designs of the stories they illustrate and publish, and to increase the significance and impact of their illustrations. The…

  2. 14 CFR 1261.403 - Consultation with appropriate officials; negotiation.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Consultation with appropriate officials; negotiation. 1261.403 Section 1261.403 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROCESSING OF MONETARY CLAIMS (GENERAL) Collection of Civil Claims of the United States Arising Out of the Activities of the National Aeronautic...

  3. MySQL based selection of appropriate indexing technique in ...

    African Journals Online (AJOL)

    This paper deals with selection of appropriate indexing technique applied on MySQL Database for a health care system and related performance issues using multiclass support vector machine (SVM). The patient database is generally huge and contains lot of variations. For the quick search or fast retrieval of the desired ...

  4. Appropriate assessment of English language competency for South ...

    African Journals Online (AJOL)

    Appropriate assessment of English language competency for South African teachers-in-training. ... albeit having regard to learner attitudes and purposes. The paper concludes that using the new communicative methods of language testing with foundation phase teachers-in-training may improve classroom practice.

  5. Educating Parents on Developmentally Age-Appropriate Learning in Preschool.

    Science.gov (United States)

    Brown, Mitzi C.

    This practicum paper reports on a project undertaken to enhance the knowledge of age-appropriate learning for parents of 3-year-old preschoolers. The project implemented a variety of techniques and strategies to improve parent knowledge, including parent education classes, a monthly newsletter for parents that addressed current research on…

  6. Relations between the technological standards and technological appropriation

    Directory of Open Access Journals (Sweden)

    Carlos Alberto PRADO GUERRERO

    2010-06-01

    Full Text Available The objective of this study is to analyze the educational practices of using Blackboard in blended learning environments with students of higher education to understand the relationship between technological appropriation and standards of educational technology. To achieve that goal, the following research question was raised: ¿To what extent are the standards of education technology with the appropriation of technology in blended learning environments in higher educa­tion related? The contextual framework of this work includes the following topics: the institution, teaching, teachers and students. The design methodology that was used is of a correlation type. Correlations were carried out to determine the frequency and level in the technological standards as well as the appropriation of technology. In the comparison of the results obtained by the students, the teachers and the platform; we found that students in the school study showed a high degree of technology ownership and this was the same for the performance shown on the technological standards. It was established that teachers play a key role in developing the techno­logical appropriation of students and performance in technology standards.

  7. The appropriateness of emergency medical service responses in the ...

    African Journals Online (AJOL)

    The appropriateness of emergency medical service responses in the eThekwini district of KwaZulu-Natal, South Africa. PR Newton, R Naidoo, P Brysiewicz. Abstract. Introduction. Emergency medical services (EMS) are sometimes required to respond to cases that are later found not to be emergencies, resulting in high ...

  8. 12 CFR 269.4 - Determination of appropriate bargaining unit.

    Science.gov (United States)

    2010-01-01

    ... requesting a representation election signed by at least thirty percent (30%) of the employees in a unit which... the labor organization should disagree with the Special Tribunal's decision, the party in disagreement... percent (30%) of the employees in a unit claimed by a labor organization as appropriate or subsequently...

  9. 5 CFR 532.217 - Appropriated fund survey jobs.

    Science.gov (United States)

    2010-01-01

    ... Laundry Worker 1 Food Service Worker 2 Cook 8 (e) A lead agency must obtain prior approval of OPM to add a... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Appropriated fund survey jobs. 532.217 Section 532.217 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS...

  10. Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Anderson de [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Comissão Nacional de Energia Nuclear - CNEN (Brazil); Rezende, Maria Fernanda [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Corrêa, Renato; Mousinho, Rodrigo [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Miranda, Sandra Marina; Oliveira, Aline Ribeiro [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Gutterres, Ricardo Fraga [Comissão Nacional de Energia Nuclear - CNEN (Brazil); Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2014-11-15

    Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

  11. towards an appropriate extension approach for agricultural and rural ...

    African Journals Online (AJOL)

    empowered to do so, an important condition is an appropriate organisational structure, which can support the process and take it forward. The community structure required is one that serves as an effective linkage structure to facilitate an effective partnership interaction between the development agent. (or organisation) and ...

  12. Is the New Partnership for Africa's Development an Appropriate ...

    African Journals Online (AJOL)

    The New Partnership for Africa's Development (NEPAD) is the African Union's socio-political and economic development programme, and one of its tasks is to accelerate African continental integration. The fundamental question is, however, whether it is the appropriate programme for this. Its success depends on the ...

  13. 34 CFR 104.33 - Free appropriate public education.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Free appropriate public education. 104.33 Section 104.33 Education Regulations of the Offices of the Department of Education OFFICE FOR CIVIL RIGHTS, DEPARTMENT OF EDUCATION NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES RECEIVING...

  14. 34 CFR 300.17 - Free appropriate public education.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Free appropriate public education. 300.17 Section 300.17 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF...

  15. FTA Training Programs: Searching for Appropriate Teaching Styles.

    Science.gov (United States)

    Byrd, Patricia; Constantinides, Janet C.

    1988-01-01

    In addition to acquiring communicative competence, teaching assistants who speak English as a second language must learn human relations skills, and how to teach content through appropriate teaching methods and skills that will help them bridge the cultural and language differences they experience in U.S. institutions of higher education. (CB)

  16. Herbal dietary supplements and knowledge of appropriate use ...

    African Journals Online (AJOL)

    %) and Aloe vera (32.2%). Fifty eight (71.6%) out of the 81 respondents on prescription drugs were using it alongside HDS. Respondents with poor, fair and good knowledge of appropriate use of HDS were 69.1%, 27.3% and 3.6% respectively.

  17. In search of an appropriate contemporary approach in Christian ...

    African Journals Online (AJOL)

    The article addresses the question: 'To what extent can Max Weber's ethic of responsibility be a helpful resource in the search of Christian Social Ethics for an appropriate contemporary approach'? This question is addressed by, first of all, providing a summary of Weber's famous speech Politics as a Vocation in which he ...

  18. A case study of culturally appropriate conservation education

    Science.gov (United States)

    David N. Bengston; Michele Schermann

    2016-01-01

    Create culturally appropriate conservation education materials for Hmong Americans, including new refugees and elders with little proficiency in English, as well as the broader, multigenerational Hmong community. This case study discusses an organizational response from the USDA Forest Service, in partnership with others, to better serve the Hmong American community....

  19. Counselling as a psychological approach to fostering appropriate ...

    African Journals Online (AJOL)

    The focus of this paper is on counselling as a psychological approach to fostering appropriate learning behaviour in Nigerian secondary school students. The paper drew attention to the confrontation, mentoring, behavioural, appraisal, and standards blending models to appeal to the consciences of students with ...

  20. Developing an Appropriate Goalball Unit for Secondary Physical Education

    Science.gov (United States)

    Laughlin, Michael K.; Happel, Kathleen

    2016-01-01

    Goalball, a sport designed for those with visual impairments, is a competitive and recreational sport enjoyed by athletes around the world. Students with and without visual impairments can experience positive outcomes when teachers appropriately include a goalball unit as part of their inclusive secondary physical education curriculum. This…

  1. Social Appropriateness in EU Counter-Terrorism Law and Policy

    DEFF Research Database (Denmark)

    Martins, Bruno Oliveira

    2015-01-01

    versus justice equation, on the issues of privacy and data protection, and on the broader respect for fundamental rights more generally. In this process, the legitimacy and the social appropriateness of some of these measures have been questioned, both at the societal level and before or by European...

  2. ACR Appropriateness Criteria® Ovarian Cancer Screening.

    Science.gov (United States)

    Pandharipande, Pari V; Lowry, Kathryn P; Reinhold, Caroline; Atri, Mostafa; Benson, Carol B; Bhosale, Priyadarshani R; Green, Edward D; Kang, Stella K; Lakhman, Yulia; Maturen, Katherine E; Nicola, Refky; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Whitcomb, Bradford; Zelop, Carolyn M; Glanc, Phyllis

    2017-11-01

    There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  3. The anaerobic baffled reactor (ABR): An appropriate technology for ...

    African Journals Online (AJOL)

    This project has studied the appropriateness of the ABR for on-site primary sanitation in low-income communities. The baffled design of the ABR ensures high solids retention resulting in high treatment rates, while the overall sludge production is characteristically low. Effluent COD values measured from a 3 000 l pilot ABR ...

  4. Identification of appropriate tools of information and communication ...

    African Journals Online (AJOL)

    Access to sufficient and desirable food is one of the principles of any developing and healthy society. One of the important means for attainment of food security is information and communication technologies (ICT). The purpose of the research was to identify appropriate tools of ICT in improving food security of Iran's rural ...

  5. Differences between Males and Females Concerning Perceived Electronic Mail Appropriateness

    Science.gov (United States)

    Harper, Vernon B., Jr.

    2008-01-01

    Electronic mail is one of the most successfully diffused modern communication technologies. Yet, few researchers have investigated whether gender differences exist in perceptions of the types of appropriateness embedded within electronic mail messages. A framework originally created by Wiemann and Backlund (1980) served as the basis for the…

  6. Appropriate hydrological modelling of climate change on river flooding

    NARCIS (Netherlands)

    Booij, Martijn J.; Rizzoli, A.E.; Jakeman, A.J.

    2002-01-01

    How good should a river basin model be to assess the impact of climate change on river flooding for a specific geographical area? The determination of such an appropriate model should reveal which physical processes should be incorporated and which data and mathematical process descriptions should

  7. Appropriability mechanisms, innovation and productivity: Evidence from the UK

    NARCIS (Netherlands)

    Hall, B.H.; Sena, V.

    2014-01-01

    We use an extended version of the well-established Crepon, Duguet and Mairesse model (1998) to model the relationship between appropriability mechanisms, innovation and firm-level productivity. We enrich this model in several ways. First, we consider different types of innovation spending and study

  8. Mediating Third-Wave Feminism: Appropriation as Postmodern Media Practice.

    Science.gov (United States)

    Shugart, Helene A.; Waggoner, Catherine Egley; Hallstein, D. Lynn O'Brien

    2001-01-01

    Analyzes gendered representations of Alanis Morissette, Kate Moss, and Ally McBeal. Argue that, in each case, the appropriation of third-wave feminist tenets is accomplished via a postmodern aesthetic code of juxtaposition that serves to recontextualize and reinscribe those sensibilities in a way that ultimately functions to reify dominant…

  9. Neural mechanism for judging the appropriateness of facial affect.

    Science.gov (United States)

    Kim, Ji-Woong; Kim, Jae-Jin; Jeong, Bum Seok; Ki, Seon Wan; Im, Dong-Mi; Lee, Soo Jung; Lee, Hong Shick

    2005-12-01

    Questions regarding the appropriateness of facial expressions in particular situations arise ubiquitously in everyday social interactions. To determine the appropriateness of facial affect, first of all, we should represent our own or the other's emotional state as induced by the social situation. Then, based on these representations, we should infer the possible affective response of the other person. In this study, we identified the brain mechanism mediating special types of social evaluative judgments of facial affect in which the internal reference is related to theory of mind (ToM) processing. Many previous ToM studies have used non-emotional stimuli, but, because so much valuable social information is conveyed through nonverbal emotional channels, this investigation used emotionally salient visual materials to tap ToM. Fourteen right-handed healthy subjects volunteered for our study. We used functional magnetic resonance imaging to examine brain activation during the judgmental task for the appropriateness of facial affects as opposed to gender matching tasks. We identified activation of a brain network, which includes both medial frontal cortex, left temporal pole, left inferior frontal gyrus, and left thalamus during the judgmental task for appropriateness of facial affect compared to the gender matching task. The results of this study suggest that the brain system involved in ToM plays a key role in judging the appropriateness of facial affect in an emotionally laden situation. In addition, our result supports that common neural substrates are involved in performing diverse kinds of ToM tasks irrespective of perceptual modalities and the emotional salience of test materials.

  10. Appropriate working hours for surgical training according to Australasian trainees.

    Science.gov (United States)

    O'Grady, Gregory; Harper, Simon; Loveday, Benjamin; Adams, Brandon; Civil, Ian D; Peters, Matthew

    2012-04-01

    The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees. All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly 'sleep loss hours' (work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work-life balance preferences. Multivariate and univariate analyses were performed. The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55-65) considered their work hours to be appropriate for 'technical' and 'non-technical' training needs compared with 55 h/week (interquartile range: 50-60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly 'sleep loss hours', was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work-life balance worked median 55 h/week. Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  11. The taxation of the petroleum products in the appropriation bill for 2001 and the correcting appropriation bill for 2000

    International Nuclear Information System (INIS)

    2000-01-01

    This document provides information on the petroleum products taxation in the framework of the appropriation bills. The following aspects are presented : the utilization of fuels more respectful of the environment, the taxation lightening measures, measures in favor of the transportation sector, the juridical references and elements for the economic situation. (A.L.B.)

  12. Appropriateness of pediatric hospitalization in a general hospital in Kuwait.

    Science.gov (United States)

    Shafik, Magdy H; Seoudi, Tarek M M; Raway, Tarek S; Al Harbash, Nowair Z; Ahmad, Meshal M A; Al Mutairi, Hanan F

    2012-01-01

    To determine the rate of inappropriate pediatric admissions using the Pediatric Appropriateness Evaluation Protocol (PAEP) and to examine variables associated with inappropriateness of admissions. A prospective study was conducted in the Department of Pediatrics, Farwania General Hospital, Kuwait, to examine successive admissions for appropriateness of admission as well as several sociodemographic characteristics over a 5-month period (August 2010 to December 2010). A total of 1,022 admissions were included. Of the 1,022 admissions, 416 (40.7%) were considered inappropriate. Factors associated with a higher rate of inappropriate admission included older age of patients and self-referral. The rate of inappropriate hospitalization of children was high in Farwania Hospital, Kuwait, probably due to the relatively free health care services, parental preference for hospital care, easy access to hospital services, and insufficient education about the child's condition. Copyright © 2012 S. Karger AG, Basel.

  13. ACR Appropriateness Criteria® Routine Chest Radiography.

    Science.gov (United States)

    McComb, Barbara L; Chung, Jonathan H; Crabtree, Traves D; Heitkamp, Darel E; Iannettoni, Mark D; Jokerst, Clinton; Saleh, Anthony G; Shah, Rakesh D; Steiner, Robert M; Mohammed, Tan-Lucien H; Ravenel, James G

    2016-03-01

    Chest radiographs are sometimes taken before surgeries and interventional procedures on hospital admissions and outpatients. This manuscript summarizes the American College of Radiology review of the literature and recommendations on routinely performed chest radiographies in these settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

  14. Software appropriation over time: from adoption to stabilization and beyond

    Directory of Open Access Journals (Sweden)

    Antonette Mendoza

    2010-01-01

    Full Text Available Technologies are introduced into an organization with the aim of improving productivity. However, persistent use of an information system is required to enhance productivity and user satisfaction. In this paper, we examine the process of technology appropriation and the factors that encourage and discourage use of an information system over time. In a longitudinal field study in an educational setting, we identify changing expectations and influences that encourage persistent use of a technology above and beyond adoption. Our work indicates that stabilization of a technology may only be a temporary plateau. Further appropriation may occur beyond initial stabilization as expectations and influences encourage persistent use of a technology. We have found that the driving forces in encouraging productive use of a technology are the ability for users to experience the technology as useful and to have easy access to ongoing training.

  15. Appropriate Determination of Net Working Capital in Corporate Financial Management

    Directory of Open Access Journals (Sweden)

    Zdeněk Motlíček

    2015-01-01

    Full Text Available Liquidity and working capital management belongs to one of the fundamental tasks of short-term financial management. However, in the context of net working capital, the issue of management of current assets and liabilities significantly overlaps with long-term financial management, in which the effects of various decisions have long-term consequences, with considerable inertia and possibility of high losses. The present study is therefore focused on the determination of appropriate amount of working capital, as an important part of financial decision making process in the company. The paper presents an empirical research aiming to identify the appropriate approach to accurate calculations of net working capital and determining its needs. The main contribution of the study can be found in the verification of calculation method of net working capital needs, which, according to the authors, may be beneficial both for business practice and teaching of financial management at universities.

  16. Development planning and appropriate technology: a dilemma and a proposal

    Energy Technology Data Exchange (ETDEWEB)

    Ellis, G.

    1981-03-01

    This paper examines the present system of project paper preparation and project planning used by the US Agency for International Development and many donor agencies. Three approaches for meeting the evident weaknesses of the system - a holistic approach to the planning problem, an operant-conditioning approach to implementation, and a process approach to planning and implementation - are presented and critiqued. On the basis of the critique, an approach grounded in a search for an approximately appropriate technology is supported; and a proposal for an appropriate-technology evaluation system which would analyze alternative technologies, deliver information to the field level, supply needed information on technologies and implementation, constrain donor planners, reduce lag time, incorporate evaluations into future planning, and reduce dependence upon planners is presented. 66 references.

  17. Methods of achieving and maintaining an appropriate caesarean section rate.

    LENUS (Irish Health Repository)

    Robson, Michael

    2013-04-01

    Caesarean section rates continue to increase worldwide. The appropriate caesarean section rate remains a topic of debate among women and professionals. Evidence-based medicine has not provided an answer and depends on interpretation of the literature. Overall caesarean section rates are unhelpful, and caesarean section rates should not be judged in isolation from other outcomes and epidemiological characteristics. Better understanding of caesarean section rates, their consequences and their benefits will improve care, and enable learning between delivery units nationally and internationally. To achieve and maintain an appropriate caesarean section rate requires a Multidisciplinary Quality Assurance Programme in each delivery unit, recognising caesarean section rates as one of many factors that determine quality. Women will always choose the type of delivery that seems safest to them and their babies. Professionals need to monitor the quality of their practice continuously in a standardised way to ensure that women can make the right choice.

  18. Diligence in determining the appropriate form of stationarity

    Directory of Open Access Journals (Sweden)

    André Heymans

    2014-11-01

    Full Text Available Orientation: One of the most vexing problems of modelling time series data is determining the appropriate form of stationarity, as it can have a significant influence on the model’s explanatory properties, which makes interpreting the results problematic. Research purpose: This article challenged the assumption that most financial time series are first differenced stationary. The common difference first, ask questions later approach was revisited by taking a more systematic approach when analysing the statistical properties of financial time series data. Motivation for the study: Since Nelson and Plosser’s (1982 argued that many macroeconomic time series are difference stationary, many econometricians simply differenced data in order to achieve stationarity. However, the inherent properties of time series data have changed over the past 30 years. This necessitates a proper evaluation of the properties of data before deciding on the appropriate course of action, in order to avoid over-differencing which causes variables to lose their explanatory ability that leads to spurious results. Research approach, design and method: This article introduced a rigorous process that enables econometricians to determine the most appropriate form of stationarity, which is led by the underlying statistical properties of several financial and economic variables. Main findings: The results highlighted the importance of consulting the d parameter to makea more informed decision, rather than only assuming that the data are I(1. Evidence also suggested that the appropriate form of stationarity can vary, but emphasises the importance to consider a series to be fractionally differenced. Practical/managerial implications: Only when data are correctly classified and transformed accordingly will the data be neither under- nor over-differenced, thus enhancing the validity of the results generated by statistical models. Contribution/value-add: By utilising this rigorous

  19. State, Foreign Operations, and Related Programs: FY2008 Appropriations

    Science.gov (United States)

    2007-12-14

    and social reforms. The President initially pledged $5 billion annually by FY2006, although funds requested and appropriated have never reached this...to Cuba. The BBG is planning to eliminate several VOA services including Uzbek, Greek, and Cantonese as well as the RFE/RL Macedonia service. BBG also...increased to $230.0 million. The increase of $195 million is entirely for social services to Iraqi refugees. FY2007 Supplemental Request. On April 25

  20. Appropriate Utilization and Stocking of Antidotes in Qatar Public Hospitals

    OpenAIRE

    Rawan Salameh; Waleed Awad Salem; ISMA Qureshi; Asma Al-Bukari; Eman Shaat; Jibin Moinudheen; Galal Aleassi; Robert Hoffman

    2017-01-01

    Background: There are a few studies that evaluate preparedness and availability of antidotes in the emergency setting and none have been conducted in Qatar. Published studies show that timely availability of antidotes in the emergency department setting is a common issue. To address this, we conducted a study to evaluate antidote stocking and utilization in Qatar hospital pharmacies and emergency departments. Methods: In order to evaluate the appropriate use and timely administration of antid...

  1. Appeal to fear in health care: appropriate or inappropriate?

    OpenAIRE

    Simpson, J. Keith

    2017-01-01

    Aim This paper examines appeal to fear in general: its perceived positive aspects, its negative characteristics, its appropriate as well as its fallacious use. Background Appeal to fear is a commonly used marketing method that attempts to change behaviour by creating anxiety in those receiving a fearful message. It is regularly used in public health initiatives such as anti-smoking, anti-drunk driving campaigns as well as in hypertension awareness campaigns. Some chiropractors appear to use a...

  2. Appropriability mechanisms, innovation and productivity: Evidence from the UK

    OpenAIRE

    Hall, B.H.; Sena, V.

    2014-01-01

    We use an extended version of the well-established Crepon, Duguet and Mairesse model (1998) to model the relationship between appropriability mechanisms, innovation and firm-level productivity. We enrich this model in several ways. First, we consider different types of innovation spending and study the differences in estimates when innovation spending (rather than R&D spending) is used to predict innovation in the CDM model. Second, we assume that a firm simultaneously innovates and chooses a...

  3. Textual appropriation in engineering master's theses: a preliminary study.

    Science.gov (United States)

    Eckel, Edward J

    2011-09-01

    In the thesis literature review, an engineering graduate student is expected to place original research in the context of previous work by other researchers. However, for some students, particularly those for whom English is a second language, the literature review may be a mixture of original writing and verbatim source text appropriated without quotations. Such problematic use of source material leaves students vulnerable to an accusation of plagiarism, which carries severe consequences. Is such textual appropriation common in engineering master's writing? Furthermore, what, if anything, can be concluded when two texts have been found to have textual material in common? Do existing definitions of plagiarism provide a sufficient framework for determining if an instance of copying is transgressive or not? In a preliminary attempt to answer these questions, text strings from a random sample of 100 engineering master's theses from the ProQuest Dissertations and Theses database were searched for appropriated verbatim source text using the Google search engine. The results suggest that textual borrowing may indeed be a common feature of the master's engineering literature review, raising questions about the ability of graduate students to synthesize the literature. The study also illustrates the difficulties of making a determination of plagiarism based on simple textual similarity. A context-specific approach is recommended when dealing with any instance of apparent copying.

  4. The Concept of Appropriateness in Issuing Administrative Acts

    Directory of Open Access Journals (Sweden)

    Iulian Nedelcu

    2011-05-01

    Full Text Available Administrative acts are a legal way of organizing the execution and enforcement of the law. Law can not and should not establish all cases and all the ways, by means of which public administration bodies interfere with administrative actions, therefore administrative public bodies must have some initiative and ought to be able to assess the situations in which they will issue these acts and to appreciate their appropriateness. The appropriateness principle of administrative acts must be correlated with the legality principle. It can be concluded that the appropriateness principle underscores the power conferred by public administration, permitted in accordance with which it has the right and duty to judge when issuing an administrative compliance of the state of lawand facts, an appreciation that public administration is based on a single criterion: the interests of the community that they represent. Also, the very organization of the state as a state of law leads to the conclusion that the law – which is the materialization of the idea of justice – should be the standard on which the activity of human individuals report both to the quality of beneficiaries of the provisions and benefits of public administration and on the other hand as officials, public servants or ordinary employees in public administration system.

  5. Guideline for appropriate use of cardiac CT in heart disease

    International Nuclear Information System (INIS)

    Kim, Young Jin; Hong, Yoo Jin; Yong, Hwan Seok; Kim, Sung Mok; Kim, Jeong A; Yang, Dong Hyun

    2014-01-01

    Heart disease is one of the leading causes of deaths in Korea, along with malignant neoplasms and cerebrovascular diseases. The proper diagnosis and management for patients with suspected heart diseases should be warranted for the public health care. Advances in CT technology have allowed detailed images of the heart to be obtained, which enable evaluations not only of the coronary arteries but also of other cardiac structures. Currently, the latest multi-detector CT machines are widespread around Korea. The appropriate use of cardiac CT may lead to improvements of the physicians' medical performances and to reduce medical costs which eventually contribute to promotions of public health. However, until now, there has been no guidelines regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases.

  6. APPROPRIATE ALLOCATION OF CONTINGENCY USING RISK ANALYSIS METHODOLOGY

    Directory of Open Access Journals (Sweden)

    Andi Andi

    2004-01-01

    Full Text Available Many cost overruns in the world of construction are attributable to either unforeseen events or foreseen events for which uncertainty was not appropriately accommodated. It is argued that a significant improvement to project management performance may result from greater attention to the process of analyzing project risks. The objective of this paper is to propose a risk analysis methodology for appropriate allocation of contingency in project cost estimation. In the first step, project risks will be identified. Influence diagramming technique is employed to identify and to show how the risks affect the project cost elements and also the relationships among the risks themselves. The second step is to assess the project costs with regards to the risks under consideration. Using a linguistic approach, the degree of uncertainty of identified project risks is assessed and quantified. The problem of dependency between risks is taken into consideration during this analysis. For the final step, as the main purpose of this paper, a method for allocating appropriate contingency is presented. Two types of contingencies, i.e. project contingency and management reserve are proposed to accommodate the risks. An illustrative example is presented at the end to show the application of the methodology.

  7. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension.

    Science.gov (United States)

    Sirajuddin, Arlene; Donnelly, Edwin F; Crabtree, Traves P; Henry, Travis S; Iannettoni, Mark D; Johnson, Geoffrey B; Kazerooni, Ella A; Maldonado, Fabien; Olsen, Kathryn M; Wu, Carol C; Mohammed, Tan-Lucien; Kanne, Jeffrey P

    2017-05-01

    Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations that may be helpful in diagnosing and determining the etiology of pulmonary hypertension are discussed. Imaging examinations that may aid in the diagnosis of pulmonary hypertension include chest radiography, ultrasound echocardiography, ventilation/perfusion scans, CT, MRI, right heart catheterization, pulmonary angiography, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  8. The emergency department: An appropriate referral rate for radiography

    International Nuclear Information System (INIS)

    Richards, P.J.; Tins, B.; Cherian, R.; Rae, F.; Dharmarajah, R.; Phair, I.C.; McCall, I.

    2002-01-01

    AIM: To evaluate the hypothesis that where there is good clinical practice in an emergency department (ED), there is a low uptake of plain radiography. MATERIALS AND METHODS: Emergency notes and radiography records were reviewed over one week in January 1999, to determine the rate of radiography of first time attenders at the North Staffordshire NHS Trust. The clinical appropriateness of the imaging was assessed by pairs of radiology specialist registrars and casualty physicians. They judged the appropriateness of the imaging by the 1998 Royal College of Radiologists (RCR) guidelines and/or their clinical judgement, by consensus. Where there was no consensus or the data appeared incomplete, the radiology and ED consultant reviewed the notes. RESULTS: A total of 1615 notes were found out of 1643 (98%). Of these, 147 (9%) return attenders were excluded and 32 patients left without being seen. The number of first time attenders was 1436 (87%), of whom 637 (44%) were radiographed; 95% of these radiography examinations were appropriate and 5% were inappropriate. Of the first time attenders who were not radiographed the decision was appropriate in 95% of cases, and inappropriate for 5%, i.e. 5% of those who had no radiography, should have been X-rayed. There were no disagreements between RCR guidelines and the clinical judgements, but in 16% there were no suitable RCR guidelines. Junior doctors were not always able to find the relevant RCR guideline (relevant clinical guideline found in 73% of cases) in the guideline book, compared to the consultants (relevant clinical guideline found in 84% of cases). CONCLUSION: The application of the RCR guidelines is taken as representing good clinical practice in determining when to refer a patient for radiography. Based on this assumption, a referral rate for radiography of 44% of first time attenders was found to be appropriate. This referral rate can be taken as a benchmark. A benchmark is necessary in order to allow departments

  9. ACR Appropriateness Criteria Assessment of Fetal Well-Being.

    Science.gov (United States)

    Simpson, Lynn; Khati, Nadia J; Deshmukh, Sandeep P; Dudiak, Kika M; Harisinghani, Mukesh G; Henrichsen, Tara L; Meyer, Benjamin J; Nyberg, David A; Poder, Liina; Shipp, Thomas D; Zelop, Carolyn M; Glanc, Phyllis

    2016-12-01

    Although there is limited evidence that antepartum testing decreases the risk for fetal death in low-risk pregnancies, women with high-risk factors for stillbirth should undergo antenatal fetal surveillance. The strongest evidence supporting antepartum testing pertains to pregnancies complicated by intrauterine fetal growth restriction secondary to uteroplacental insufficiency. The main ultrasound-based modalities to determine fetal health are the biophysical profile, modified biophysical profile, and duplex Doppler velocimetry. In patients at risk for cardiovascular compromise, fetal echocardiography may also be indicated to ensure fetal well-being. Although no single antenatal test has been shown to be superior, all have high negative predictive values. Weekly or twice-weekly fetal testing has become the standard practice in high-risk pregnancies. The timing for the initiation of assessments of fetal well-being should be tailored on the basis of the risk for stillbirth and the likelihood of survival with intervention. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. ACR Appropriateness Criteria® First Trimester Vaginal Bleeding.

    Science.gov (United States)

    Brown, Douglas L; Packard, Ann; Maturen, Katherine E; Deshmukh, Sandeep Prakash; Dudiak, Kika M; Henrichsen, Tara L; Meyer, Benjamin J; Poder, Liina; Sadowski, Elizabeth A; Shipp, Thomas D; Simpson, Lynn; Weber, Therese M; Zelop, Carolyn M; Glanc, Phyllis

    2018-05-01

    Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention. Less common causes of first trimester vaginal bleeding include gestational trophoblastic disease and arteriovenous malformations. Pulsed methods of Doppler US should generally be avoided in the first trimester when there is a normal, or a potentially normal, IUP. Once a normal IUP has been excluded, Doppler US may be useful when other diagnoses such as retained products of conception or arteriovenous malformations are suspected. MRI may occasionally be helpful as a problem-solving tool. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Trends in metformin utilisation and dose appropriateness in Australia.

    Science.gov (United States)

    Moon, J; Kumar, S S; Graham, G G; Baysari, M T; Williams, K M; Chen, W; Viardot, A; Greenfield, J R; Day, R O

    2016-12-01

    The study aimed to (1) determine the trends in the utilisation of metformin in Australia, (2) determine the appropriateness of metformin dosing in an Australian teaching hospital and (3) gather the opinions of prescribers on the relationship between metformin dose and renal function. National prescription data between 1990 and 2012 were accessed. A retrospective audit (2008-2012) of metformin doses and patient renal function (20 % random sample of all in-patients prescribed metformin) was conducted at St Vincent's Hospital (SVH), Sydney. Prescribers of metformin were interviewed (semi-structured; consultants at SVH) or surveyed (Australian endocrinologists) to gather their understanding of metformin dosing in relation to renal function. Metformin utilisation increased fivefold nationally between 1995 and 2012. Metformin tended to be under-dosed in SVH patients with normal renal function (83.5 %) and over-dosed in patients with impaired renal function (estimated glomerular filtration rate (eGFR) metformin doses needed to be reduced in renal impairment. Most endocrinologists (61 %) were comfortable prescribing metformin down to eGFRs around 30 mL/min. The use of metformin increased greatly over the period of the study. Metformin is prescribed frequently for patients with eGFR values below the minimal level approved in the product label (60 mL/min). While prescribers expressed their understanding of the need to reduce metformin doses in patients with renal impairment, we found that metformin doses were higher than appropriate in patients with impaired renal function. Metformin may be used safely when renal function is poor provided dosage is appropriately reduced.

  12. Is BMD testing appropriate for all menopausal women?

    Science.gov (United States)

    Kleerekoper, Michael; Nelson, Dorothy A

    2005-01-01

    The United States Preventive Services Task Force has provided an evidence-based guideline indicating that bone mineral density (BMD) testing is appropriate for all women aged 65 or older. This does not preclude BMD testing in younger postmenopausal women but places the onus on the treating physician to justify the procedure to the patient and often the patient's insurance carrier. There are very few circumstances in which BMD testing is appropriate for healthy premenopausal women, but BMD testing in younger postmenopausal women is often appropriate: when there is a family history of osteoporosis with fracture, a personal history of fracture as an adult, and a medical, surgical or therapeutic history that might be associated with accelerated bone loss or increased risk of fracture. Medical conditions include intestinal diseases associated with malabsorption, such as non-tropical sprue, or primary hyperparathyroidism. Women who have neurologic conditions that increase the risk of falling should also be tested. There are data to suggest that patients with hemoglobinopathy are at increased risk for osteoporosis. Surgical conditions include the increasingly performed surgery for obesity and other surgery resulting in bowel resection (e.g., for inflammatory bowel disease). The major medication-related concern is corticosteroid therapy, but chronic or over-treatment with thyroxine, and chronic heparin therapy, should also be considered risk factors for osteoporosis. When performing a BMD test for the first time, it is essential to remember that 50% of women at menopause will have a negative T-score, but this does not imply that the patient has indeed lost any bone from her peak bone mass.

  13. ACR Appropriateness Criteria® Breast Cancer Screening.

    Science.gov (United States)

    Mainiero, Martha B; Moy, Linda; Baron, Paul; Didwania, Aarati D; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Nance, Kara J; Niell, Bethany L; Slanetz, Priscilla J; Stuckey, Ashley R; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

    2017-11-01

    Breast cancer screening recommendations are based on risk factors. For average-risk women, screening mammography and/or digital breast tomosynthesis is recommended beginning at age 40. Ultrasound (US) may be useful as an adjunct to mammography for incremental cancer detection in women with dense breasts, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision. For intermediate-risk women, US or MRI may be indicated as an adjunct to mammography depending upon specific risk factors. For women at high risk due to prior mantle radiation between the ages of 10 to 30, mammography is recommended starting 8 years after radiation therapy but not before age 25. For women with a genetic predisposition, annual screening mammography is recommended beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. Annual screening MRI is recommended in high-risk women as an adjunct to mammography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study

    Science.gov (United States)

    Marino, Marcello; Crimi, Gabriele; Maiorana, Florinda; Rizzotti, Diego; Lettieri, Corrado; Bettari, Luca; Zuccari, Marco; Sganzerla, Paolo; Tresoldi, Simone; Adamo, Marianna; Ghiringhelli, Sergio; Sponzilli, Carlo; Pasquetto, Giampaolo; Pavei, Andrea; Pedon, Luigi; Bassan, Luciano; Bollati, Mario; Camisasca, Paola; Trabattoni, Daniela; Brancati, Marta; Poli, Arnaldo; Panciroli, Claudio; Lettino, Maddalena; Tarelli, Giuseppe; Tarantini, Giuseppe; De Luca, Leonardo; Varbella, Ferdinando; Musumeci, Giuseppe; De Servi, Stefano

    2017-01-01

    Objectives To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. Design Retrospective, pilot study. Setting 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. Participants 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. Primary and secondary outcome measures Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. Results Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). Conclusions Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting

  15. Appropriateness criteria of FDG PET/CT in oncology

    International Nuclear Information System (INIS)

    Agrawal, Archi; Rangarajan, Venkatesh

    2015-01-01

    18 Fluorine-2-fluoro-2-Deoxy-d-glucose ( 18 F-FDG) positron emission tomography/computerized tomography (PET/CT) is a well-established functional imaging method widely used in oncology. In this article, we have incorporated the various indications for 18 FDG PET/CT in oncology based on available evidence and current guidelines. Growing body of evidence for use of 18 FDG PET/CT in select tumors is also discussed. This article attempts to give the reader an overview of the appropriateness of using 18 F-FDG PET/CT in various malignancies

  16. Development and appropriation of an integration policy for sport

    DEFF Research Database (Denmark)

    Agergaard, Sine

    2011-01-01

    the history and culture of the society in which it is created. Second, policy is seen as discourses that are articulated by specific institutions, and third, the anthropological perspective focuses on the ways in which policy is a applied and interpreted in practice. The first part of this article therefore...... explores Danish immigration history and the development of an integration policy that currently focuses on adaptation of the cultural values and norms of immigrants. The second part of this article looks at current state funds that aim to promote this kind of adaptation through sports. It becomes clear......-Danish ethnic background) appropriate these political assumptions....

  17. The Subordinates in the Fictions of Appropriation of Minors

    OpenAIRE

    Souto, Luz Celestina

    2013-01-01

    the rol of the subordinates in the appropriation of children during the Argentinian Dictatorship has been questioned in several disciplines. However, are the works of  the writer Martín Kohan which have managed to tell the untold history in a very effective way by condensing it in the creation of a credible fictional world and, because of that, grinding. In Dos veces junio, as well as in Cuentas pendientes, the consequences of the banality of evil are obvious, since it represents the consensu...

  18. Appropriate Contrast Enhancement Measures for Brain and Breast Cancer Images

    Directory of Open Access Journals (Sweden)

    Suneet Gupta

    2016-01-01

    Full Text Available Medical imaging systems often produce images that require enhancement, such as improving the image contrast as they are poor in contrast. Therefore, they must be enhanced before they are examined by medical professionals. This is necessary for proper diagnosis and subsequent treatment. We do have various enhancement algorithms which enhance the medical images to different extents. We also have various quantitative metrics or measures which evaluate the quality of an image. This paper suggests the most appropriate measures for two of the medical images, namely, brain cancer images and breast cancer images.

  19. Understanding the Concept of Nationally Appropriate Mitigation Action

    DEFF Research Database (Denmark)

    Sharma, Sudhir; Desgain, Denis DR

    This publication is intended to enable national policy makers and other stakeholders, such as the private sector and technical experts, to acquaint themselves with the concept of NAMA. It aims to provide a comprehensive overview of the Nationally Appropriate Mitigation Action (NAMA) concept...... and enhance the understanding of NAMAs by explaining the underlying decisions of the Conference of the Parties in layman’s terms. The first chapter describes how the concept of NAMA emerged in the context of the negotiations on climate change. The chapter gives an overview of how the concepts of NAMA...

  20. The appropriate use of the emergengy department for paediatric patients

    OpenAIRE

    Benahmed, Nadia; Laokri, Samia; Zhang, Wei Hong; Cohen, Laurent; Karlin, Sophie; De Wever, Alain

    2011-01-01

    Objective: To determine the factors associated with paediatric inappropriate use (IU) of the accident and emergency department (A&E). Method: An observational prospective survey was performed. All the patients (< 16 years) attending A&E in 12 Belgian hospitals during 2 weeks in 2010 were included. The use of A&E was considered appropriate if, at least, one of the following criteria was met: child referred by a doctor or the police, brought by ambulance, need for a short stay, need for technic...

  1. What is "appropriate" for school-aged children with autism?

    Science.gov (United States)

    Conroy, Tim; Conroy, Terrye

    2006-10-01

    Compliance with the IDEA and S.C. Board of Education procedures is only the first step toward providing a student with autism with an IEP that is reasonably calculated to enable that student to receive educational benefits--a FAPE. At the heart of the IEP process is instruction specially designed to meet the unique needs, talents, and experiences of each child. While disagreements over the appropriateness of the IEP, including the methodologies used to provide such instruction, may arise, it is through the successful collaboration of parents, health care providers, and school professionals that a child with autism will develop into an adult with a life of community and meaning.

  2. Hiring appropriate providers for different populations: acute care nurse practitioners.

    Science.gov (United States)

    Haut, Cathy; Madden, Maureen

    2015-06-01

    Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients. ©2015 American Association of Critical-Care Nurses.

  3. Diverse structural approaches to haem appropriation by pathogenic bacteria.

    Science.gov (United States)

    Hare, Stephen A

    2017-04-01

    The critical need for iron presents a challenge for pathogenic bacteria that must survive in an environment bereft of accessible iron due to a natural low bioavailability and their host's nutritional immunity. Appropriating haem, either direct from host haemoproteins or by secreting haem-scavenging haemophores, is one way pathogenic bacteria can overcome this challenge. After capturing their target, haem appropriation systems must remove haem from a high-affinity binding site (on the host haemoprotein or bacterial haemophore) and transfer it to a binding site of lower affinity on a bacterial receptor. Structural information is now available to show how, using a combination of induced structural changes and steric clashes, bacteria are able to extract haem from haemophores, haemopexin and haemoglobin. This review focuses on structural descriptions of these bacterial haem acquisition systems, summarising how they bind haem and their target haemoproteins with particularly emphasis on the mechanism of haem extraction. Copyright © 2017 The Author. Published by Elsevier B.V. All rights reserved.

  4. Appropriate methodologies for empirical bioethics: it's all relative.

    Science.gov (United States)

    Ives, Jonathan; Draper, Heather

    2009-05-01

    In this article we distinguish between philosophical bioethics (PB), descriptive policy orientated bioethics (DPOB) and normative policy oriented bioethics (NPOB). We argue that finding an appropriate methodology for combining empirical data and moral theory depends on what the aims of the research endeavour are, and that, for the most part, this combination is only required for NPOB. After briefly discussing the debate around the is/ought problem, and suggesting that both sides of this debate are misunderstanding one another (i.e. one side treats it as a conceptual problem, whilst the other treats it as an empirical claim), we outline and defend a methodological approach to NPOB based on work we have carried out on a project exploring the normative foundations of paternal rights and responsibilities. We suggest that given the prominent role already played by moral intuition in moral theory, one appropriate way to integrate empirical data and philosophical bioethics is to utilize empirically gathered lay intuition as the foundation for ethical reasoning in NPOB. The method we propose involves a modification of a long-established tradition on non-intervention in qualitative data gathering, combined with a form of reflective equilibrium where the demands of theory and data are given equal weight and a pragmatic compromise reached.

  5. From Adaptation to Appropriation: Framing the World Through News Translation

    Directory of Open Access Journals (Sweden)

    Valdeón Roberto A.

    2014-02-01

    Full Text Available Terminological issues are problematic in the analysis of translation processes in news production. In the 1980s, Stetting coined the term “transediting”, which has been widely used in the translation studies literature, but “translation” itself becomes contentious in communication studies, a discipline closely related to news translation research. Only a few communication scholars have specifically dealt with the linguistic and cultural transformations of source texts, but they tend to regard translation as word-for-word transfer, unusual news production. More productive for the study of news translation seems to be the application of the concept of framing, widely used in communication studies. Framing considers the linguistic and paralinguistic elements of news texts in the promotion of certain organizing ideas that the target audience can identify with. In news translation, this entails the adaptation of a text for the target readership, a process can lead to appropriation of source material. Two examples are mentioned to illustrate this point: the appropriation of the US Department of State cables by the Wikileak organisation, and the pro-Romanian slogans produced by the Gandul newspaper as a response to Britain’s anti-immigration campaigns. The final section relates news adaptation to adaptation of other text types, such as literary and historical works.

  6. HOW TO SELECT APPROPRIATE STATISTICAL TEST IN SCIENTIFIC ARTICLES

    Directory of Open Access Journals (Sweden)

    Vladimir TRAJKOVSKI

    2016-09-01

    Full Text Available Statistics is mathematical science dealing with the collection, analysis, interpretation, and presentation of masses of numerical data in order to draw relevant conclusions. Statistics is a form of mathematical analysis that uses quantified models, representations and synopses for a given set of experimental data or real-life studies. The students and young researchers in biomedical sciences and in special education and rehabilitation often declare that they have chosen to enroll that study program because they have lack of knowledge or interest in mathematics. This is a sad statement, but there is much truth in it. The aim of this editorial is to help young researchers to select statistics or statistical techniques and statistical software appropriate for the purposes and conditions of a particular analysis. The most important statistical tests are reviewed in the article. Knowing how to choose right statistical test is an important asset and decision in the research data processing and in the writing of scientific papers. Young researchers and authors should know how to choose and how to use statistical methods. The competent researcher will need knowledge in statistical procedures. That might include an introductory statistics course, and it most certainly includes using a good statistics textbook. For this purpose, there is need to return of Statistics mandatory subject in the curriculum of the Institute of Special Education and Rehabilitation at Faculty of Philosophy in Skopje. Young researchers have a need of additional courses in statistics. They need to train themselves to use statistical software on appropriate way.

  7. Bounded authority: Expanding "appropriate" police behavior beyond procedural justice.

    Science.gov (United States)

    Trinkner, Rick; Jackson, Jonathan; Tyler, Tom R

    2018-06-01

    This paper expands previous conceptualizations of appropriate police behavior beyond procedural justice. The focus of the current study is on the notion of bounded authority-that is, acting within the limits of one's rightful authority. According to work on legal socialization, U.S. citizens come to acquire three dimensions of values that determine how authorities ought to behave: (a) neutral, consistent, and transparent decision-making; (b) interpersonal treatment that conveys respect, dignity, and concern; and (c) respecting the limits of one's rightful power. Using survey data from a nationally representative sample of U.S. adults, we show that concerns over bounded authority, respectful treatment, and neutral decision-making combine to form a strong predictor of police and legal legitimacy. We also find that legal legitimacy is associated with greater compliance behavior, controlling for personal morality and perceived likelihood of sanctions. We discuss the implications of a boundary perspective with respect to ongoing debates over the appropriate scope of police power and the utility of concentrated police activities. We also highlight the need for further research specifically focused on the psychological mechanisms underlying the formation of boundaries and why they shape the legitimacy of the police and law. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  8. Appropriateness of lumbar spine magnetic resonance imaging in Spain

    Energy Technology Data Exchange (ETDEWEB)

    Kovacs, Francisco M. [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Research Department, Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Arana, Estanislao, E-mail: aranae@uv.es [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Servicio de Radiología, Fundación Instituto Valenciano de Oncología, Valencia (Spain); Fundación Instituto de Investigación en Servicios de Salud, Valencia (Spain); Royuela, Ana [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); CIBER Epidemiología y Salud Pública (CIBERESP) (Spain); Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Ctra. Colmenar Km. 9.1, 28034 Madrid (Spain); Cabrera, Alberto [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Hospital de Galdakao, Barrio Labeaga, 48960 Galdakao, Vizcaya (Spain); Casillas, Carlos [Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca (Spain); Instituto de Traumatología Unión de Mutuas, Av. del Lledó, C/Juan de Herrera, 27 12004 Castellón (Spain); and others

    2013-06-15

    Objectives: To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice. Methods: LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as “appropriate”, “uncertain” or “inappropriate” based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one “red flag” were classified as “appropriate”. A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription. Results: Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists’ assessment with this classification was substantial (k = 0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)]. Conclusion: Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.

  9. Classifying decommissioning wastes for allocation to appropriate final repositories

    International Nuclear Information System (INIS)

    Alder, J.C.; Tunaboylu, K.

    1982-01-01

    For the safe disposal of radioactive wastes in different repositories, it is of advantage to classify them in well-defined conditioned categories, appropriate for final disposal. These categories, the so-called waste sorts are characterized by similar radionuclide distribution, similar nuclide-specific activity concentrations and similar waste matrix. A methodology is presented for classifying decommissioning wastes and is applied to the decommissioning wastes arising from a Swiss program of 6 GWe. The amounts and nuclide-specific activity inventories of the decommissioning waste sorts have been estimated. A first allocation into two different repository types has been performed. Such a classification enables one to define the source parameters for repository safety analysis and allows one to allocate the different waste categories into appropriate final repositories. This work presents a first iteration to determine which waste sorts belong to which repository type. The characteristics of waste sorts have to be better defined and the protective strength of the repository barriers has to be optimized. 7 references, 2 figures, 4 tables

  10. Natura 2000 appropriate assessment: Shortcomings and improvements in Finnish practice

    International Nuclear Information System (INIS)

    Soederman, Tara

    2009-01-01

    The EU Habitats Directive 92/43/EEC requires impact assessments called Appropriate Assessments (AA) for plans and projects probably having adverse effects on the sites of European ecological importance, Natura 2000 sites. Seventy-three Appropriate Assessment reports and seventy official opinions given on them by regional environmental authorities from 1997 to 2005 were reviewed. The findings of the study demonstrate typical shortcomings of ecological impact assessment: a weak information basis for assessment outcomes and lack of proper cumulative impact assessment with respect to ecological structures and processes. The quality of reporting has improved over time with respect to direct impacts on individual habitat types and species and detailed mitigation measures. Regional environment centres considered one fifth of the AA reports to be inadequate because of lacking data. In most cases the regional environment centres demanded a change of plan or project, added mitigation measures, choice of only one alternative for further planning or a new completed assessment with additional information in order to be able to evaluate the significance of the effects. The study underlines the need for iterative planning practices in which the preparation of a plan or project with alternative options goes hand in hand with the impact assessment equipped with sufficient data

  11. Appropriating religion: understanding religion as an object of science

    Directory of Open Access Journals (Sweden)

    Donald Wiebe

    1999-01-01

    Full Text Available In this paper, the author focuses on the study of religion as a scientific project, for it is the scientific interest in religion which has constituted the grounds for admitting the study of religion into the curriculum of the modern Western university. Despite that academic legitimation, however, the study of religion in the setting of the modern research university is not held in high esteem relative to the other sciences. It if the scientific study of religion is to be legitimately ensconced in the modern research university, the notion of religion will have to be wholly appropriated by science; only then will we be able to establish a conceptual foundation from which to make valid knowledge claims about religion on a level commensurate with the pronouncements of the natural and social sciences. Indeed, to go one step further, given the hold on the concept of religion by those committed to the humanistic study of religion, we might need to talk here not of the appropriation but of expropriation of religion by science—that is, of wresting ownership of the concept from the humanists by using it solely as a taxonomic device to differentiate and explain a peculiar range of human behaviour demonstrated in religious practices.

  12. Appropriateness of lumbar spine magnetic resonance imaging in Spain

    International Nuclear Information System (INIS)

    Kovacs, Francisco M.; Arana, Estanislao; Royuela, Ana; Cabrera, Alberto; Casillas, Carlos

    2013-01-01

    Objectives: To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice. Methods: LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as “appropriate”, “uncertain” or “inappropriate” based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one “red flag” were classified as “appropriate”. A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription. Results: Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists’ assessment with this classification was substantial (k = 0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)]. Conclusion: Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes

  13. Improving the radiologist–CAD interaction: designing for appropriate trust

    International Nuclear Information System (INIS)

    Jorritsma, W.; Cnossen, F.; Ooijen, P.M.A. van

    2015-01-01

    Computer-aided diagnosis (CAD) has great potential to improve radiologists' diagnostic performance. However, the reported performance of the radiologist–CAD team is lower than what might be expected based on the performance of the radiologist and the CAD system in isolation. This indicates that the interaction between radiologists and the CAD system is not optimal. An important factor in the interaction between humans and automated aids (such as CAD) is trust. Suboptimal performance of the human–automation team is often caused by an inappropriate level of trust in the automation. In this review, we examine the role of trust in the radiologist–CAD interaction and suggest ways to improve the output of the CAD system so that it allows radiologists to calibrate their trust in the CAD system more effectively. Observer studies of the CAD systems show that radiologists often have an inappropriate level of trust in the CAD system. They sometimes under-trust CAD, thereby reducing its potential benefits, and sometimes over-trust it, leading to diagnostic errors they would not have made without CAD. Based on the literature on trust in human–automation interaction and the results of CAD observer studies, we have identified four ways to improve the output of CAD so that it allows radiologists to form a more appropriate level of trust in CAD. Designing CAD systems for appropriate trust is important and can improve the performance of the radiologist–CAD team. Future CAD research and development should acknowledge the importance of the radiologist–CAD interaction, and specifically the role of trust therein, in order to create the perfect artificial partner for the radiologist. This review focuses on the role of trust in the radiologist–CAD interaction. The aim of the review is to encourage CAD developers to design for appropriate trust and thereby improve the performance of the radiologist–CAD team. - Highlights: • Radiologists often have an inappropriate

  14. Technical rigidity and appropriate technology in less-developed countries

    Energy Technology Data Exchange (ETDEWEB)

    Forsyth, D J.C. [Univ. of Strathyclyde, England; McBain, N S; Solomon, R F

    1980-05-01

    The extent to which the use of capital-intensive methods in LDCs can properly be ascribed to the inherent rigidity of the factor proportions embodied in modern technology - rather than to distortions and aberrrations in the process of technology choice - is still a matter of considerable uncertainty after two decades of debate. In this study, an engineering-based index is developed to summarize the opportunities for, and barriers to, substitution of labor for capital in a wide range of industries. The index is used to compare the technology actually installed in manufacturing in Ghana, the Philippines, Turkey, and Malaysia with the feasible alternatives. The finding that opportunities for use of labor-intensive methods are to a large extent exploited is interpreted as casting doubt on the ability of even the most appropriate choice from currently feasible technologies to reduce unemployment significantly. 46 references, 5 figures, 6 tables.

  15. Appropriate electromagnetic techniques for imaging geothermal fracture zones

    Energy Technology Data Exchange (ETDEWEB)

    Groom, R; Walker, P [PetRos EiKon Incorporated, Ontario (Canada)

    1996-05-01

    Electromagnetic surface detection of fracture zones has often been approached by using the magnetotelluric method. This technique suffers greatly from the quantity and scale of the conductive inhomogeneities lying above the fracture zones. Additionally, it suffers from the inherent inability to focus the source on the target. There are no such source focusing capabilities in magnetotellurics. Accordingly, the quantity of magnetotelluric data required to resolve targets in such complex conditions can make the technique inefficient and insufficient from a cost perspective. When attempting to reveal a subsurface structure and image it, the basic physical responses at hand must be kept in mind, and the appropriate source must be utilized, which most effectively illuminates the target. A further advantage to controlled sources is that imaging techniques may be used to accentuate the response due to knowledge and control of the source.

  16. Determination of appropriate models and parameters for premixing calculations

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ik-Kyu; Kim, Jong-Hwan; Min, Beong-Tae; Hong, Seong-Wan

    2008-03-15

    The purpose of the present work is to use experiments that have been performed at Forschungszentrum Karlsruhe during about the last ten years for determining the most appropriate models and parameters for premixing calculations. The results of a QUEOS experiment are used to fix the parameters concerning heat transfer. The QUEOS experiments are especially suited for this purpose as they have been performed with small hot solid spheres. Therefore the area of heat exchange is known. With the heat transfer parameters fixed in this way, a PREMIX experiment is recalculated. These experiments have been performed with molten alumina (Al{sub 2}O{sub 3}) as a simulant of corium. Its initial temperature is 2600 K. With these experiments the models and parameters for jet and drop break-up are tested.

  17. Registered indians and tobacco taxation: a culturally-appropriate strategy?

    Science.gov (United States)

    Wardman, A E Dennis; Khan, Nadia A

    2005-01-01

    Taxation of tobacco is a widely-used strategy that prompts smoking cessation among adults and reduces cigarette consumption among continuing smokers. Registered Indian tobacco use prevalence is at least double that of the rest of Canadians and is in part due to the lower cost of tobacco products purchased on reserve by Registered Indians (RIs) as they are tax exempt. Although registered Indian communities have the ability to collect tax on tobacco products and direct the use of these revenues, this strategy is rarely utilized. Tobacco taxation could have substantial health and economic benefits to RI communities, but perhaps is not culturally-appropriate. In order to better support RI communities, governments and other organizations need to examine this policy instrument in the context of RI populations.

  18. Appropriate location of the nipple-areola complex in males.

    Science.gov (United States)

    Shulman, O; Badani, E; Wolf, Y; Hauben, D J

    2001-08-01

    Gynecomastia is a common deformity encountered by plastic surgeons. The appropriate location of the nipple-areola complex is a major determinant of the aesthetic success of the procedure. To study the natural location of the nipple-areola complex in the normally built male, 50 nonobese men with no evidence of gynecomastia and an average age of 27.9 years were examined. Three ratios were calculated and found to be relatively constant; they were the ratio between the height of the nipple and the height of the patient, the ratio between the distance between the nipples and chest circumference, and the ratio between the suprasternal notch-to-nipple distance and the height of the patient. Using these three parameters, a method of locating the nipple-areola complex on the male chest wall was devised. The method is advocated as a reliable, simple, and useful technique.

  19. An Assessment of Culturally Appropriate Design: A Malaysian University Context

    Directory of Open Access Journals (Sweden)

    Shamsul Arrieya Ariffin

    2018-03-01

    Full Text Available The growing popularity of mobile devices, together with the constant technological improvement of mobile websites and applications informed about the quality of the user interface design. However, the particularities of mobile devices require special attention in terms of their usability aspects, such as culture. Therefore, this study evaluated the use of culturally appropriate design guidelines for a mobile learning web site. The research methodology used comprised a survey from heuristic evaluation questionnaires with undergraduate students. This research captured the students’ experiences in using the MLearn website of Universiti Pendidikan Sultan Idris, Malaysia.  From the study, the lowest ranking is realistic error management at 3.5, and the highest is suitable content for local culture at 4.6.  This study affirmed that general usability and cultural principles in design are important for a usable mobile learning website system in a local university context.

  20. Determination of appropriate models and parameters for premixing calculations

    International Nuclear Information System (INIS)

    Park, Ik-Kyu; Kim, Jong-Hwan; Min, Beong-Tae; Hong, Seong-Wan

    2008-03-01

    The purpose of the present work is to use experiments that have been performed at Forschungszentrum Karlsruhe during about the last ten years for determining the most appropriate models and parameters for premixing calculations. The results of a QUEOS experiment are used to fix the parameters concerning heat transfer. The QUEOS experiments are especially suited for this purpose as they have been performed with small hot solid spheres. Therefore the area of heat exchange is known. With the heat transfer parameters fixed in this way, a PREMIX experiment is recalculated. These experiments have been performed with molten alumina (Al 2 O 3 ) as a simulant of corium. Its initial temperature is 2600 K. With these experiments the models and parameters for jet and drop break-up are tested

  1. Narrative Intertextuality: How Pacheco Appropriates The Go-Between

    Directory of Open Access Journals (Sweden)

    Jorge Alcázar

    2016-01-01

    Full Text Available This essay explores the role of rewriting in postmodern fiction, whether it goes under such names as appropriation, adaptation or the interaction between a hypotext and a hypertext. The core of the article is concerned with a minute comparison between H. P. Hartley’s novel The Go-Between (1953 and José Emilio Pacheco’s Las batallas en el desierto (1981. Similarities such as the role of a child/adult narrator, his infatuation with a mature woman, the traumatic experience it entails, how a distant past is recreated, the clash of opposite social classes, the narrative thematics of music, as well as other minor details are brought to the fore.

  2. Cultural Appropriations; Ethnic-Racial Representations; Black Press

    Directory of Open Access Journals (Sweden)

    Maria Angélica Zubaran

    2015-12-01

    Full Text Available This paper investigates the exchange and circulation of ideas in the black diaspora, particularly in the newspaper The Example, mapping and discussing the ethnic-racial and gender representations constructed in the narratives produced by the editors of this newspaper, during the campaign for the construction of a monument to the “Black Mother”. The aim is to analyze how the newspaper’s editors have appropriated texts that circulated in other newspapers about the campaign to the monument of the “Black Mother”, adapted them to their own interests and given them new meanings. From the theoretical approach of Cultural Studies, we understand the black press as a cultural artifact that not only informs but also produces discourses and representations that contribute to the formation of black subjectivities and identities.

  3. The appropriateness of a proton pump inhibitor prescription.

    LENUS (Irish Health Repository)

    Moran, N

    2014-11-01

    Proton pump inhibitors (PPIs) are one of the most commonly prescribed groups of drug in Ireland, at great expense to the Irish healthcare executive. This study aims to evaluate the appropriateness of PPI prescriptions on admission and discharge in a tertiary referral hospital. All non-elective admissions in the Emergency Department in one week were included in the study. 102 patients in total were included, with 36 (35.4%) treated with a PPI on admission. Of these, only 3 (8.3%) had a clear indication noted as per current NICE guidelines. 18 new in-hospital PPI prescriptions were documented. 11 (61%) of which were present on discharge prescriptions. Continuing PPI prescription on discharge into the community may be inappropriate, costly and potentially harmful. Brief interventions aimed at reducing inappropriate PPI prescriptions have been shown to be effective at reducing the cost and potential harm of unnecessary treatment.

  4. Determination of the appropriate energy policy for Turkey

    International Nuclear Information System (INIS)

    Ulutas, B.H.

    2005-01-01

    Energy is an inevitable necessity for human beings. But the energy source is predicted to be scarce in the coming years as a result of population growth. Therefore people prefer energy sources that are renewable, clean and cost effective. Unfortunately there is not a sole energy source to meet these demands. Determination of the appropriate energy policy problem with interactive criteria and alternatives can be viewed as a multiple criteria decision making (MCDM) problem within the context of the long range and strategic process. The analytic network process (ANO), one of MCDM methods, deals with the dependency and feedback that the problem has. The goal of this paper is to apply the ANP model to evaluate the alternative energy sources for the country. Finally when the results are discussed, it is apparent that the model can produce reasonable and applicable solutions for the case. (author)

  5. The importance of having an appropriate data segmentation (partitioning)

    CERN Document Server

    Dimitrov, Gancho; The ATLAS collaboration

    2014-01-01

    In this presentation will be shown real life examples from database applications in the ATLAS experiment @ LHC where we make use of many Oracle partitioning techniques available in Oracle 11g. With the broadly used range partitioning and its option of automatic interval partitioning we add our own logic in PLSQL for sustaining data sliding windows in order to enforce various data retention policies. We also make use of the reference partitioning in some use cases, however the most challenging was to segment the data of a large bookkeeping system which resulted in tens of thousands list partitions and list sub-partitions. Partition and sub-partition management, index strategy, statistics gathering and queries execution plan stability are important factors when choosing an appropriate for the use case data management model. The gained experience with all of those will be shared with the audience.

  6. The importance of applying an appropriate data partitioning

    CERN Document Server

    Dimitrov, Gancho; The ATLAS collaboration

    2015-01-01

    In this presentation are described specific technical solutions put in place in various database applications of the ATLAS experiment at LHC where we make use of several partitioning techniques available in Oracle 11g. With the broadly used range partitioning and its option of automatic interval partitioning we add our own logic in PLSQL procedures and scheduler jobs to sustain data sliding windows in order to enforce various data retention policies. We also make use of the new Oracle 11g reference partitioning in the ATLAS Nightly Build System to achieve uniform data segmentation. However the most challenging was to segment the data of the new ATLAS Distributed Data Management system, which resulted in tens of thousands list type partitions and sub-partitions. Partition and sub-partition management, index strategy, statistics gathering and queries execution plan stability are important factors when choosing an appropriate physical model for the application data management. The so-far accumulated knowledge wi...

  7. Appropriate use of the increment entropy for electrophysiological time series.

    Science.gov (United States)

    Liu, Xiaofeng; Wang, Xue; Zhou, Xu; Jiang, Aimin

    2018-04-01

    The increment entropy (IncrEn) is a new measure for quantifying the complexity of a time series. There are three critical parameters in the IncrEn calculation: N (length of the time series), m (dimensionality), and q (quantifying precision). However, the question of how to choose the most appropriate combination of IncrEn parameters for short datasets has not been extensively explored. The purpose of this research was to provide guidance on choosing suitable IncrEn parameters for short datasets by exploring the effects of varying the parameter values. We used simulated data, epileptic EEG data and cardiac interbeat (RR) data to investigate the effects of the parameters on the calculated IncrEn values. The results reveal that IncrEn is sensitive to changes in m, q and N for short datasets (N≤500). However, IncrEn reaches stability at a data length of N=1000 with m=2 and q=2, and for short datasets (N=100), it shows better relative consistency with 2≤m≤6 and 2≤q≤8 We suggest that the value of N should be no less than 100. To enable a clear distinction between different classes based on IncrEn, we recommend that m and q should take values between 2 and 4. With appropriate parameters, IncrEn enables the effective detection of complexity variations in physiological time series, suggesting that IncrEn should be useful for the analysis of physiological time series in clinical applications. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. A guide to public engagement and appropriate dispute resolution

    Energy Technology Data Exchange (ETDEWEB)

    Jonsson, C.

    2006-10-15

    This guide was developed to help oil and gas companies operating in British Columbia to understand what tools are available to them when entering a public engagement process. It describes the BC Oil and Gas Commission's (OGC's) expectations regarding public engagement and appropriate dispute resolutions (ADR) associated with applications for oil and gas exploration, development and production in the province. The OGC's comprehensive application review process is designed to balance environmental, economic and social factors. The public engagement process is intended to allow the public to express concerns about how proposed oil and gas operations may affect them. This document also emphasized the government's responsibility to consult with First Nations on their treaty rights. The guide presented key concepts and best practices in the public engagement process and explained how to engage participants before, during and after application decisions are made. The OGC may impose conditions on the applicant to mitigate concerns of the affected public. The concerns typically range from noise of oil and gas machinery; air pollution; concern for health and safety; traffic control; water quality; and, aesthetics. A table of possible mitigative measures to these concerns was presented to demonstrate some options that may be used by industry and the affected public in resolving issues related to oil and gas activities. The OGC promotes the independent resolution of concerns. However, if conflicts exist, the OGC encourages participants to use appropriate dispute resolution (ADR) to help resolve any differences. Although participation in ADR is voluntary, its use allows affected parties to gain a sense of ownership over the proceedings and outcomes. In addition to being less costly than legal proceedings, ADR can lead to win-win outcomes, improve relationships and lead to more routine applications for oil and gas activities. refs., tabs., figs.

  9. Encouraging appropriate, evidence-based use of oral nutritional supplements.

    Science.gov (United States)

    Stratton, Rebecca J; Elia, Marinos

    2010-11-01

    With the considerable cost of disease-related malnutrition to individuals and to society (estimated to be >£13×109 for the UK, 2007 prices), there is a need for effective and evidence-based ways of preventing and treating this condition. The wide range of oral nutritional supplements that may be prescribed for the dietary management of malnutrition and other conditions account for only about 1% (about £99×106, 2007 data) of the prescribing budget in England. Systematic reviews and meta-analyses consistently suggest that ready-made, multi-nutrient liquids which may be prescribed can improve energy and nutritional intake, body weight and have a variety of clinical and functional benefits in a number of patient groups. Meta-analyses have repeatedly shown that oral nutritional supplements produce significant reductions in complications (e.g. infections) and mortality, and a recent meta-analysis shows a reduction in hospital admissions (OR 0·56 (95% CI 0·41, 0·77), six randomised controlled trials). Such benefits suggest that the appropriate use of oral nutritional supplements should form an integral part of the management of malnutrition, particularly as there is currently a lack of evidence for alternative oral nutrition strategies (e.g. food fortification and counselling). As with all therapies, compliance to oral nutritional supplements needs to be maximised and the use monitored. To make sure that those at risk of malnutrition are identified and treated appropriately, there is a need to embed national and local policies into routine clinical practice. In doing so, the economic burden of this costly condition can be curtailed. As recently suggested by the National Institute for Health and Clinical Excellence, substantial cost savings could be made if screening and treatment of malnourished patients was undertaken.

  10. ACR Appropriateness Criteria®  Resectable Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Jones William E

    2012-09-01

    Full Text Available Abstract The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+ benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to

  11. Male appropriation and medicalization of childbirth: an historical analysis.

    Science.gov (United States)

    Cahill, H A

    2001-02-01

    This paper aims to explore through historical analysis some of the means by which medicine successfully appropriated and medicalized pregnancy and childbirth and to consider the impact that this has had on women's experiences within maternity care. The appropriation and medicalization of pregnancy and childbirth by men are rooted in a patriarchal model that has been centuries in the making. A model that perceives women as essentially abnormal, as victims of their reproductive systems and hormones, it is also one that defines pregnancy as inherently pathological - a clinical crisis worthy of active intervention. In both law and medicine men have used their power to define reproduction as a biological defect (LeMoncheck L. 1996 Journal of Clinical Ethics 7, 160--176), requiring both legal regulation and medical intervention, whilst feminist writers have long argued that women's experiences within the health care system at least to some extent reflects their social position. Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (Cahill H. 1999 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors' interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women's bodies as inherently defective continue to shape women's position in society. Maternity care is a key area in which women's ability to exercise real choice and make informed decisions is limited and where doctor-patient interactions are themselves constructions of existing gender orders; women's autonomy continues to be violated through both quite subtle and overt discourse and practice.

  12. Defining appropriate incentive levels: A review of theory and practice

    International Nuclear Information System (INIS)

    Parfett, R.S.; Lodola, J.C.

    1990-01-01

    The theoretical and practical aspects related to determining the incentive levels for demand-side management (DSM) programs are discussed. The theoretical aspects comprise the efficiency criteria, from a social point of view; the equity issue, or ensuring that no one pays higher rates as a result of conservation programs; and the method of recovering the customer's investment, or the implicit discount rate method. The study of these theoretical aspects takes into account the perspectives of all the concerned parties and focuses on the need to harmonize the efficiency criteria which are in opposition. From this process are derived general criteria for aiding program planners and managers to determine the incentive levels for their DSM programs. Past experience has shown that incentive levels cannot be determined in an isolated manner. Other characteristics affecting the carrying out of DSM programs will also have repercussions on the success rate. To determine the appropriate incentives, it is important to have a clear understanding of what the DSM program intends to achieve. Factors such as the market sector, the technology chosen, and demographic characteristics can influence all aspects of the design and implementation of the program, including the type and level of incentive offered. When the goals of the program are clearly established and the intended market is clearly determined, a strategy should be formed which will have the greatest chance of fulfilling the program objectives. The role of each element in the program must be well understood. It is only at this stage that it is possible to determine an appropriate level of incentive. 7 refs

  13. Formal and informal appropriation mechanisms: the role of openness and innovativeness

    NARCIS (Netherlands)

    Zobel, Ann-Kristin; Lokshin, Boris; Hagedoorn, John

    2016-01-01

    This paper analyses how firms’ degree of openness and innovativeness influence their use of formal and informal appropriation mechanisms. Patents, trademarks, copyrights, and design rights are formal appropriation mechanisms. Secrecy, lead-time, and complexity are examples of informal appropriation

  14. [Appropriateness of ketorolac use in a trauma hospital].

    Science.gov (United States)

    Angeles González-Fernández, M

    2009-06-01

    To evaluate the suitability of ketorolac and non-steroidal anti-inflamatory drugs (NSAIDs) and other analgesic drugs currently used in the hospital. We have followed the steps to develop a PDCA cycle (plan, do, check, act) or quality improvement cycle. The quality problem was analysed using an Ishikawa diagram. We defined both qualitative quality indicators, those that measure prescription quality, and quantitative ones (defined daily dose, DDD/100BDs), which measure drug consumption, being the objectives to achieve. The study was conducted in all patients admitted to the hospital and who were admitted to orthopaedic and trauma surgery and plastic surgery departments with unit-dose dispensing systems. The strategy used was to give information to physicians through meetings and documentation. Finally, the results were analysed and compared with the initial objectives. The study was performed on 260 patients in the first study period and 292 in the second. Qualitative indicators: intravenous ketorolac use or =65 years old at dose < or =60 mg/day it increased 27.7% (p<0.05). Quantitative indicators: in the second study period, ketorolac use decreased (plastic surgery department: 61.8 DDD/100BDs to 14.8), whereas tramadol, ibuprofen and metamizole increased (plastic surgery department: 0 to 14.1 in tramadol, 8.7 to 48.6 in ibuprofen and 50.1 to 71 in metamizole). Appropriateness of ketorolac, NSAIDs and tramadol use has been achieved, thus improving patient safety. Strategies have been effective.

  15. Appropriate Separator Sizing: A Modified Stewart and Arnold Method

    Directory of Open Access Journals (Sweden)

    F. Boukadi

    2012-01-01

    Full Text Available Oil and gas separators were one of the first pieces of production equipment to be used in the petroleum industry. The different stages of separation are completed using the following three principles: gravity, centrifugal force, and impingement. The sizes of the oil droplets, in the production water, are based mainly on the choke valve pressure drop. The choke valve pressure drop creates a shearing effect; this reduces the ability of the droplets to combine. One of the goals of oil separation is to reduce the shearing effect of the choke. Separators are conventionally designed based on initial flow rates; as a result, the separator is no longer able to accommodate totality of produced fluids. Changing fluid flow rates as well as emulsion viscosity effect separator design. The reduction in vessel performance results in recorded measurements that do not match actual production levels inducing doubt into any history matching process and distorting reservoir management programs. In this paper, the new model takes into account flow rates and emulsion viscosity. The generated vessel length, vessel diameter, and slenderness ratio monographs are used to select appropriate separator size based on required retention time. Model results are compared to API 12J standards.

  16. Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

    Science.gov (United States)

    Wynell-Mayow, William; Guevel, Borna; Quansah, Benjamin; O'Leary, Ronan; Carrothers, Andrew D

    2016-10-01

    Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate - ppolytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  17. Sugammadex: Appropriate Use in the Context of Budgetary Constraints.

    Science.gov (United States)

    Cammu, Guy

    2018-01-01

    The purpose of this review is to assess how sugammadex impacts postoperative residual curarization using appropriate doses based on neuromuscular transmission monitoring and whether the advantages of sugammadex versus neostigmine outweigh its higher cost. An accurate assessment of neuromuscular blockade with monitoring is necessary before selecting neostigmine versus sugammadex for reversal at the end of surgery to overcome incomplete neuromuscular recovery. The main advantages of sugammadex over neostigmine are its predictability and its ability to extend the range of blockade reversal. The cost of sugammadex is greater when higher doses of sugammadex are required for antagonism of deep block. Sugammadex probably has the potential to be cost-effective compared with neostigmine if its time savings are put to productive use in clinical practice. However, to date, the economic benefits of the drug are unknown. With sugammadex, almost any degree of neuromuscular block can be antagonized within 2-3 min; neostigmine is the only reversal agent effective against benzylisoquinolines and can ideally be used for reversal of lower levels of residual paralysis. The performance of the more expensive sugammadex on improving patient outcomes may depend on several elements of clinical strategy.

  18. SUSTAINABLE URBAN LANDSCAPE: AN APPROACH FOR ASSESSING AND APPROPRIATING INDICATORS

    Directory of Open Access Journals (Sweden)

    Ahmed Mohamed Amin

    2012-07-01

    Full Text Available The impact of development on its context is considered a key issue that governs the discussion and understanding of sustainability. For the reason, that ethics of sustainability are based on developing with no or less negative impacts on the contextual environment despite its urban scale whether limited or extended. This describes types of development that increase the good impacts on the tangible and intangible aspects of the built environment. Thus, achieving sustainability is no more a choice but it is a must especially, in an environment suffering from a lot of threats and stresses that affect all aspects of life; socially, economically, environmentally and also affect the beauty and aesthetics of urban fabrics. Assessing sustainability, the applied indicators and ways of assessment are allimportant concerns for urban sustainability discourses. Especially in such sensitive interacting domains as landscape, that links nature with the built environment. Approaching these concerns has a great deal when enhancing our environment aiming at better urban life containers. This paper aims at investigating the issue of sustainable urban landscape assessment through discussing the hue of indicators, their ways of classification, the criteria of selection and stating the variety of methods in which they can be assessed. Finally, it appropriates an approach for stating and assessing urban landscape sustainability indicators, which evaluates their both qualitative and quantitative value upon performance scale.

  19. Survey of appropriate endothermic processes for association with the HTR

    International Nuclear Information System (INIS)

    Brown, G.; Harrison, G.E.; Gent, C.W.; Plummer, J.

    1975-01-01

    Emphasis is placed on association of the HTR system as a heat source with chemical processes requiring temperatures up to 850 to 900 0 C, corresponding to a reactor coolant temperature of 950 0 C, though processes requiring temperatures up to 1100 0 C and above are reviewed. Particular attention is given to processes for the production of hydrogen-containing gases, including coal/lignite gasification which has been the subject of a recent study. Rising fuel prices make the HTR an attractive proposition if design concepts and materials can be developed to match the requirements. Other appropriate endothermic processes considered are oil processing, including tar sands and shales, and also energy production. Since the full temperature range of the reactor system must be utilised mention is made of low grade heat uses. Even very large chemical works have relatively small energy requirement by nuclear heat standards and adoption of the HTR as a heat source is likely only if it is associated with a large chemical/metallurgical complex or with the processing of a natural resource. (author)

  20. Hepatitis B virus reactivation during immunosuppressive therapy: Appropriate risk stratification.

    Science.gov (United States)

    Seto, Wai-Kay

    2015-04-28

    Our understanding of hepatitis B virus (HBV) reactivation during immunosuppresive therapy has increased remarkably during recent years. HBV reactivation in hepatitis B surface antigen (HBsAg)-positive individuals has been well-described in certain immunosuppressive regimens, including therapies containing corticosteroids, anthracyclines, rituximab, antibody to tumor necrosis factor (anti-TNF) and hematopoietic stem cell transplantation (HSCT). HBV reactivation could also occur in HBsAg-negative, antibody to hepatitis B core antigen (anti-HBc) positive individuals during therapies containing rituximab, anti-TNF or HSCT.For HBsAg-positive patients, prophylactic antiviral therapy is proven to the effective in preventing HBV reactivation. Recent evidence also demonstrated entecavir to be more effective than lamivudine in this aspect. For HBsAg-negative, anti-HBc positive individuals, the risk of reactivations differs with the type of immunosuppression. For rituximab, a prospective study demonstrated the 2-year cumulative risk of reactivation to be 41.5%, but prospective data is still lacking for other immunosupressive regimes. The optimal management in preventing HBV reactivation would involve appropriate risk stratification for different immunosuppressive regimes in both HBsAg-positive and HBsAg-negative, anti-HBc positive individuals.

  1. Translation research: from accurate diagnosis to appropriate treatment

    Directory of Open Access Journals (Sweden)

    Pass Harvey I

    2004-10-01

    Full Text Available Abstract This review article focuses on the various aspects of translational research, where research on human subjects can ultimately enhance the diagnosis and treatment of future patients. While we will use specific examples relating to the asbestos related cancer mesothelioma, it should be stressed that the general approach outlined throughout this review is readily applicable to other diseases with an underlying molecular basis. Through the integration of molecular-based technologies, systematic tissue procurement and medical informatics, we now have the ability to identify clinically applicable "genotype"-"phenotype" associations across cohorts of patients that can rapidly be translated into useful diagnostic and treatment strategies. This review will touch on the various steps in the translational pipeline, and highlight some of the most essential elements as well as possible roadblocks that can impact success of the program. Critical issues with regard to Institutional Review Board (IRB and Health Insurance Portability and Accountability Act (HIPAA compliance, data standardization, sample procurement, quality control (QC, quality assurance (QA, data analysis, preclinical models and clinical trials are addressed. The various facets of the translational pipeline have been incorporated into a fully integrated computational system, appropriately named Dx2Tx. This system readily allows for the identification of new diagnostic tests, the discovery of biomarkers and drugable targets, and prediction of optimal treatments based upon the underlying molecular basis of the disease.

  2. PATTERNS FOR IDENTIFYING APPROPRIATE KNOWLEDGE MANAGEMENT STRATEGIES IN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Khadijeh Salmani

    2012-06-01

    Full Text Available Nowadays, striving to find an efficient way for developing or identifying appropriate knowledge management strategies in organizations has become so critical. Researchers and practitioners have attached great importance to information pyramids in organizations and have highlighted the lack of trained and skilled staff as a serious problem. On the other hand, having more flexibility at workplace, offering better service, and fulfilling customers' demands require a strategy for managing knowledge and its consequence. Knowledge management provides a wide range of different strategies and methods for identifying, creating, and sharing knowledge in organizations. This deep insight which consists of individual, organization’s experience, knowledge, and understanding helps organization respond to both internal and external stimuli and act in harmony. One fact which has seemingly achieved a consensus is the need for different strategies of knowledge management. Among the wide range of various and often unclear knowledge management strategies one can choose a strategy in a specific situation. The aim of this paper is to respond to strategic questions which emphasize competitive intelligence and internal knowledge retrieval system. The implications are discussed in detail.

  3. Developing a culturally appropriate mental health care service for Samoa.

    Science.gov (United States)

    Enoka, Matamua Iokapeta Sina; Tenari, Aliilelei; Sili, Tupou; Peteru, Latama; Tago, Pisaina; Blignault, Ilse

    2013-06-01

    Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family-focused community mental health care services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  4. Evaluating the Appropriateness and Use of Domain Critical Errors

    Directory of Open Access Journals (Sweden)

    Chad W. Buckendahl

    2012-10-01

    Full Text Available The consequences associated with the uses and interpretations of scores for many credentialing testing programs have important implications for a range of stakeholders. Within licensure settings specifically, results from examination programs are often one of the final steps in the process of assessing whether individuals will be allowed to enter practice. This article focuses on the concept of domain critical errors and suggests a framework for considering their use in practice. Domain critical errors are defined here as knowledge, skills, abilities, or judgments that are essential to the definition of minimum qualifications in a testing program's pass-'fail decision-making process. Using domain critical errors has psychometric and policy implications, particularly for licensure programs that are mandatory for entry-level practice. Because these errors greatly influence pass-'fail decisions, the measurement community faces an ongoing challenge to promote defensible practices while concurrently providing assessment literacy development about the appropriate design and use of testing methods like domain critical errors.

  5. Understanding the concept of nationally appropriate mitigation action

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, S.; Desgain, D.

    2013-05-15

    This publication is intended to enable national policy makers and other stakeholders, such as the private sector and technical experts, to acquaint themselves with the concept of NAMA. It aims to provide a comprehensive overview of the Nationally Appropriate Mitigation Action (NAMA) concept and enhance the understanding of NAMAs by explaining the underlying decisions of the Conference of the Parties in layman's terms. The first chapter describes how the concept of NAMA emerged in the context of the negotiations on climate change. The chapter gives an overview of how the concepts of NAMA and related MRV and financing issues have evolved through the different COPs. The second chapter clarifies the understanding of NAMAs in the context of the global temperature goal, and moves on to discuss the legal nature and scope of NAMAs. The chapter subsequently analyses the diversity of NAMAs submitted by developing countries to the UNFCCC, and ends by proposing a structure for formal submission of a NAMA. The third chapter specifically addresses the concept of measurement, reporting and verification (MRV), and describes the implications for countries implementing the MRV requirements. The last chapter discusses institutional arrangements, under the Convention, for providing financing to develop and implement NAMAs. The chapter also briefly discusses the different financial sources for implementing NAMAs, and concludes by explaining the concept of incremental cost in this specific context. (Author)

  6. Appropriate treatment of acute sigmoid volvulus in the emergency setting

    Science.gov (United States)

    Lou, Zheng; Yu, En-Da; Zhang, Wei; Meng, Rong-Gui; Hao, Li-Qiang; Fu, Chuan-Gang

    2013-01-01

    AIM: To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting. METHODS: A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis. RESULTS: Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus. CONCLUSION: Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis. PMID:23946604

  7. Who owns urban waste? Appropriation conflicts in emerging countries.

    Science.gov (United States)

    Cavé, Jérémie

    2014-09-01

    Managing solid waste in developing cities is not an easy task and many public policies have failed to bring the expected results. It is here argued that comprehending the solid waste handling in the South implies reconsidering the proper definition of waste. Where does the product end and where does rubbish begin? The answer to this question is far from being obvious. Solid waste appears as a blurred concept. Such a thorny issue is all the more relevant today, as municipal solid waste management approaches in the developing world are being reformulated: dumping sites are banned, sanitary landfills are imposed, and separate collection is being introduced. The current sector transformations are here analysed through a novel theoretical analysis combined with an original qualitative and quantitative empirical work. Through two case-studies of one-million inhabitant cities from emerging countries, it is shown that if appropriation conflicts arise that is because the urban solid waste deposit in Southern countries can be defined as an impure public good. This issue does not only involve private service operators and informal wastepickers; several other actors covet the urban solid waste deposit's cream, that is, recyclable items. In emerging countries, huge industrial groups are starting to target domestic recyclable waste as an alternative for raw materials, which costs are increasing ever more. © The Author(s) 2014.

  8. Appropriate bare potentials for studying fusion induced by 6He

    International Nuclear Information System (INIS)

    Crema, E; Chamon, L.C; Gomes, P.R.S.

    2007-01-01

    Although there are some recent studies questioning the use of the same optical potential to explain simultaneously fusion and quasi-elastic experimental data [1] or even to explain deep sub-barrier- and above-barrier fusion [2], during the last decades, the bare nuclear interaction between the nuclei at near barrier energies has been widely represented by a frozen potential with a Woods-Saxon shape. Another well established fact is the strong dependence of nuclear reaction calculations on the choice of the primary interaction. Of course, comparison between data and theoretical calculations are strongly potential-dependent. So, the choice of an appropriate nuclear bare interaction between two colliding nuclei, although it is a difficult task, is a crucial step in the data interpretation. As one has not direct access to the true bare potential, some procedures have been developed in order to constrain the choice of the bare potential to be used. The first procedure is the analysis of the elastic scattering data within the context of an optical potential, where an imaginary potential is added to the real potential, in order to take into account the flux deviated from the elastic channel. The optical potential that gives the best fit to the elastic scattering data is then used to describe other reaction channels, even in coupled channel calculations including inelastic and transfer reactions in the coupling matrix. However, this kind of calculation suffers from several inconsistencies. Another procedure that has been widely used to obtain the bare potential is the fit of the high-energy fusion data by a single barrier penetration model (BPM). However this method also has its uncertainties, since there might be channels that hinder the fusion cross section at energies near and above the Coulomb barrier. Hence, the bare potential extracted through this method can be contaminated by different processes. The derivation of experimental barrier distributions probably is the

  9. Appropriate Utilization and Stocking of Antidotes in Qatar Public Hospitals

    Directory of Open Access Journals (Sweden)

    Rawan Salameh

    2017-09-01

    Full Text Available Background: There are a few studies that evaluate preparedness and availability of antidotes in the emergency setting and none have been conducted in Qatar. Published studies show that timely availability of antidotes in the emergency department setting is a common issue. To address this, we conducted a study to evaluate antidote stocking and utilization in Qatar hospital pharmacies and emergency departments. Methods: In order to evaluate the appropriate use and timely administration of antidotes, research assistants prospectively collected data on ED patients. All ED patients who received any key antidote over the 6-month study period were identified through both ED and pharmacy records. In order to evaluate the stocking of the 31 most important antidotes in our main public hospitals, a survey assessing the stocking of these key antidotes was sent to the four general hospitals in Qatar, to determine their availability and whether they are stocked in the ED or only in the main pharmacy. Results: Poison exposure was evaluated in 471 cases. Antidotes were given within 30 minutes in 73% of cases, which included atropine, calcium, dextrose, flumazenil, naloxone, pralidoxime, sodium bicarbonate, thiamine, vitamin K and scorpion and snake antivenoms. Administration occurred later than 60 minutes in 2% of cases, exclusively with N-acetylcysteine and activated charcoal. Atropine, calcium, dextrose, naloxone, pralidoxime (2-PAM, sodium bicarbonate, and anti-venoms were clinically indicated 92% of the times they were ordered. N-acetylcysteine was indicated in only 51.5% of administrations. Significant variation in antidote stocking existed between hospitals, and there was no stocked hydroxocobalamin as antidotes for cyanide poisoning or fomepizole for toxic alcohol poisoning. Conclusion: Antidote stocking varied significantly between hospitals, and antidotes necessary for cyanide and toxic alcohol poisoning were deficient in all public hospitals. The

  10. Fluxes of radiocesium to milk and appropriate countermeasures

    International Nuclear Information System (INIS)

    Howard, J.; Hove, K.; Prister, B.; Sobolev, A; Ratnikov, A; Travnikova, I.; Averin, V.; Tronevitch, V.; Strand, P.; Bogdanov, G.

    1996-01-01

    Radiocesium contamination of milk persists in some areas of Belarus, Ukraine and Russian Federation which received fallout from the Chernobyl accident. In general, effective countermeasures have been used which ensure that radiocesium activity concentrations in milk from collective farms does not exceed intervention limits. However, farming practices differ greatly between the large collective farms, and the small, family operated private farms which are responsible for a major part of the food consumed in many rural areas. As a result of comparative low rate of use of fertilizers and utilization of poor quality land 137 Cs activity concentrations in milk from family-owned cows continues to exceed intervention limits in some areas. It is therefore important to be able reliably to quantify the rates of transfer of 137 Cs to private milk, so that all areas where persistent problems occur are identified, and appropriate countermeasure strategies applied. Where there is considerable variation, within a few km 2 , in both soil type and deposition, the 137 Cs content of private milk is highly variable. However, combining information about soil type, transfer rates for each major soil type, deposition, pasture size and grazing strategies can be a useful method of quantifying transfer of radiocesium to milk. Geographical information systems provide a promising new tool to integrate these factors. Effective Countermeasures are available to reduce radiocesium transfer to private milk. Private farmers are more sceptical of such methods than the scientists, administrators and agriculturalists in their society, particularly those methods involving the use of chemical additives given to their animals. Increased information efforts on the local level appears to be a prerequisite for a successful implementation of necessary Countermeasures

  11. Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.

    Science.gov (United States)

    Goodman, Karyn A; Patton, Caroline E; Fisher, George A; Hoffe, Sarah E; Haddock, Michael G; Parikh, Parag J; Kim, John; Baxter, Nancy N; Czito, Brian G; Hong, Theodore S; Herman, Joseph M; Crane, Christopher H; Hoffman, Karen E

    2016-01-01

    To summarize results of a Clinical Practice Statement on radiation therapy for stage II-III rectal cancer, which addressed appropriate customization of (neo)adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection. The RAND/University of California, Los Angeles, Appropriateness Method was applied to combine current evidence with multidisciplinary expert opinion. A systematic literature review was conducted and used by the expert panel to rate appropriateness of radiation therapy options for different clinical scenarios. Treatments were categorized by median rating as Appropriate, May Be Appropriate, or Rarely Appropriate. In the neoadjuvant setting, chemoradiation was rated Appropriate and the ratings indicated short-course radiation therapy, chemotherapy alone, and no neoadjuvant therapy are potential options in selected patients. However, neoadjuvant endorectal brachytherapy was rated Rarely Appropriate. For adjuvant therapy, chemoradiation (plus ≥4 months of chemotherapy) was rated Appropriate and chemotherapy alone May Be Appropriate for most scenarios. For medically inoperable patients, definitive external beam radiation therapy and chemotherapy alone were rated May Be Appropriate, whereas endorectal brachytherapy and chemoradiation plus endorectal brachytherapy were possible approaches for some scenarios. The last option, definitive chemoradiation, was rated Appropriate to May Be Appropriate based on performance status. Finally, for patients with low-lying tumors refusing abdominoperineal resection, definitive chemoradiation alone, chemoradiation plus endorectal brachytherapy, and chemoradiation plus external beam radiation therapy were all rated Appropriate. This Clinical Practice Statement demonstrated the central role of radiation therapy in stage II-III rectal cancer management and evaluated ways to better individualize its use in the neoadjuvant, adjuvant, and definitive settings

  12. Selection of an appropriately simple storm runoff model

    Directory of Open Access Journals (Sweden)

    A. I. J. M. van Dijk

    2010-03-01

    Full Text Available An appropriately simple event runoff model for catchment hydrological studies was derived. The model was selected from several variants as having the optimum balance between simplicity and the ability to explain daily observations of streamflow from 260 Australian catchments (23–1902 km2. Event rainfall and runoff were estimated from the observations through a combination of baseflow separation and storm flow recession analysis, producing a storm flow recession coefficient (kQF. Various model structures with up to six free parameters were investigated, covering most of the equations applied in existing lumped catchment models. The performance of alternative structures and free parameters were expressed in Aikake's Final Prediction Error Criterion (FPEC and corresponding Nash-Sutcliffe model efficiencies (NSME for event runoff totals. For each model variant, the number of free parameters was reduced in steps based on calculated parameter sensitivity. The resulting optimal model structure had two or three free parameters; the first describing the non-linear relationship between event rainfall and runoff (Smax, the second relating runoff to antecedent groundwater storage (CSg, and a third that described initial rainfall losses (Li, but which could be set at 8 mm without affecting model performance too much. The best three parameter model produced a median NSME of 0.64 and outperformed, for example, the Soil Conservation Service Curve Number technique (median NSME 0.30–0.41. Parameter estimation in ungauged catchments is likely to be challenging: 64% of the variance in kQF among stations could be explained by catchment climate indicators and spatial correlation, but corresponding numbers were a modest 45% for CSg, 21% for Smax and none for Li, respectively. In gauged catchments, better

  13. Annual Status Report on Nationally Appropriate Mitigation Actions (NAMAs) 2013

    Energy Technology Data Exchange (ETDEWEB)

    Haensel, G.; Roeser, F.; Hoehne, N. [Ecofys, Utrecht (Netherlands); Van Tilburg, X.; Cameron, L. [ECN Policy Studies, Amsterdam (Netherlands)] (eds.)

    2013-11-15

    results of an online survey that collected respondents' considerations taken when designing and implementing NAMAs and elements perceived as key in operationalising a NAMA registry. UNEP Risoe Centre reflects on the linkages between lowcarbon development strategies, nationally appropriate mitigation actions and measuring, reporting and verification processes. The Overseas Environmental Cooperation Center (OECC) reflects on domestic institutional arrangement instead as essential elements in the development, coordination and implementation of NAMAs and their MRV. The contribution of the World Resources Institute (WRI) seeks to unpack MRV needs for estimating the greenhouse gas emissions reductions associated with NAMAs, as well as existing resources available to assist countries. The NAMA Facility presents an overview of its objectives, governance structure and selection and implementation procedures for NAMA support projects.

  14. Appeal to fear in health care: appropriate or inappropriate?

    Science.gov (United States)

    Simpson, J Keith

    2017-01-01

    This paper examines appeal to fear in general: its perceived positive aspects, its negative characteristics, its appropriate as well as its fallacious use. Appeal to fear is a commonly used marketing method that attempts to change behaviour by creating anxiety in those receiving a fearful message. It is regularly used in public health initiatives such as anti-smoking, anti-drunk driving campaigns as well as in hypertension awareness campaigns. Some chiropractors appear to use appeal to fear to promote subluxation awareness and thereby encourage the use of chiropractic treatment. Research supporting its use is equivocal; nevertheless, when used judiciously, appeal to fear probably has sufficient strengths to warrant its continued conditional use. When used to promote care for which there is no supporting evidence, its use is fallacious. Appeal to fear has been used in health promotion campaigns for sixty years or more with the intent of modifying behaviours. While there is evidence to suggest that appeal to fear may motivate some individuals to modify offending behaviour or adopt recommended behaviour there is growing resistance to the use of appeal to fear on ethical and psychological grounds. Using appeal to fear as a tool of persuasion can be valid or fallacious depending on the truth of the premises within the argument. When used to raise awareness about genuine health concerns such as smoking, drunk driving and hypertension appeal to fear is considered to be a valid approach with certain caveats. However, when appeal to fear, not based on evidence or reason, is used as motivator to get others to accept unnecessary interventions for unproven disorders, the use of appeal to fear is fallacious. In spite of the evidence against its use, it seems likely that appeal to fear will continue to be used in conjunction with other public awareness initiatives to modify recognized detrimental behaviours such as smoking and drunk driving as well as silent killers such as

  15. 18 CFR 367.4360 - Account 436, Appropriations of retained earnings.

    Science.gov (United States)

    2010-04-01

    ..., Appropriations of retained earnings. 367.4360 Section 367.4360 Conservation of Power and Water Resources FEDERAL... NATURAL GAS ACT Retained Earnings Accounts § 367.4360 Account 436, Appropriations of retained earnings. This account must include appropriations of retained earnings as follows: (a) Appropriations required...

  16. MEDIA APPROPRIATIONS OF BLACK FEMINISM IN BRAZILIAN CONTEMPORANEITY

    Directory of Open Access Journals (Sweden)

    Telma Sueli Pinto Johnson

    2017-03-01

    Full Text Available RESUMO Este artigo examina apropriações midiáticas pelo feminismo negro baseadas em reflexões teórico-conceituais sobre a problemática da comunicação em sociedades midiatizadas e suas relações com a literacia midiática. O Instituto da Mulher Negra Geledés, fundado em 1998 no período da redemocratização brasileira, constitui-se no objeto de investigação. O movimento Geledés foi observado e mapeado em sua página no site de rede social Facebook, durante um período consecutivo de oito semanas em 2016, com o propósito de identificar modalidades de interações entre seus visitantes. A análise dedica-se, para além das postagens do Geledés, a apreender e compreender o que acontece na esfera da recepção quando se trata de tipos de usos, apropriações e produções de sentidos. Um construto metodológico baseado na Cartografia de Controvérsias (CC foi operacionalizado para analisar as interações dos actantes sociais do Geledés no Facebook, revelando predominância de interações passivas e elevado número de comentários participativos desqualificados sob a ótica do debate público racional.   PALAVRAS-CHAVE: Comunicação; Redes Sociais; Feminismo Negro; Literacia Midiática; Cartografia de Controvérsias.     ABSTRACT This article examines media appropriations by black feminism based on theoretical-conceptual reflections on the problem of communication in mediatized societies and their relations with media literacy. The Geledés Black Women's Institute, founded in 1998 in the period of Brazilian redemocratization, is the object of this research. The Geledés movement was observed and mapped on its page on the social networking site Facebook, during a consecutive period of eight weeks in 2016, with the purpose of identifying modalities of interactions among its visitors. The analysis is dedicated, in addition to the posts of the Geledés, to apprehend and to understand what happens in the sphere of the reception when

  17. Annual Status Report on Nationally Appropriate Mitigation Actions (NAMAs) 2012

    Energy Technology Data Exchange (ETDEWEB)

    Haensel, G.; Roeser, F.; Hoehne, N. [Ecofys, Utrecht (Netherlands); Van Tilburg, X.; Cameron, L. [ECN Policy Studies, Amsterdam (Netherlands)] (eds.)

    2012-11-15

    The development of Nationally Appropriate Mitigation Actions (NAMAs) has increased significantly over the last few years. The flexibility of the NAMA mechanism is widely regarded as an opportunity to deliver benefits that go far beyond greenhouse gas (GHG) emission reductions. Many developing countries are developing pilot NAMAs that deliver important insights into the challenges of, and opportunities for, NAMA development from a national perspective. A few countries are already a step ahead and experiences gained from pilot NAMA development are feeding into the formulation of national climate change policies in which NAMAs are becoming a key element. To maintain the momentum in NAMA development, clear signs at the international level are needed that developed countries will follow through with their financial commitments made under the Copenhagen Accord. Without this financial support, NAMAs will not be able to realise their full potential and induce transformational change. The Annual Status Report on NAMAs 2012 is a continuation of previously published NAMA Status Reports. The report presents an overview of the state of play of NAMAs and of support activities for NAMA development and implementation. A new feature of the Annual Status Report on NAMAs 2012 is that it is produced as a joint effort by several organizations that are closely involved in analysing and supporting NAMA development processes worldwide. The Annual Status Report on NAMAs 2012 is written by authors from Ecofys, the Energy research Centre of the Netherlands, the Center of Clean Air Policy (CCAP), the World Resources Institute (WRI) and Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ). In the section on 'Selected contributions on NAMAs', each organization discusses a specific topic of interest in relation to NAMA development that is closely related to their current NAMA activities or that is expected to provide 'food for thought' on potential ways forward for

  18. [Appropriateness admissions to the Department of Internal Medicine of the Hospital de Santa Luzia (Elvas) evaluated by the AEP (Appropriateness Evaluation Protocol)].

    Science.gov (United States)

    Cordero, A; Aguila, J; Massalana, A; Escoto, V; Lopes, L; Susano, R

    2004-01-01

    The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of patients had less mean age (63 + 16 vs 69 + 16; p <0.01), and less mean days of admission (7.1 + 6 vs 9.3 + 7; p <0.01) than group with appropriateness admissions. Appropriateness admissions were mainly found in patients admitted from the emergency room (86% vs 49%; p <0.001). Most of patients with non-appropriate admissions were admitted to undergo diagnostic tests (44%; CI95%: 35-53), or to be referred to other medical centres for specialized study and/or treatment (12%; CI95%: 6-18).

  19. Is Early Appropriate Care of axial and femoral fractures appropriate in multiply-injured elderly trauma patients?

    Science.gov (United States)

    Reich, M S; Dolenc, A J; Moore, T A; Vallier, H A

    2016-09-26

    Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied. Patients aged ≤30 years (n = 114), 30 to 60 years (n = 184), and ≥60 years (n = 37) with Injury Severity Scores (ISS) ≥16 and unstable fractures of the pelvis, acetabulum, spine, and/or diaphyseal femur were treated within 36 h, provided they showed evidence of adequate resuscitation. ISS, Glasgow Coma Scale (GCS), and American Society of Anesthesiologists (ASA) classification were determined. Lactate, pH, and base excess (BE) were measured at 8-h intervals. Complications included pneumonia, pulmonary embolism (PE), acute renal failure, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), deep vein thrombosis, infection, sepsis, and death. Patients ≤30 years old (y/o) were more likely to sustain gunshot wounds (p = 0.039), while those ≥60 y/o were more likely to fall from a height (p = 0.002). Complications occurred at similar rates for patients ≤30 y/o, 30 to 60 y/o, and ≥60 y/o. There were no differences in lactate, pH, or BE at the time of surgery. For patients ≤30 y/o, there were increased overall complications if pH was <7.30 (p = 0.042) or BE <-6.0 (p = 0.049); patients ≥60 y/o demonstrated more sepsis if BE was <-6.0 (p = 0.046). EAC aims to definitively manage axial and femoral shaft fractures once patients have been adequately resuscitated to minimize complications. EAC is associated with comparable complication rates in young and elderly

  20. HANPP Collection: Global Patterns in Human Appropriation of Net Primary Productivity (HANPP)

    Data.gov (United States)

    National Aeronautics and Space Administration — The Global Patterns in Human Appropriation of Net Primary Productivity (HANPP) portion of the HANPP Collection represents a digital map of human appropriation of net...

  1. HANPP Collection: Human Appropriation of Net Primary Productivity (HANPP) by Country and Product

    Data.gov (United States)

    National Aeronautics and Space Administration — The Global Patterns in Human Appropriation of Net Primary Productivity (HANPP) portion of the HANPP Collection represents a digital map of human appropriation of net...

  2. Assessment of inpatient multimodal cardiac imaging appropriateness at large academic medical centers.

    Science.gov (United States)

    Remfry, Andrew; Abrams, Howard; Dudzinski, David M; Weiner, Rory B; Bhatia, R Sacha

    2015-11-14

    Responding to concerns regarding the growth of cardiac testing, the American College of Cardiology Foundation (ACCF) published Appropriate Use Criteria (AUC) for various cardiac imaging modalities. Single modality cardiac imaging appropriateness has been reported but there have been no studies assessing the appropriateness of multiple imaging modalities in an inpatient environment. A retrospective study of the appropriateness of cardiac tests ordered by the inpatient General Internal Medicine (GIM) and Cardiology services at three Canadian academic hospitals was conducted over two one-month periods. Cardiac tests characterized were transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), single-photon emission tomography myocardial perfusion imaging (SPECT), and diagnostic cardiac catheterization. Overall, 553 tests were assessed, of which 99.8% were classifiable by AUC. 91% of all studies were categorized as appropriate, 4% may be appropriate and 5% were rarely appropriate. There were high rates of appropriate use of all modalities by GIM and Cardiology throughout. Significantly more appropriate diagnostic catheterizations were ordered by Cardiology than GIM (93% vs. 82%, p = imaging modalities in this multi-centered study on Cardiology and GIM inpatients in the acute care setting. The rate of appropriate ordering was high across all imaging modalities. We recommend further work towards improving appropriate utilization of cardiac imaging resources focus on the out-patient setting.

  3. The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases : The Neuromodulation Appropriateness Consensus Committee

    NARCIS (Netherlands)

    Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason; Krames, Elliot; Leong, Michael; Levy, Robert M.; Abejon, David; Buchser, Eric; Burton, Allen; Buvanendran, Asokumar; Candido, Kenneth; Caraway, David; Cousins, Michael; de Jongste, Micheal; Diwan, Sudhir; Eldabe, Sam; Gatzinsky, Kliment; Foreman, Robert D.; Hayek, Salim; Kim, Philip; Kinfe, Thomas; Kloth, David; Kumar, Krishna; Rizvi, Syed; Lad, Shivanand P.; Liem, Liong; Linderoth, Bengt; Mackey, Sean; McDowell, Gladstone; McRoberts, Porter; Poree, Lawrence; Prager, Joshua; Raso, Lou; Rauck, Richard; Russo, Marc; Simpson, Brian; Slavin, Konstantin; Staats, Peter; Stanton-Hicks, Michael; Verrills, Paul; Wellington, Joshua; Williams, Kayode; North, Richard

    Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended

  4. CPD Appropriations

    Data.gov (United States)

    Department of Housing and Urban Development — The datasets are the full-year allocations for HUD's Office of Community Planning and Development (CPD) formula programs: Community Development Block Grants (CDBG);...

  5. Constrained Appropriations

    DEFF Research Database (Denmark)

    Wildermuth, Norbert

    2008-01-01

    cultures of media consumption which unify and divide Brazil's (urban) youth, attention is also given to an  understanding of the relationship between young people and media, as developed in concrete attempts to increase the cultural competences of young, ‘disprivileged' media consumers. The contribution......  A discussion of the contingent character of young Brazilian's media culture is the focus of my contribution's theoretical approach. Thus, while giving recognition to young people's active agency in the creation of media-centred lifestyles and youth cultures, I will seek to demonstrate...

  6. Appropriate technology

    International Development Research Centre (IDRC) Digital Library (Canada)

    was not the primary target species and fetched a much lower price. Fortunately, in recent decades both the ... even if they have low market value, may nonetheless be vital components of the marine ecosystem. Bert Allsopp ... First, the catch of non-target species is being reduced through the use of “excluder” devices on ...

  7. Collaborative Appropriation

    DEFF Research Database (Denmark)

    Muller, Michael; Neureiter, Katja; Verdezoto, Nervo

    2016-01-01

    Previous workshops and papers have examined how individual users adopt and adapt technologies to meet their own local needs, by “completing design through use.” However, there has been little systematic study of how groups of people engage collaboratively in these activities. This workshop opens ...

  8. Appropriate Pupilness

    DEFF Research Database (Denmark)

    Kofoed, Jette

    2008-01-01

    for football are selected. The article opens up for a microanalysis of everyday practices at the margins and at the core of what this article terms `pupilness'. The concept of intersectionality is suggested as a useful analytical tool to understand the multiple activities of pupils in everyday school life...

  9. Pragmatic awareness of Suggestions: From (Im)Polite Mannerism to Attitudinal Appropriateness

    OpenAIRE

    Hamid Allami; Nasim Boustani

    2017-01-01

    The present research seeks to determine: (a) Iranian EFL learners’ application of suggestion semantic formulae ;(b) their attitude of appropriateness in terms of confidence in the employment of appropriate supportive moves; (c), their (im)polite mannerism with respect to the selected strategies; and (d) the relationship between attitude of appropriateness and mannerism of (im)politeness. An Oxford Quick placement Test (OQPT) was administered among 60 Iranian EFL learners to check their langua...

  10. Design and Construction for Community Health Service Precision Fund Appropriation System Based on Performance Management.

    Science.gov (United States)

    Gao, Xing; He, Yao; Hu, Hongpu

    2017-01-01

    Allowing for the differences in economy development, informatization degree and characteristic of population served and so on among different community health service organizations, community health service precision fund appropriation system based on performance management is designed, which can provide support for the government to appropriate financial funds scientifically and rationally for primary care. The system has the characteristic of flexibility and practicability, in which there are five subsystems including data acquisition, parameter setting, fund appropriation, statistical analysis system and user management.

  11. Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness.

    Science.gov (United States)

    Juillerat, Pascal; Pittet, Valérie; Vader, John-Paul; Burnand, Bernard; Gonvers, Jean-Jacques; de Saussure, Philippe; Mottet, Christian; Seibold, Frank; Rogler, Gerhard; Sagmeister, Markus; Felley, Christian; Michetti, Pierre; Froehlich, Florian

    2010-11-01

    Antitumor necrosis factor a agents have significantly improved the management of Crohn's disease (CD), but not all patients benefit from this therapy. We used data from the Swiss Inflammatory Bowel Disease Cohort Study and predefined appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients. EPACT II (European Panel on the Appropriateness of CD Therapy, 2007; www.epact.ch) appropriateness criteria have been developed using a formal explicit panel process combining evidence from the published literature and expert opinion. Questionnaires relating to EPACT II criteria were used at enrollment and follow-up of all Swiss Inflammatory Bowel Disease Cohort Study patients. A step-by-step analysis of all possible indications for IFX therapy in a given patient allowed identification of the most appropriate indication and final classification in a single appropriateness category (appropriate, uncertain, inappropriate). Eight hundred and twenty-one CD patients were prospectively enrolled between November 2006 and March 2009. IFX was administered to 146 patients (18%) at enrollment and was most frequently used for complex fistulizing disease and for the maintenance of remission induced by biological therapy. IFX therapy was considered appropriate in 44%, uncertain in 44%, and inappropriate in 10% of patients. In this cohort, 9 out of 10 indications for IFX therapy were clinically generally acceptable (appropriate or uncertain) according to EPACT II criteria. Uncertain indications resulted mainly from the current more liberal use of IFX in clinical practice as compared with the EPACT II criteria.

  12. Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

    Science.gov (United States)

    Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

    2017-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in

  13. A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia

    NARCIS (Netherlands)

    van der Spek, K.; Gerritsen, D.L.; Smalbrugge, M.; Nelissen-Vrancken, M.H.J.M.; Wetzels, R.B.; Smeets, C.H.W.; Zuidema, S.U.; Koopmans, R.T.C.M.

    2015-01-01

    Objectives The aim of this study was to develop an index derived from the Medication Appropriateness Index (MAI) items that is suited for clinical studies evaluating appropriateness of psychotropic drug use (PDU) for neuropsychiatric symptoms (NPS) in patients with dementia in nursing homes and to

  14. 42 CFR 456.6 - Review by State medical agency of appropriateness and quality of services.

    Science.gov (United States)

    2010-10-01

    ... and quality of services. 456.6 Section 456.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Provisions § 456.6 Review by State medical agency of appropriateness and quality of services. (a) The... professional health personnel of the appropriateness and quality of Medicaid services. (b) The purpose of this...

  15. FY2014 Appropriations Lapse and the Department of Homeland Security: Impact and Legislation

    Science.gov (United States)

    2013-10-24

    and Programs Directorate (NPPD) • Office of Biometric Identity Management • Federal Protective Service Under the Federal Emergency Management...performance of excepted work during the period of the appropriations lapse. After appropriations are enacted, payroll centers will pay all excepted...four hours of work completely dedicated to de- activating a function, such as securing documents, completing payroll , etc.12 Presidential appointees

  16. Preservice and Inservice Teachers' Perceptions of Appropriateness of Teacher Self-Disclosure

    Science.gov (United States)

    Zhang, Shaoan; Shi, Qingmin; Tonelson, Stephen; Robinson, Jack

    2009-01-01

    This study investigated preservice and inservice teachers' perceptions of appropriateness of teacher self-disclosure. A sample of 180 preservice teachers and 135 preK-12 teachers participated in the study. Results showed statistically significant differences between the groups of teachers in their perceptions of appropriateness of teacher…

  17. Teaching Young Adults with Disabilities to Respond Appropriately to Lures from Strangers

    Science.gov (United States)

    Fisher, Marisa H.; Burke, Meghan M.; Griffin, Megan M.

    2013-01-01

    We taught 5 adults with mild intellectual disabilities to respond appropriately to lures from strangers. Skills were taught in the classroom first and then in situ. Before training, participants did not walk away from confederate strangers who tried to lure them away. Participants demonstrated appropriate responses during classroom and in situ…

  18. Appropriating Geometric Series as a Cultural Tool: A Study of Student Collaborative Learning

    Science.gov (United States)

    Carlsen, Martin

    2010-01-01

    The aim of this article is to illustrate how students, through collaborative small-group problem solving, appropriate the concept of geometric series. Student appropriation of cultural tools is dependent on five sociocultural aspects: involvement in joint activity, shared focus of attention, shared meanings for utterances, transforming actions and…

  19. Creating a University System for the 21st Century. Analysis of 2009-2011 Legislative Appropriation

    Science.gov (United States)

    North Dakota University System, 2009

    2009-01-01

    The 2009-11 state general fund appropriation is $597.9 million for the eleven campuses, University of North Dakota (UND) School of Medicine and Health Sciences (SMHS), Forest Service and North Dakota University System Office, which is an increase of $153.4 million over the 2007-09 adjusted appropriation, less 07-09 one-time funding. This includes…

  20. The effect of product–context appropriateness on emotion associations in evoked eating occasions

    NARCIS (Netherlands)

    Piqueras Fiszman, B.; Jaeger, S.R.

    2015-01-01

    The aim of this research was to investigate the impact that perceived product–context appropriateness exerts on elicited emotion associations. The experimental approach consisted in creating eating occasions (as a multi-component entity) varying in appropriateness, which consumers were instructed to

  1. Mobile phone appropriation in the favelas of Rio de Janeiro, Brazil

    DEFF Research Database (Denmark)

    de Souza e Silva, Adriana Araujo; Sutko, Daniel; Salis, Fernando

    2011-01-01

    This qualitative case study describes the social appropriation of mobile phones among low-income communities in Rio de Janeiro (Brazil) by asking how favela (slum) residents appropriate cell phones. Findings highlight the difficulty these populations encounter in acquiring and using cell phones due...

  2. The Effects of a Developmentally Appropriate Music and Movement Program on Motor Performance

    Science.gov (United States)

    Zachopoulou, E.; Tsapakidou, A.; Derri, V.

    2004-01-01

    Basic motor skills development is achieved through the implementation of different types of physical education programs. The purpose of this study was to investigate and to compare the effect of a developmentally appropriate music and movement program and of a developmentally appropriate physical education program on the development of jumping and…

  3. Energy and water development appropriations for 1994. Hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Third Congress, First Session. Part 5

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    Part 5 of the hearings for the Energy and Water Development Appropriations for 1994 contains budget hearings for the Department of Energy. Contained in this volume is the statement of the Secretary of Energy and budget proposals and justifications for Departmental Administration, Energy Research, Nuclear Energy and Commercial Waste Management, Solar and Renewables, and Power Marketing Administrations

  4. Energy and water development appropriations for 1999: Part 5. Hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Fifth Congress, Second Session

    International Nuclear Information System (INIS)

    1998-01-01

    This is part 5 of the hearings before the subcommittee on energy and water development of the committee on appropriations. Included are statements from witnesses of the Secretary of Energy, departmental administration, energy research, renewable energy, nuclear energy, Power Marketing Administration, Federal Energy Regulatory Commission, and the Nuclear Regulatory Commission

  5. [Hospital emergencies arising from nursing homes in a region: evolution, characteristics and appropriateness].

    Science.gov (United States)

    Sánchez-Pérez, Inma; Comes Garcia, Nuri; Romero Piniella, Lola; Prats Martos, Gemma; Arnau Bataller, Gemma; Coderch, Jordi

    Hospital emergencies (HE) arising from nursing homes (NH) are on the rise. We analyse the evolution, characteristics and appropriateness of HE of NH residents in a region, as well as resulting hospital admissions. Retrospective descriptive study between 2010 and 2013 of institutionalised residents of 11 NH located in Baix Empordà (704 beds) and Palamós Hospital. Gender, age, morbidity and relative weight according to clinical risk groups (CRG), NH, length of stay, diagnosis of the emergency, appropriateness of HE according to Bermejo's criteria and the HE appropriateness protocol (HEAP), and appropriateness of hospitalisations according to the Appropriateness Evaluation Protocol (AEP). Sample to evaluate appropriateness: 159 HE and 91 hospitalisations. frequency, mean, standard deviation, percentiles, Fisher's exact test and ANOVA, with a confidence interval of 95% and using IBM SPSS Statistics 23. 1,474 people were enrolled, of which 73% were women. Group ≥85 years increased to 60.3% and the mean weight of morbidity was 3.2 to 4.0 (p <0.001). 1,805 HE were generated. The annual rate per 1,000 stays arising from NH increased from 1.64 to 2.05, of which 90.6% were appropriate according to Bermejo's criteria and 93.7% according to the HEAP. Of these, 502 involved hospitalisation. The annual rate per 10 emergencies fell from 2.96 to 2.64 and 98.9% were appropriate according to the AEP. Hospital emergencies and hospitalisations of NH residents are increasing and are appropriate. Increasing age and disease burden could explain this phenomenon. NH and hospitals should react appropriately, considering the specific needs of this population sector. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Providing Appropriate Technology for Emerging Markets: Case Study on China’s Solar Thermal Industry

    Directory of Open Access Journals (Sweden)

    Jianghua Zhou

    2017-01-01

    Full Text Available Building on a case study of five Chinese solar thermal companies and one association, our study aims to understand how the innovator’s choices regarding the use of technology and organizational practices for new product development enable companies to design and diffuse appropriate technology in emerging markets. The study uncovers two critical factors that enhance the appropriateness of technology: redefining the identity of technology and building a local supply system. Our analysis shows that synergic innovation in both architecture and component leads to the appropriate functionalities desired by emerging markets. Moreover, modular design and the building of a local supply system enhance the process appropriateness of technology. Our study provides an empirical basis for advocating going beyond minor adaptations of existing products to creating appropriate technology for emerging markets, and extends our understandings of the upstream process of designing appropriate technology. Moreover, the emphasis on the local supply system reflects a holistic framework for shaping and delivering appropriate technology, expanding the existing research focus on the perspective of the technology itself. Our research also has managerial implications that may help firms tap into emerging markets.

  7. An Audit on the Appropriateness of Coronary Computed Tomography Angiography Referrals in a Tertiary Cardiac Center.

    Science.gov (United States)

    Alderazi, Ahmed Ali; Lynch, Mary

    2017-01-01

    In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines. To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain. This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain. Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%). This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of "uncertain" cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.

  8. Identity appropriateness and the structure of the theory of planned behaviour.

    Science.gov (United States)

    Case, Philippa; Sparks, Paul; Pavey, Louisa

    2016-03-01

    In contrast to the cost-benefit, utility-based approach to decision-making implicit in models such as the theory of planned behaviour (TPB), the logic of appropriateness (March, 1994. A Primer on Decision Making: How decisions happen. New York, NY: The Free Press) describes decision-making in terms of heuristic decision rules that involve matching identities to situations. This research is the first to apply the logic of appropriateness in conjunction with the theoretical structure of the TPB and assessed whether a measure of identity appropriateness might independently predict adults' intentions to engage in binge drinking. In Study 1, participants (N = 197) completed questionnaires assessing attitudes, subjective norm, perceived behavioural control, past behaviour, and identity appropriateness in relation to binge drinking. Path analysis revealed an independent predictive effect of identity appropriateness on intentions in addition to an indirect effect via attitudes. In Study 2 (N = 179), a prospective measure of behaviour was included in a similar study: Identity appropriateness again predicted intentions independently of the extended TPB predictors. It was again also found to be a strong predictor of attitudes. We suggest that the notion of identity appropriateness may assist in explaining the capacity of measures of self-identity to predict people's behavioural intentions. © 2015 The British Psychological Society.

  9. Public Opinion Regarding Whether Speaking With Patients About Firearms Is Appropriate: Results of a National Survey.

    Science.gov (United States)

    Betz, Marian E; Azrael, Deborah; Barber, Catherine; Miller, Matthew

    2016-10-18

    Health care providers have been encouraged to discuss firearms with patients; whether patients view these discussions as appropriate is unclear. To estimate, in a national sample, the perceived appropriateness of provider discussions about firearms. Probability-based online survey conducted in April 2015. Analyses used survey weights to generate nationally representative estimates. U.S. adults. 3914 English-speaking adults (55% participation rate). Participants were asked, "In general, would you think it is never, sometimes, usually, or always appropriate for physicians and other health professionals to talk to their patients about firearms?" A majority (66% [95% CI, 63% to 69%]) of participants said that it is at least sometimes appropriate for providers to talk to patients about firearms. Specifically, 23% (CI, 20% to 25%) said that provider discussions about firearms were always appropriate, 14% (CI, 11% to 16%) said that they were usually appropriate, and 30% (CI, 27% to 33%) thought they were sometimes appropriate; 34% (CI, 31% to 37%) felt that such discussions were never appropriate. Views varied by firearm ownership: 54% (CI, 52% to 57%) of gun owners said that provider discussions are at least sometimes appropriate, compared with 67% (CI, 62% to 71%) of nonowners living with an owner and 70% (CI, 66% to 74%) of nonowners not living with an owner. Firearm owners who were more likely to think that firearm discussions are at least sometimes appropriate included those with children at home (62% [CI, 57% to 67%]), those who thought that having a gun at home increases suicide risk (75% [CI, 67% to 83%), and those who thought that provider discussions of seat belts are at least sometimes appropriate (73% [CI, 70% to 75%]). The provider discussion question did not specify clinical context. Two thirds of non-firearm owners and over one half of firearm owners in the United States believe that health care provider discussions about firearms are at least sometimes

  10. HANPP Collection: Human Appropriation of Net Primary Productivity as a Percentage of Net Primary Productivity

    Data.gov (United States)

    National Aeronautics and Space Administration — The Human Appropriation of Net Primary Productivity (HANPP) as a Percentage of Net Primary Product (NPP) portion of the HANPP Collection represents a map identifying...

  11. Archival standards, in archival open access software And offer appropriate software for internal archival centers

    Directory of Open Access Journals (Sweden)

    Abdolreza Izadi

    2016-12-01

    Full Text Available The purpose of this study is Study of Descriptive Metadata Standards in Archival open source software, to determine the most appropriate descriptive metadata standard (s and also Encoder Software support of these standards. The approach of present study is combination and library methods, Delphi and descriptive survey are used. Data gathering in library study is fiche, in the Delphi method is questionnaire and in descriptive survey is checklist. Statistical population contains 5 Archival open source software. The findings suggest that 5 metadata standards, consist of EAD, ISAD, EAC-CPF, ISAAR & ISDF, diagnosed appropriate by Delphi Panel members as the most appropriate descriptive metadata standards to use for archival software. Moreover, ICA-ATOM and Archivist toolkit in terms of support for standards that were suitable, diagnosed as the most appropriate archival software.

  12. Stakeholder involvement in development and implementation of appropriate emergency preparedness routines in Slovakia

    International Nuclear Information System (INIS)

    Duranova, T.

    2009-01-01

    The presentation presents the process of stakeholder involvement in development and implementation of appropriate emergency preparedness routines in Slovakia in last five years. The presentation gives detailed information on used practices and real process taken place in Slovakia

  13. 27 CFR 70.42 - Returns prepared or executed by appropriate TTB officers.

    Science.gov (United States)

    2010-04-01

    ...) of this section and subscribed by the appropriate TTB officer is prima facie good and sufficient for... PROCEDURE AND ADMINISTRATION Discovery of Liability and Enforcement of Laws General Powers and Duties § 70...

  14. Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Sigurdardottir, N. R.; Nielsen, A. B. S.; Munck, A.

    2015-01-01

    Objective: To compare the appropriateness of antibiotic prescribing for upper respiratory tract infections (URTIs) in two countries with different prevalence of antimicrobial resistance: Denmark and Iceland.Design: A cross-sectional study. Settings and subjects. General practitioners (GPs...

  15. Sensory quality and appropriateness of raw and boiled Jerusalem artichoke tubers (Helianthus tuberosus L.)

    DEFF Research Database (Denmark)

    Bach, Vibe; Kidmose, Ulla; Thybo, Anette

    2013-01-01

    BACKGROUND: The aim of the present study was to investigate the sensory attributes, dry matter and sugar content of five varieties of Jerusalem artichoke tubers and their relation to the appropriateness of the tubers for raw and boiled preparation. RESULTS: Sensory evaluation of raw and boiled...... Jerusalem artichoke tubers was performed by a trained sensory panel and a semi-trained consumer panel of 49 participants, who also evaluated the appropriateness of the tubers for raw and boiled preparation. The appropriateness of raw Jerusalem artichoke tubers was related to Jerusalem artichoke flavour...... attributes can be used as predictors of the appropriateness of Jerusalem artichoke tubers for raw and boiled consumption. Knowledge on the quality of raw and boiled Jerusalem artichoke tubers can be used to inform consumers on the right choice of rawmaterial and thereby increase the consumption...

  16. HANPP Collection: Human Appropriation of Net Primary Productivity (HANPP) by Country and Product

    Data.gov (United States)

    National Aeronautics and Space Administration — The Human Appropriation of Net Primary Productivity (HANPP) by Country and Product portion of the HANPP Collection contains tabular data on carbon-equivalents of...

  17. Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?

    NARCIS (Netherlands)

    Pouwels, K B; Van Kleef, E; Vansteelandt, S; Batra, R; Edgeworth, J D; Smieszek, T; Robotham, J V

    2017-01-01

    BACKGROUND: Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy. AIM: To evaluate these associations while adjusting for potential time-varying

  18. Appropriate passive design approaches for the various climatic regions in South Africa

    CSIR Research Space (South Africa)

    Conradie, Dirk CU

    2013-01-01

    Full Text Available Previous chapters, Maximising the Sun (Conradie, 2011) and SA Climate Zones and Weather Files (Conradie, 2012), gave an introduction of the current South African climatic characteristics. This chapter explores appropriate passive design approaches...

  19. Are We Appropriately Developing Leaders to Fight and Lead in the Future Full Spectrum of Conflict?

    National Research Council Canada - National Science Library

    Pricone, Bob

    2002-01-01

    The thesis of this SRP is to examine whether we are appropriately training and developing our junior leaders to serve and lead in the future full spectrum environment and organizations, both Interim and Objective...

  20. Explicit appropriate basis function method for numerical solution of stiff systems

    International Nuclear Information System (INIS)

    Chen, Wenzhen; Xiao, Hongguang; Li, Haofeng; Chen, Ling

    2015-01-01

    Highlights: • An explicit numerical method called the appropriate basis function method is presented. • The method differs from the power series method for obtaining approximate numerical solutions. • Two cases show the method is fit for linear and nonlinear stiff systems. • The method is very simple and effective for most of differential equation systems. - Abstract: In this paper, an explicit numerical method, called the appropriate basis function method, is presented. The explicit appropriate basis function method differs from the power series method because it employs an appropriate basis function such as the exponential function, or periodic function, other than a polynomial, to obtain approximate numerical solutions. The method is successful and effective for the numerical solution of the first order ordinary differential equations. Two examples are presented to show the ability of the method for dealing with linear and nonlinear systems of differential equations

  1. Midwives' views on of appropriate antenatal counselling for congenital anomaly tests: do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey.

  2. Audience perceptions of candidates' appropriateness as a function of nonverbal behaviors displayed during televised political debates.

    Science.gov (United States)

    Seiter, John S; Weger, Harry

    2005-04-01

    Compared to televised debates using a single-screen format, such debates using a split screen presenting both debaters simultaneously show viewers the nonverbal reactions of each debater's opponent. The authors examined how appropriate or inappropriate such nonverbal behaviors are perceived to be. Students watched one of four versions of a televised debate. One version used a single-screen format, showing only the speaker, whereas the other three versions used a split-screen format in which the speaker's oppodent displayed constant, occasional, or no nonverbal disagreement with the speaker. Students then rated the debaters' appropriateness. Analysis indicated that the opponent was perceived to be less appropriate when he displayed any background disagreement compared to when he did not. The students perceived the speaker as most appropriate when his opponent displayed constant nonverbal disagreement.

  3. Status Report on Nationally Appropriate Mitigation Actions (NAMAs). Mid-year update June 2013

    Energy Technology Data Exchange (ETDEWEB)

    Van Tilburg, X.; Bristow, S. [ECN Policy Studies, Amsterdam (Netherlands); Roeser, F.; Escalante, D.; Fekete, H. [Ecofys, Cologne (Germany)

    2013-06-15

    This mid-year update of the Annual Status Report on Nationally Appropriate Mitigation Actions, last published by Ecofys and ECN in November 2012, highlights recent trends in NAMA development and support and identifies where more progress is needed.

  4. An Empirical Examination of Reverse Auction Appropriateness in B2B Source Selection

    National Research Council Canada - National Science Library

    Hawkins, Timothy G

    2006-01-01

    .... This study relies upon strategic sourcing concepts coupled with theories of competition, goal-setting, and leadership to develop a conceptual model of antecedents to appropriateness of e-RA usage...

  5. Budget estimates, fiscal year 1984/85. Appropriation: salaries and expenses

    International Nuclear Information System (INIS)

    1983-01-01

    This report contains the fiscal year budget justifications to Congress. The budget estimates for salaries and expenses for fiscal year 1984 to 1985 provide for obligations of $466,800,000 to be funded in total by a new appropriation

  6. Guidebook for the Development of a Nationally Appropriate Mitigation Action for Solar Water Heaters

    DEFF Research Database (Denmark)

    Haselip, James Arthur; Lütken, Søren E.; Sharma, Sudhir

    This guidebook provides an introduction to designing government-led interventions to scale up investment in solar water heater (SWH) markets, showing how these interventions can be packaged as Nationally Appropriate Mitigation Actions (NAMAS). Reflecting the changing balance in global greenhouse...... gas emissions, NAMAs embody the principle of common but differentiated responsibilities. In addition to developed countries’ commitments to make quantitative reductions of greenhouse gas emissions, developing countries are invited to contribute with voluntary actions that are ‘nationally appropriate...

  7. Selecting Appropriate Spatial Scale for Mapping Plastic-Mulched Farmland with Satellite Remote Sensing Imagery

    Directory of Open Access Journals (Sweden)

    Hasituya

    2017-03-01

    Full Text Available In recent years, the area of plastic-mulched farmland (PMF has undergone rapid growth and raised remarkable environmental problems. Therefore, mapping the PMF plays a crucial role in agricultural production, environmental protection and resource management. However, appropriate data selection criteria are currently lacking. Thus, this study was carried out in two main plastic-mulching practice regions, Jizhou and Guyuan, to look for an appropriate spatial scale for mapping PMF with remote sensing. The average local variance (ALV function was used to obtain the appropriate spatial scale for mapping PMF based on the GaoFen-1 (GF-1 satellite imagery. Afterwards, in order to validate the effectiveness of the selected method and to interpret the relationship between the appropriate spatial scale derived from the ALV and the spatial scale with the highest classification accuracy, we classified the imagery with varying spatial resolution by the Support Vector Machine (SVM algorithm using the spectral features, textural features and the combined spectral and textural features respectively. The results indicated that the appropriate spatial scales from the ALV lie between 8 m and 20 m for mapping the PMF both in Jizhou and Guyuan. However, there is a proportional relation: the spatial scale with the highest classification accuracy is at the 1/2 location of the appropriate spatial scale generated from the ALV in Jizhou and at the 2/3 location of the appropriate spatial scale generated from the ALV in Guyuan. Therefore, the ALV method for quantitatively selecting the appropriate spatial scale for mapping PMF with remote sensing imagery has theoretical and practical significance.

  8. Esthetic experiences and technology – about the possibilities and potential uses and appropriations of smartphones

    Directory of Open Access Journals (Sweden)

    Graziela Soares Bianchi

    2013-04-01

    Full Text Available This paper brings reflections and noteson the esthetic experiences in communication studies. Are thoughtful and related possibilities and movements in process from the appropriations of mobile platforms, especially smartphone, observed in a particular way, in their uses and appropriations for young users. Based in authors like Kerckhove (2009, Manovich (2001, Winocur (2009, among others, to reflect the communicative experience in the sociocultural context of mobility and interaction.

  9. Department of Defense Research, Development, Test, and Evaluation (RDT and E): Appropriations Structure

    Science.gov (United States)

    2016-12-13

    Research Projects Agency website, accessed December 5, 2016, http://www.darpa.mil/about-us/mission. Appropriations Structure of Defense RDT&E...funding streams. Among the many other factors that may affect the effectiveness of the performance of RDT&E are: organizational structures and...Department of Defense Research, Development, Test, and Evaluation (RDT&E): Appropriations Structure John F. Sargent Jr. Specialist in

  10. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2012-09-19

    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  11. Collaboration, campaigns and champions for appropriate imaging: feedback from the Zagreb workshop.

    Science.gov (United States)

    Remedios, D; Brkljacic, B; Ebdon-Jackson, S; Hierath, M; Sinitsyn, V; Vassileva, J

    2018-04-01

    Leading radiologists and representatives from national radiation protection regulatory authorities and health ministries from 19 countries of the European region worked together with five experts at the workshop on justification and appropriate use of imaging in Zagreb, Croatia, from 26 to 28 October 2017 jointly organised by the IAEA and the European Society of Radiology. The workshop served as a forum to exchange information on challenges and solutions for improving justification and the appropriate use of diagnostic imaging. Common barriers to improving the use of imaging referral guidelines were discussed and the need for increased collaboration identified. Examples of good practices were presented, including use of Clinical Decision Support (CDS) systems to facilitate rapid and good justification decisions. The workshop identified some of the needs of European countries for achieving more appropriate imaging proposing wider use of collaboration, campaigns and champions. • Drivers for appropriate imaging in Europe are similar to those elsewhere globally. • Implementing imaging referral guidelines is the main barrier to more appropriate imaging. • Clinical Decision Support systems (CDS) facilitates good referral practice and justification decisions. • Collaboration, campaigns and champions may improve awareness, appropriateness and audit.

  12. Sensory quality and appropriateness of raw and boiled Jerusalem artichoke tubers (Helianthus tuberosus L.).

    Science.gov (United States)

    Bach, Vibe; Kidmose, Ulla; Thybo, Anette K; Edelenbos, Merete

    2013-03-30

    The aim of the present study was to investigate the sensory attributes, dry matter and sugar content of five varieties of Jerusalem artichoke tubers and their relation to the appropriateness of the tubers for raw and boiled preparation. Sensory evaluation of raw and boiled Jerusalem artichoke tubers was performed by a trained sensory panel and a semi-trained consumer panel of 49 participants, who also evaluated the appropriateness of the tubers for raw and boiled preparation. The appropriateness of raw Jerusalem artichoke tubers was related to Jerusalem artichoke flavour, green nut flavour, sweetness and colour intensity, whereas the appropriateness of boiled tubers was related to celeriac aroma, sweet aroma, sweetness and colour intensity. In both preparations the variety Dwarf stood out from the others by being the least appropriate tuber. A few sensory attributes can be used as predictors of the appropriateness of Jerusalem artichoke tubers for raw and boiled consumption. Knowledge on the quality of raw and boiled Jerusalem artichoke tubers can be used to inform consumers on the right choice of raw material and thereby increase the consumption of the vegetable. © 2012 Society of Chemical Industry.

  13. Investigating the use of appropriation in the writing of a child with autism: A case study.

    Science.gov (United States)

    Maxwell, Jamie; Weill, Christine; Damico, Jack

    This case study investigated how a 10year old child with ASD (Autism Spectrum Disorder), Kameron (pseudonym), utilized appropriation as a writing strategy in the context of group therapy. Using the same questions as Lensmire and Beals (1994) in their study of a typically developing third-grader, written products were collected over the course of one semester and analyzed, along with video, audio, and participant observation data, to consider the following questions: 1) Where did the material come from? 2) What was taken? and 3) How was it used? Analysis of the process of Kameron's writing revealed utilization of appropriation as a strategy for 2 of the 4 written products. Material was appropriated from both adult authored texts performed via read alouds and from topics and values located in the local peer culture. Kameron's appropriation of shared experiences provided substance to initiate and engage in a shared peer culture. Increased engagement in the writing process and fewer off task behaviors were noted when appropriations were evidenced compared to the writing pieces where no appropriation occurred. The results demonstrate the powerful implications of both a process oriented and strength-based approach to writing and greater social awareness than expected in children with ASD. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. STATE BUDGET APPROPRIATION MANAGERS AS THE SUBJECTS OF BUDGET PLANNING IN THE REPUBLIC OF LITHUANIA

    Directory of Open Access Journals (Sweden)

    Bronius Sudavicius

    2017-01-01

    Full Text Available The subject. The article deals with the problem of legal status of the state budget appropriation managers in the process of budget planning in the Republic of Lithuania.The purpose of the article is evaluation of state budget appropriation managers’ role in the process of budget planning in the Republic of Lithuania.The methodology of research is the analysis of the budgetary legislation of the Republic of Lithuania and the scientific literature, using the methods of logical and systematic analysis and other methods of scientific researchMain results, and scope of it’s application. The legal definition and the system of state budget appropriation managers is analyzed in the article. Particular attention is given to the question of role of state budget appropriation managers in the process of budget framework. The role of the Government and Parliament, as well as a special body of management of public finances (in the Republic of Lithuania, the Ministry of Finance – legislative and executive authorities – is emphasized in the scientific literature. But it is often not mentioned what an important place in this process other participants of budgetary relations – state budget appropriation managers – takes. The main participation of state budget appropriation managers in the budget planning process related to the planning of the budget expenditures.Preparation of strategic plans and programmes of budgetary funds by state budget appropriation managers can be considered part of governance activities in general. For budget planning drawn up draft budgets of the programs by state budget appropriation managers is particularly important.Conclusions. The efficiency of the use of state funds depends on the spending of funds, the quality and validity of the developed programmes of activities led by their agencies. State budget appropriation managers are involved, along with other entities, on each stage of the budget planning. They provide the

  15. [Appropriate use of benzodiazepines zolpidem and zopiclone in diseases attended in primary care].

    Science.gov (United States)

    Granados Menéndez, M Isabel; Salinero Fort, Miguel Angel; Palomo Ancillo, Marta; Aliaga Gutiérrez, Laura; García Escalonilla, Carmen; Ortega Orcos, Rebeca

    2006-01-01

    To estimate the proportion of benzodiazepine prescriptions that comply with the guidelines for appropriate prescription. To identify the variables associated with appropriate prescription. Observational, cross-sectional study. Monóvar Health Centre in Area IV, Madrid, Spain. Random sample of 270 active benzodiazepine prescriptions in adult patients from the prescriptions record of the OMI-AP V. 5.0 computer system. The chosen dimensions for appropriate prescription were: a) correct diagnostic indication; b) absence of benzodiazepines with long half-life in the elderly; c) existence of support or monitoring visits; d) overall appropriateness or coexistence of correct diagnostic indications and monitoring visits. Independent variables were recorded in relation to patient, person prescribing and prescription. Diagnostic indication, 75.6%; absence of benzodiazepines with long half-life in the elderly, 79.8%; existence of support visits, 63.3%; overall appropriateness, 53%. Main diagnoses: pure anxiety, 29%; anxiety related to other illness, 18.6%; insomnia, 14.8%; cardiovascular illness, 14.8%; alcohol and drug abuse, 4.5%; osteo-muscular illness, 4.4%; schizophrenia, 4.4%. Most prescribed substances: lorazepam, 27.8%; bromazepam, 23.7%. Average life of prescriptions: 18.58 months. Origins: health centre, 68.5%; out-patient psychiatry, 10%; hospital, 10%. The variable that is most closely associated with overall appropriateness, fitted with the rest of the variables, is out-patient psychiatry prescription (OR, 6.67; 95% CI, 1.92-23.18). The mean duration of the prescriptions infringes all standards. The overall appropriateness or correct coexistence of adequate diagnostic indication with follow-up visits is associated with out-patient Psychiatry prescription.

  16. The Appropriateness of Renal Angioplasty. The ANPARIA Software: A Multidisciplinary Expert Panel Approach

    International Nuclear Information System (INIS)

    Gerbaud, Laurent; Manhes, Geraud; Debourse, Juliette; Gouby, Gerald; Glanddier, Phyllis-Yvonne; Vader, John-Paul; Boyer, Louis; Deteix, Patrice

    2008-01-01

    Percutaneous transluminal renal angioplasty (PTRA) is an invasive technique that is costly and involves the risk of complications and renal failure. The ability of PTRA to reduce the administration of antihypertensive drugs has been demonstrated. A potentially greater benefit, which nevertheless remains to be proven, is the deferral of the need for chronic dialysis. The aim of the study (ANPARIA) was to assess the appropriateness of PTRA to impact on the evolution of renal function. A standardized expert panel method was used to assess the appropriateness of medical treatment alone or medical treatment with revascularization in various clinical situations. The choice of revascularization by either PTRA or surgery was examined for each clinical situation. Analysis was based on a detailed literature review and on systematically elicited expert opinion, which were obtained during a two-round modified Delphi process. The study provides detailed responses on the appropriateness of PTRA for 1848 distinct clinical scenarios. Depending on the major clinical presentation, appropriateness of revascularization varied from 32% to 75% for individual scenarios (overal 48%). Uncertainty as to revascularization was 41% overall. When revascularization was appropriate, PTRA was favored over surgery in 94% of the scenarios, except in certain cases of aortic atheroma where sugery was the preferred choice. Kidney size >7 cm, absence of coexisting disease, acute renal failure, a high degree of stenosis (≥70%), and absence of multiple arteries were identified as predictive variables of favorable appropriateness ratings. Situations such as cardiac failure with pulmonary edema or acute thrombosis of the renal artery were defined as indications for PTRA. This study identified clinical situations in which PTRA or surgery are appropriate for renal artery disease. We built a decision tree which can be used via Internet: the ANPARIA software (http://www

  17. A Decision Aid to Promote Appropriate Colorectal Cancer Screening among Older Adults: A Randomized Controlled Trial.

    Science.gov (United States)

    Lewis, Carmen L; Kistler, Christine E; Dalton, Alexandra F; Morris, Carolyn; Ferrari, Renée; Barclay, Colleen; Brewer, Noel T; Dolor, Rowena; Harris, Russell; Vu, Maihan; Golin, Carol E

    2018-07-01

    Concerns have been raised about both over- and underutilization of colorectal cancer (CRC) screening in older patients and the need to align screening behavior with likelihood of net benefit. The purpose of this study was to test a novel use of a patient decision aid (PtDA) to promote appropriate CRC screening in older adults. A total of 424 patients ages 70 to 84 y who were not up to date with CRC screening participated in a double-blinded randomized controlled trial of a PtDA targeted to older adults making decisions about whether to undergo CRC screening from March 2012 to February 2015. Patients were randomized to a targeted PtDA or an attention control. The PtDA was designed to facilitate individualized decision making-helping patients understand the potential risks, benefits, and uncertainties of CRC screening given advanced age, health state, preferences, and values. Two composite outcomes, appropriate CRC screening behavior 6 mo after the index visit and appropriate screening intent immediately after the visit, were defined as completed screening or intent for patients in good health, discussion about screening with their provider for patients in intermediate health, and no screening or intent for patients in poor health. Health state was determined by age and Charlson Comorbidity Index. Four hundred twelve (97%) and 421 (99%) patients were analyzed for the primary and secondary outcomes, respectively. Appropriate screening behavior at 6 mo was higher in the intervention group (55% v. 45%, P = 0.023) as was appropriate screening intent following the provider visit (61% v. 47%, P = 0.003). The study took place in a single geographic region. The appropriate CRC screening classification system used in this study has not been formally validated. A PtDA for older adults promoted appropriate CRC screening behavior and intent. Clinicaltrials.gov, registration number NCT01575990. https://clinicaltrials.gov/ct2/show/NCT01575990?term=epic-d&rank=1.

  18. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

    Science.gov (United States)

    Bhadra, Arup K.; Altman, Roy; Dasa, Vinod; Myrick, Karen; Rosen, Jeffrey; Vad, Vijay; Vitanzo, Peter; Bruno, Michelle; Kleiner, Hillary; Just, Caryn

    2016-01-01

    Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA. PMID:28618868

  19. Energy and water development appropriations for 1986. Part 7. Hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, Ninety-Ninth Congress, First Session

    International Nuclear Information System (INIS)

    Anon.

    1985-01-01

    Part 7 of the hearing record covers three areas of the DOE appropriations: Atomic Energy Defense activities, power marketing administrations, and departmental administration. Representatives of DOE and the US Army reviewed the nuclear defense mission and activities under the defense and arms control programs. The administrators of the Alaska, Bonneville, Southeastern, Southwestern, and Western Power Administrations and a representative of the Conservation and Renewable Energy division described programs and budget requirements, as well as estimates of power demands for their regions. Administrative personnel described DOE procedures and explained the budget requests. Supporting documentation accompanies the testimony of the 16 witnesses

  20. Cultural Appropriation in Games : A Comparative Study Between Far Cry 3 (2012), Overwatch (2016) and Horizon Zero Dawn (2017)

    OpenAIRE

    Svensson, Tova

    2017-01-01

    This thesis is a comparative study between Far Cry 3 (2012), Overwatch (2016) and Horizon Zero Dawn (2017) to determine how game developers appropriate minority cultures in character design. The character designs are compared to the cultures of origin to determine whether they have been appropriated and to what extent. Far Cry 3 appropriates Maori and Samoan cultures, Horizon Zero Dawn appropriates native American cultures, and Overwatch appropriates both Maori and native American cultures. A...

  1. Discordance between age- and size-based criteria of child passenger restraint appropriateness.

    Science.gov (United States)

    Smiley, Mary L; Bingham, C Raymond; Jacobson, Peter D; Macy, Michelle L

    2018-04-03

    In this study, we sought to accomplish the following objectives: to (1) calculate the percentage of children considered appropriately restrained across 8 criteria of increasing restrictiveness; (2) examine agreement between age- and size-based appropriateness criteria; (3) assess for changes in the percentage of children considered appropriately restrained by the 8 criteria between 2011 (shortly after updates to U.S. guidelines) and 2015. Data from 2 cross-sectional surveys of 928 parents of children younger than 12 years old (n = 591 in 2011, n = 337 in 2015) were analyzed in 2017. Child age, weight, and height were measured at an emergency department visit and used to determine whether the parent-reported child passenger restraint was considered appropriate according to 8 criteria. Age-based criteria were derived from Michigan law and U.S. Weight, height, and size-based criteria were derived from typical restraints available in the United States in 2007 and 2011. The percentage appropriate restraint use was calculated for each criterion. The kappa statistic was used to measure agreement between criteria. Change in appropriateness from 2011 to 2015 was assessed with chi-square statistics. Percentage appropriate restraint use varied from a low of 19% for higher weight limits in 2011 to a high of 91% for Michigan law in 2015. Agreement between criteria was slight to moderate. The lowest kappa was for Michigan law and higher weight limits in 2011 (κ = 0.06) and highest for U.S. guidelines and lower weight limits in 2011 (κ = 0.60). Percentage appropriate restraint use was higher in 2015 than 2011 for the following criteria: U.S. guidelines (74 vs. 58%, P consistency in reporting results from studies of child passenger safety in the United States. Potential explanations for the increased percentage of children considered appropriately restrained between 2011 and 2015 include adoption of the updated U.S. guidelines and the use of child passenger restraints with

  2. Adoption, adaptation, and abandonment: Appropriation of science education professional development learning

    Science.gov (United States)

    Longhurst, Max L.

    Understanding factors that impact teacher utilization of learning from professional development is critical in order maximize the educational and financial investment in teacher professional learning. This study used a multicase mixed quantitative and qualitative methodology to investigate the factors that influence teacher adoption, adaption, or abandonment of learning from science teacher professional development. The theoretical framework of activity theory was identified as a useful way to investigate the phenomenon of teacher appropriation of pedagogical practices from professional development. This framework has the capacity to account for a multitude of elements in the context of a learning experience. In this study educational appropriation is understood through a continuum of how an educator acquires and implements both practical and conceptual aspects of learning from professional development within localized context. The variability associated with instructional changes made from professional development drives this inquiry to search for better understandings of the appropriation of pedagogical practices. Purposeful sampling was used to identify two participants from a group of eighth-grade science teachers engaged in professional development designed to investigate how cyber-enabled technologies might enhance instruction and learning in integrated science classrooms. The data from this investigation add to the literature of appropriation of instructional practices by connecting eight factors that influence conceptual and practical tools with the development of ownership of pedagogical practices in the appropriation hierarchy. Recommendations are shared with professional development developers, providers, and participants in anticipation that future science teaching experiences might be informed by findings from this study.

  3. Culinary preparation of beetroot (Beta vulgaris L.): the impact on sensory quality and appropriateness.

    Science.gov (United States)

    Bach, Vibe; Mikkelsen, Laerke; Kidmose, Ulla; Edelenbos, Merete

    2015-07-01

    Beetroot is a diverse vegetable available in different shapes and colours. The objectives of this study were to evaluate sensory qualities, and sugar and dry matter content of five beetroot varieties in relationship to the appropriateness for raw, boiled and pan-fried preparation. Sensory evaluation by descriptive sensory analysis and consumer tests showed clear distinctions between red varieties Taunus, Rocket and Pablo, and the pink-white striped Chioggia and yellow Burpee's Golden in raw preparations. However, variety delimination was more difficult after boiling and pan-frying. Different sensory qualities were important for beetroot appropriateness in raw, boiled and pan-fried preparations. Appropriateness of raw beetroots was associated with high sensory scores in beetroot flavour, crispness and juiciness, and low scores in bitterness. Appropriateness of boiled beetroots was related to high scores in beetroot and earthy flavours. Pan-fried beetroot appropriateness was associated with high scores in beetroot flavour, colour intensity and crispness. This study showed that the quality of raw materials is integral in culinary preparations. These results can be used to guide consumers in the use of beetroot in culinary preparations and subsequently increase consumption. © 2014 Society of Chemical Industry.

  4. Ethics under uncertainty: the morality and appropriateness of utilitarianism when outcomes are uncertain.

    Science.gov (United States)

    Kortenkamp, Katherine V; Moore, Colleen F

    2014-01-01

    Real-life moral dilemmas inevitably involve uncertainty, yet research has not considered how uncertainty affects utilitarian moral judgments. In addition, even though moral dilemma researchers regularly ask respondents, "What is appropriate?" but interpret it to mean, "What is moral?," little research has examined whether a difference exists between asking these 2 types of questions. In this study, 140 college students read moral dilemmas that contained certain or uncertain consequences and then responded as to whether it was appropriate and whether it was moral to kill 1 to save many (a utilitarian choice). Ratings of the appropriateness and morality of the utilitarian choice were lower under uncertainty than certainty. A follow-up experiment found that these results could not be explained entirely by a change in the expected values of the outcomes or a desire to avoid the worst-case scenario. In addition, the utilitarian choice to kill 1 to save many was rated as more appropriate than moral. The results imply that moral decision making may depend critically on whether uncertainties in outcomes are admitted and whether people are asked about appropriateness or morality.

  5. Crowdfunding as an Alternative Means for Funding Sustainable Appropriate Technology: Acceptance Determinants of Backers

    Directory of Open Access Journals (Sweden)

    Younghwan Moon

    2018-05-01

    Full Text Available The research and development as well as the propagation of sustainable, appropriate technology requires the availability of stable funding. Crowdfunding is a form of funding whereby small sums of investments or contributions are collected from the general public and used to finance the development of goods or services. This method has been widely used in the arts and cultural fields and presents a useful alternative means by which to fund appropriate technology projects. The aim of this study is to identify the factors that influence backers who participate in appropriate technology projects through crowdfunding platforms, analyze the connections among these factors, and thereby establish the usefulness of crowdfunding as a viable new funding alternative. Results indicate that the key factors influencing user intention to crowdfund appropriate technology projects include social influence, effort expectancy, and perceived trust. In comparison to the findings of previous studies, performance expectancy was not found to have a significant effect. When compared to crowdfunding conducted in other fields, these results suggest that crowdfunding for appropriate technology is closer in nature to donations. Accordingly, for funding of these projects to be successful, aggressive online exposure using the social network service (SNS of backers should be pursued from the earliest stages of funding.

  6. Pragmatic awareness of Suggestions: From (ImPolite Mannerism to Attitudinal Appropriateness

    Directory of Open Access Journals (Sweden)

    Hamid Allami

    2017-09-01

    Full Text Available The present research seeks to determine: (a Iranian EFL learners’ application of suggestion semantic formulae ;(b their attitude of appropriateness in terms of confidence in the employment of appropriate supportive moves; (c, their (impolite mannerism with respect to the selected strategies; and (d the relationship between attitude of appropriateness and mannerism of (impoliteness. An Oxford Quick placement Test (OQPT was administered among 60 Iranian EFL learners to check their language proficiency level and to satisfy the assumption of homogeneity among the learners. These participants along with 10 American native speakers then underwent a suggestion DCT. The questionnaire included questions addressing interlocutors’ with higher, lower or equal power status and intimate or strange social distance. The DCT also involved attitudinal appropriateness scale and (impoliteness mannerism likert scale to examine the learners’ degree of confidence and mannerism. Besides similarities and differences in the application of suggestion semantic formulae between the Iranian learners and American speakers, the results revealed variations in the two groups’ performances for appropriateness and (impoliteness. The results also indicated a positive relationship between the attitude and mannerism scales.

  7. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management.

    Science.gov (United States)

    Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L

    2014-01-01

    To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

  8. The appropriateness of health services for adolescents: youth's opinions and attitudes.

    Science.gov (United States)

    Resnick, M; Blum, R W; Hedin, D

    1980-12-01

    Minnesota high school students were surveyed about their attitudes, beliefs, and opinions about health, illness, and medical care. Data were obtained from small group discussions conducted by the adolescents themselves in schools and agencies throughout the state. This paper reports their views toward adolescent medical services. Teenagers emphasized the idea of service appropriateness as central to promoting service utilization. Key to the concept of appropriateness were the components of staff, cost and confidentiality. Each of these dimensions is examined from the view of youth as to implications for increased appropriateness of services for both utilization and improved health. Findings are discussed in terms of differences in problem definition between the adolescent and professional, and their implications for medical care in conventional and alternative settings.

  9. Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia

    DEFF Research Database (Denmark)

    Gradel, Kim O.; Jensen, Ulrich S; Schønheyder, Henrik C.

    2017-01-01

    of bacteraemia patients. Methods: A cohort study including all patients hospitalized with incident bacteraemia during 2007-2008 in the Copenhagen City and County areas and the North Denmark Region. EAT was defined as the antibiotic treatment given at the 1st notification of a positive blood culture...... models. Results: In 6483 eligible patients, 712 (11%) had a recurrent episode. A total of 3778 (58%) patients received appropriate EAT, 1290 (20%) received inappropriate EAT, while EAT status was unrecorded for 1415 (22%) patients. The 2-30 day mortality was 15.1%, 17.4% and 19.2% in patients receiving...... appropriate EAT, inappropriate EAT, and unknown EAT, respectively. Among patients alive on day 30, the 31-365 day mortality was 22.3% in patients given appropriate EAT compared to 30.7% in those given inappropriate EAT. Inappropriate EAT was independently associated with recurrence (HR 1.25; 95% CI = 1...

  10. Appropriate Health Promotion for Australian Aboriginal and Torres Strait Islander Communities

    DEFF Research Database (Denmark)

    Demaio, Alessandro Rhyll; Drysdale, Marlene; de Courten, Maximilian

    2012-01-01

    building, community empowerment and local ownership. Culturally-Appropriate Health Promotion is a framework of principles developed in 2008 with the World Health Organization (Geneva) and Global Alliance for Health Promotion. It guides community-focused health promotion practice built on and shaped...... by the respect, understanding and utilisation of local knowledge and culture. Culturally-Appropriate Health Promotion is not about ‘targeting’, ‘intervening’ or ‘responding’. Rather, it results in health program planners and policy-makers understanding, respecting, empowering and collaborating with communities......, and their socio-cultural environment, towards better health. This commentary aims to examine and apply the 8 principles of Culturally-Appropriate Health Promotion to the Australian Aboriginal and Torres Strait Islander context. It proposes its widespread adoption as a framework for a more respectful...

  11. Is the Appropriateness of Emotions Culture-Dependent? The Relevance of Social Meaning

    Directory of Open Access Journals (Sweden)

    Welpinghus Anna

    2018-02-01

    Full Text Available This paper contributes to the question to what extent the socio-cultural context is relevant for the appropriateness of emotions, while appropriateness of an emotion means that the emotion entails a correct, or adequate, evaluation of its object. In a first step, two adequacy conditions for theories of emotions are developed: the first condition ensures that the socio-cultural context is not neglected: theories must allow for the fact that appropriateness often depends on the social meaning of the emotion’s particular object. The second condition rules out implausible forms of cultural determinism. In a second step, an account that meets both conditions is presented: the Acceptance within Social Context account.

  12. A conceptual review of decision making in social dilemmas: applying a logic of appropriateness.

    Science.gov (United States)

    Weber, J Mark; Kopelman, Shirli; Messick, David M

    2004-01-01

    Despite decades of experimental social dilemma research, "theoretical integration has proven elusive" (Smithson & Foddy, 1999, p. 14). To advance a theory of decision making in social dilemmas, this article provides a conceptual review of the literature that applies a "logic of appropriateness" (March, 1994) framework. The appropriateness framework suggests that people making decisions ask themselves (explicitly or implicitly), "What does a person like me do in a situation like this? " This question identifies 3 significant factors: recognition and classification of the kind of situation encountered, the identity of the individual making the decision, and the application of rules or heuristics in guiding behavioral choice. In contrast with dominant rational choice models, the appropriateness framework proposed accommodates the inherently social nature of social dilemmas, and the role of rule and heuristic based processing. Implications for the interpretation of past findings and the direction of future research are discussed.

  13. Direct-to-consumer advertising of COX-2 inhibitors: effect on appropriateness of prescribing.

    Science.gov (United States)

    Spence, Michele M; Teleki, Stephanie S; Cheetham, T Craig; Schweitzer, Stuart O; Millares, Mirta

    2005-10-01

    Spending on direct-to-consumer advertising (DTCA) of prescription drugs has increased dramatically in the past several years. An unresolved question is whether such advertising leads to inappropriate prescribing. In this study, the authors use survey and administrative data to determine the association of DTCA with the appropriate prescribing of cyclooxygenase-2 (COX-2) inhibitors for 1,382 patients. Treatment with either a COX-2 or a traditional nonsteroidal anti-inflammatory drug (NSAID) was defined as appropriate or not according to three different definitions of gastrointestinal risk. Patients who saw or heard a COX-2 advertisement and asked their physician about the advertised drug were significantly more likely to be prescribed a COX-2 (versus a NSAID, as recommended by evidence-based guidelines) than all other patients. Findings also suggest that some patients may benefit from DTCA. The authors discuss the need for balanced drug information for consumers, increased physician vigilance in prescribing appropriately, and further study of DTCA.

  14. The neural basis of novelty and appropriateness in processing of creative chunk decomposition.

    Science.gov (United States)

    Huang, Furong; Fan, Jin; Luo, Jing

    2015-06-01

    Novelty and appropriateness have been recognized as the fundamental features of creative thinking. However, the brain mechanisms underlying these features remain largely unknown. In this study, we used event-related functional magnetic resonance imaging (fMRI) to dissociate these mechanisms in a revised creative chunk decomposition task in which participants were required to perform different types of chunk decomposition that systematically varied in novelty and appropriateness. We found that novelty processing involved functional areas for procedural memory (caudate), mental rewarding (substantia nigra, SN), and visual-spatial processing, whereas appropriateness processing was mediated by areas for declarative memory (hippocampus), emotional arousal (amygdala), and orthography recognition. These results indicate that non-declarative and declarative memory systems may jointly contribute to the two fundamental features of creative thinking. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Application of Appropriate Use Criteria for Initial Transthoracic Echocardiography in an Academic Outpatient Pediatric Cardiology Program.

    Science.gov (United States)

    Safa, Raya; Aggarwal, Sanjeev; Misra, Amrit; Kobayashi, Daisuke

    2017-08-01

    Transthoracic echocardiography (TTE) is a non-invasive diagnostic modality for children with suspected heart disease. The American College of Cardiology published Appropriate Use Criteria (AUC) for an initial outpatient pediatric TTE in 2014 to promote effective care and improve resource utilization. The objective was to determine the appropriateness of TTE per the published AUC in a single academic pediatric cardiology clinic as a baseline performance quality measure. The echocardiography database was used to identify initial outpatient TTE in children during January-March 2014. TTE indications (appropriate [A], may be appropriate [M], or rarely appropriate [R]) and findings (normal, incidental, or abnormal) were recorded. The effect of AUC and age groups on yield of abnormal TTE findings was analyzed. Of the 2166 screened studies, our study cohort consisted of 247 TTEs. Indications rated A, M, and R were found in 129, 27, and 90, respectively, and 1 was unclassifiable. Majority of TTE (n = 183) were normal, although incidental findings were noted in 32 and abnormal findings in 32 cases. Abnormal findings were noted in 26/129 of A, 2/27 of M, and 4/90 of R. Indications rated A were significantly associated with yield of abnormal TTE findings, adjusted by age group. Infants and adolescents were more likely to have abnormal TTE findings compared to young children. Recently published AUC were validated for initial TTE in the outpatient pediatric cardiology clinic. Appropriateness rated by AUC was highly associated with yield of abnormal TTE findings and worked best in infants and adolescent.

  16. ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Singh-Bhinder, Nimarta; Kim, David H; Holly, Brian P; Johnson, Pamela T; Hanley, Michael; Carucci, Laura R; Cash, Brooks D; Chandra, Ankur; Gage, Kenneth L; Lambert, Drew L; Levy, Angela D; Oliva, Isabel B; Peterson, Christine M; Strax, Richard; Rybicki, Frank J; Dill, Karin E

    2017-05-01

    Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to

  17. A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

    Science.gov (United States)

    Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

    2015-03-01

    Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process

  18. Appropriating A Female Voice: Nicholas Breton And The Countess Of Pembroke

    Directory of Open Access Journals (Sweden)

    DASCĂL REGHINA

    2014-12-01

    Full Text Available The sixteenth century author Nicholas Breton appropriates a female voice in many of his writings, among which Marie Magdalens Loue and The Pilgrimage to Paradise joyned with the Countesse of Penbrookes Loue feature prominently. The Countess of Pembroke, celebrated by Aemilia Lanyer in her Salve Deus Rex Judaeorum as a paragon of female religious devotion, is often associated in Breton's texts with Mary Magdalene. This paper will analyse some of the anxieties engendered by this appropriation of voice and of the Magdalene figure, anxieties that prove to be disruptive of Elizabethan gender hierarchies.

  19. Flowmeters for use in the nuclear industry: How to select the appropriate instrument

    International Nuclear Information System (INIS)

    Hardy, J.E.

    1991-01-01

    Because flow is one of the most common process variables measured, numerous types of flowmeters based on a variety of measurement principles are available. Although these numerous flowmeter types allow one to measure almost any flow, the wide variety also makes selecting an appropriate flowmeter a complex and potentially difficult task. This paper reviews the definition and importance of basic hydraulic principles and the design parameters critical to an accurate flow measurement, the principles used in flow monitoring and their advantages and disadvantages, and a method for selecting an appropriate flowmeter. 6 refs

  20. Activists’ appropriations in social networking websites: the collective action dynamics in #forasarney

    Directory of Open Access Journals (Sweden)

    BATISTA, Jandré Corrêa

    2013-01-01

    Full Text Available This paper aims to study the appropriation of Twitter (twitter.com for activists ends. To this end, we intend to present the analysis of intentionality (Thompson, 2000 of symbolic forms perceived in the appropriations social networking site (Boyd and Elisson, 2006 in case # forasarney. From the Depth Hermeneutics of Thompson (2000, the study interprets five intentions: convocacional, informational, divulgacional, feedback and conversational. The messages were classified by analyzing categorical content analysis of Bardin (2009,interpreted in accordance with its purposes.

  1. Research notes about the ways of appropriation of films by educators in young and adults education

    Directory of Open Access Journals (Sweden)

    Evelyn Fernandes Azevedo Faheina

    2014-01-01

    Full Text Available This paper analyzes the presence of film useage in young and adults education. It shows results of a survey that aimed to know the ways of appropriation of film at school by the educators of adult education. To understand that question, it was analyzed the content of the speech of teachers and observed some teaching practice in which film was used. From the analysis of collected data, it was concluded that educators have appropriated and used film like illus - tration of the curriculum contents and of the subjects studied, cha - racterizing the use of film as an additional and secondary resource in activities of school.

  2. What do preschoolers know about alcohol? Evidence from the electronic Appropriate Beverage Task (eABT)

    NARCIS (Netherlands)

    Kuntsche, E.N.; Mével, l. le; Zucker, R.A.

    2016-01-01

    While much is known about alcohol use in adolescence and beyond, factors leading to such behaviors are rooted much earlier in life. To investigate what preschoolers (aged three to six) know about alcohol and adult alcohol use, we developed an electronic version (eABT) of the Appropriate Beverage

  3. Moving beyond Screen Time: Redefining Developmentally Appropriate Technology Use in Early Childhood Education. Policy Brief

    Science.gov (United States)

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    Conversations about what constitutes "developmentally appropriate" use of technology in early childhood education have, to date, focused largely on a single, blunt measure--screen time--that fails to capture important nuances, such as what type of media a child is accessing and whether technology use is taking place solo or with peers.…

  4. The appropriateness of using various Minkowskian metrics for representing cognitive configurations

    OpenAIRE

    G D Richardson

    1981-01-01

    Cognitive mapping has been a rapidly growing area of research concerned with how cognitive information about environments is represented, interpreted, and used. One area of research has been concerned with what geometry best represents cognitive spatial information. This paper further pursues this topic by examining which of three Minkowskian metrics (city-block, Euclidean, dominance) is most appropriate for representing cognitive configurations.

  5. Using a Relational Models Perspective to Understand Normatively Appropriate Conduct in Ethical Leadership

    NARCIS (Netherlands)

    S.R. Giessner (Steffen); N. van Quaquebeke (Niels)

    2011-01-01

    textabstractTo describe leadership as ethical is largely a perceptional phenomenon informed by beliefs about what is normatively appropriate. Yet there is a remarkable scarcity in the leadership literature regarding how to define what is “normatively appropriate”. To shed light on this issue, we

  6. Information Activities and Appropriation in Teacher Trainees' Digital, Group-Based Learning

    Science.gov (United States)

    Hanell, Fredrik

    2016-01-01

    Introduction: This paper reports results from an ethnographic study of teacher trainees' information activities in digital, group-based learning and their relation to the interplay between use and appropriation of digital tools and the learning environment. Method: The participants in the present study are 249 pre-school teacher trainees in…

  7. Appropriate Educational Means of Dealing with the Phenomenon of Smoking among Zarqa University Students

    Science.gov (United States)

    hatamleh, habes Moh'd; al Khaza'leh, Mohammed Salman

    2016-01-01

    The study aimed to identify the (appropriate educational means of dealing with the phenomenon of smoking among Zarqa University students), and to achieve this goal, the descriptive approach has been used, also used a questionnaire submitted to (800) students of the sample, and a couple of open questions has been submitted to 70 members of the…

  8. Selecting the Most Appropriate Primary Learning Medium for Students with Functional Vision.

    Science.gov (United States)

    Mangold, S.; Mangold, P.

    1989-01-01

    Five considerations for determining the most appropriate learning medium for students with functional vision are: (1) working distance from the page; (2) portability of reading skills; (3) reading rates and accuracy; (4) visual fatigue; and (5) interpretation of assessment results. (Author/DB)

  9. Can Suicide Be Ethical? A Utilitarian Perspective on the Appropriateness of Choosing to Die

    Science.gov (United States)

    Feldman, David B.

    2006-01-01

    In his article in the current issue of Death Studies, "Can Suicide be a Good Death?" David Lester argues that each person should determine whether suicide is appropriate for him or her in relative isolation from the opinions of others. In the present article, I use a utilitarian ethical perspective to critique this assertion. According to…

  10. Rethinking the Modernist Curriculum with Habermas's Concept of Self-Critical Appropriation

    Science.gov (United States)

    Sarid, Ariel

    2017-01-01

    The primary objective of this paper is to discuss the implications of applying Habermas's concept of self-critical appropriation for rethinking the structure of the modernist curriculum, specifically the organization of school subjects and instruction time devoted to each of them. To this end, the paper examines Habermas's differentiation between…

  11. Dress in Choral Evensongs in the Dutch Context : Appropriation and Transformation of Religiosity in the Netherlands

    NARCIS (Netherlands)

    Rijken, Hanna; Hoondert, Martin; Barnard, Marcel

    2017-01-01

    In this article the appropriation of the Anglican choral evensong in the Netherlands, outside the context of the Anglican church, and more specifically the dress in the choral evensong will be investigated in order to gain more insight into religiosity in the Netherlands. The authors will explore

  12. Determining the Appropriateness of Visual Based Activities in the Primary School Books for Low Vision Students

    Science.gov (United States)

    Cakmak, Salih; Yilmaz, Hatice Cansu; Isitan, Hacer Damlanur

    2017-01-01

    The general aim of this research is to try to determine the appropriateness of the visuals in the primary school Turkish workbooks for the students with low visibility in terms of visual design elements. In the realization of the work, the document review method was used. In this study, purposive sampling method was used in the selection of…

  13. 41 CFR 101-39.102-1 - Records, facilities, personnel, and appropriations.

    Science.gov (United States)

    2010-07-01

    ..., TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management Systems § 101-39.102-1 Records, facilities, personnel, and appropriations. (a) If GSA decides to establish a fleet management system, GSA, with the assistance of the...

  14. Factors Influencing Teacher Appropriation of Professional Learning Focused on the Use of Technology in Science Classrooms

    Science.gov (United States)

    Longhurst, Max L.; Jones, Suzanne H.; Campbell, Todd

    2017-01-01

    Understanding factors that impact teacher implementation of learning from professional development is critical in order to maximize the educational and financial investment in teacher professional learning. This multi-case qualitative investigation elucidates factors that influence the appropriation of instructional tools associated with…

  15. Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

    Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine

  16. Department of the Army - The Fiscal Year 2008 Military Personnel, Army Appropriation and the Antideficiency Act

    Science.gov (United States)

    2010-06-22

    of the Army, U.S. Army Audit Agency, Budgeting for the Military Personnel, Army Appropriation, Report No. A-2010-0028- FFM (Jan. 6, 2010); Department...of the Army, U.S. Army Audit Agency, Military Personnel, Army FY 05 Subsistence Charges, Report No. A-2008-0037- FFM (Feb. 12, 2008); Department of

  17. Arab Americans with Disabilities and Their Families: A Culturally Appropriate Approach for Counselors

    Science.gov (United States)

    Al Khateeb, Jamal M.; Al Hadidi, Muna S.; Al Khatib, Amal J.

    2014-01-01

    The authors present a brief introduction to Americans of Arab descent and a brief overview of Arab culture. Then, culturally appropriate counseling considerations related to family, attitudes toward disability, religion, communication, acculturation, help-seeking behaviors, and stereotypes are highlighted. In the last section, the authors provide…

  18. 29 CFR 1608.3 - Circumstances under which voluntary affirmative action is appropriate.

    Science.gov (United States)

    2010-07-01

    ... OPPORTUNITY COMMISSION AFFIRMATIVE ACTION APPROPRIATE UNDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, AS... are circumstances in which the available pool, particularly of qualified minorities and women, for..., which emphasize providing minorities and women with the opportunity, skill, and expericence necessary to...

  19. 76 FR 9694 - Prevailing Rate Systems; Redefinition of the Northeastern Arizona and Colorado Appropriated Fund...

    Science.gov (United States)

    2011-02-22

    ... 3206-AM33 Prevailing Rate Systems; Redefinition of the Northeastern Arizona and Colorado Appropriated... changes are based on recent consensus recommendations of the Federal Prevailing Rate Advisory Committee to... Northeastern Arizona wage area. The Federal Prevailing Rate Advisory Committee (FPRAC), the national labor...

  20. Instructed Concept Appropriation and L2 Pragmatic Development in the Classroom

    Science.gov (United States)

    van Compernolle, Rémi A.; Henery, Ashlie

    2014-01-01

    In this article, we investigate the integration of concept-based pragmatics instruction, grounded in Vygotskian sociocultural psychology, in an intact second-semester French class (n = 13) over the course of an academic term. Our focus is on learners' appropriation of the concepts of self-presentation, social distance, and power with respect…

  1. Kindergarten Teachers' Perspectives on Developmentally Appropriate Practices (DAP): A Study Conducted in Mumbai (India)

    Science.gov (United States)

    Hegde, Archana V.; Cassidy, Deborah J.

    2009-01-01

    A qualitative study examining teachers' beliefs regarding developmentally appropriate practices was conducted in the city of Mumbai, India. Twelve kindergarten teacher's were interviewed for this study, and a constant comparative method was used to analyze the interviews. Six themes were identified within this study. The themes highlighted…

  2. Selecting the most appropriate inferential statistical test for your quantitative research study.

    Science.gov (United States)

    Bettany-Saltikov, Josette; Whittaker, Victoria Jane

    2014-06-01

    To discuss the issues and processes relating to the selection of the most appropriate statistical test. A review of the basic research concepts together with a number of clinical scenarios is used to illustrate this. Quantitative nursing research generally features the use of empirical data which necessitates the selection of both descriptive and statistical tests. Different types of research questions can be answered by different types of research designs, which in turn need to be matched to a specific statistical test(s). Discursive paper. This paper discusses the issues relating to the selection of the most appropriate statistical test and makes some recommendations as to how these might be dealt with. When conducting empirical quantitative studies, a number of key issues need to be considered. Considerations for selecting the most appropriate statistical tests are discussed and flow charts provided to facilitate this process. When nursing clinicians and researchers conduct quantitative research studies, it is crucial that the most appropriate statistical test is selected to enable valid conclusions to be made. © 2013 John Wiley & Sons Ltd.

  3. Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap.

    Science.gov (United States)

    Demaio, Alessandro; Drysdale, Marlene; de Courten, Maximilian

    2012-06-01

    Health promotion for Australian Aboriginal and Torres Strait Islander communities and their people has generally had limited efficacy and poor sustainability. It has largely failed to recognise and appreciate the importance of local cultures and continues to have minimal emphasis on capacity building, community empowerment and local ownership. Culturally Appropriate Health Promotion is a framework of principles developed in 2008 with the World Health Organization and the Global Alliance for Health Promotion. It serves as a guide for community-focused health promotion practice to be built on and shaped by the respect for understanding and utilisation of local knowledge and culture. Culturally Appropriate Health Promotion is not about targeting, intervening or responding. Rather, it encourages health programme planners and policymakers to have a greater understanding, respect, a sense of empowerment and collaboration with communities, and their sociocultural environment to improve health. This commentary aims to examine and apply the eight principles of Culturally Appropriate Health Promotion to the Australian Aboriginal and Torres Strait Islander context. It proposes a widespread adoption of the framework for a more respectful, collaborative, locally suitable and therefore appropriate approach to Australian Aboriginal and Torres Strait Islander health promotion.

  4. The Chief Financial Officer's Perception of Financial Management Response to Eroding State Appropriations

    Science.gov (United States)

    Tate, James Adam

    2012-01-01

    State fiscal support for public higher education is declining, particularly during recessionary periods. Public colleges and universities have limited channels of revenue and depend on state appropriations for current operating needs. There is an imperative now for public institutions to do more with less, be more efficient and effective in order…

  5. Improving appropriateness of antibiotic prescribing for lower respiratory tract infections. The physician's decision

    NARCIS (Netherlands)

    Engel, M.F.

    2013-01-01

    Stud­ies suggest that increasing appropriate use of antimicrobials leads to a reduced pressure on the development of antimicrobial resistance. In this thesis we evaluated several different strategies with the aim to improve the quality of antibiotic prescribing for community-acquired pneumonia

  6. Exploring Elementary Teachers' Perceptions about the Developmental Appropriateness and Importance of Nature of Science Aspects

    Science.gov (United States)

    Sahin, Elif Adibelli; Deniz, Hasan

    2016-01-01

    This study explored how four elementary teachers assessed the developmental appropriateness and importance of nine nature of science (NOS) aspects after participating in a yearlong professional development program. A multiple-embedded case study design was employed. The primary data sources included (a) Views of Nature of Science Elementary School…

  7. 6 CFR 5.44 - Testimony and production of documents prohibited unless approved by appropriate Department...

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Testimony and production of documents prohibited... in Litigation § 5.44 Testimony and production of documents prohibited unless approved by appropriate... or request, including in connection with any litigation, provide oral or written testimony by...

  8. Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach.

    Science.gov (United States)

    Callahan, Michael J; Talmadge, Jennifer M; MacDougall, Robert D; Kleinman, Patricia L; Taylor, George A; Buonomo, Carlo

    2017-04-01

    In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.

  9. Perceptions and Beliefs about Textual Appropriation and Source Use in Second Language Writing

    Science.gov (United States)

    Polio, Charlene; Shi, Ling

    2012-01-01

    Perceptions and judgments on plagiarism or acceptable use of source texts are contingent on one's interpretations and experiences in reading and writing academic texts in a specific disciplinary context. The lack of consensus on what is acceptable textual appropriation in student writing has led to the scholarship on perceptions of textual…

  10. Geometric mean IELT and premature ejaculation: appropriate statistics to avoid overestimation of treatment efficacy

    NARCIS (Netherlands)

    Waldinger, Marcel D.; Zwinderman, Aeilko H.; Olivier, Berend; Schweitzer, Dave H.

    2008-01-01

    INTRODUCTION: The intravaginal ejaculation latency time (IELT) behaves in a skewed manner and needs the appropriate statistics for correct interpretation of treatment results. AIMS: To explain the rightful use of geometrical mean IELT values and the fold increase of the geometric mean IELT because

  11. the extent to which the Chemistry textbook of grade 11 is appropriate

    African Journals Online (AJOL)

    unesco

    grade 11 in Ethiopian schools is appropriate for learner-centered approach. ... Romey (3) developed the students involvement index of texts presentation for grades 7- ... texts of science textbooks by using that involvement index (4). .... under 'passive involvement of learners 'i.e., lower order thinking and the rest two levels:.

  12. Affordances for Participation: Children's Appropriation of Rules in a Reggio Emilia School

    Science.gov (United States)

    Martin, Cathrin; Evaldsson, Ann-Carita

    2012-01-01

    This study explores how young children appropriate school rules and what opportunities for active participation are afforded in a Reggio Emilia elementary classroom with particular interest in the interactional and communicative competences children display in situated practice. An ethnographic and microanalytic approach is used to study how the…

  13. Social Studies, Social Competence and Citizenship in Early Childhood Education: Developmental Principles Guide Appropriate Practice

    Science.gov (United States)

    Kemple, Kristen M.

    2017-01-01

    The purpose of this article is to examine the nature of appropriate social studies education in the Kindergarten and Pre-Kindergarten years. The importance of social competence development as a basic foundation of the social studies in the early years of schooling is examined, with particular attention to the commonalities shared between goals and…

  14. 44 CFR 11.11 - Administrative claim; when presented; appropriate FEMA office.

    Science.gov (United States)

    2010-10-01

    ... Federal Tort Claims Act § 11.11 Administrative claim; when presented; appropriate FEMA office. (a) For the purpose of this part, and the provisions of the Federal Tort Claims Act a claim is deemed to have been... Administrator of the FEMA Regional Office in which is employed the FEMA employee whose negligence or wrongful...

  15. Social models provide a norm of appropriate food intake for young women.

    Directory of Open Access Journals (Sweden)

    Lenny R Vartanian

    Full Text Available It is often assumed that social models influence people's eating behavior by providing a norm of appropriate food intake, but this hypothesis has not been directly tested. In three experiments, female participants were exposed to a low-intake model, a high-intake model, or no model (control condition. Experiments 1 and 2 used a remote-confederate manipulation and were conducted in the context of a cookie taste test. Experiment 3 used a live confederate and was conducted in the context of a task during which participants were given incidental access to food. Participants also rated the extent to which their food intake was influenced by a variety of factors (e.g., hunger, taste, how much others ate. In all three experiments, participants in the low-intake conditions ate less than did participants in the high-intake conditions, and also reported a lower perceived norm of appropriate intake. Furthermore, perceived norms of appropriate intake mediated the effects of the social model on participants' food intake. Despite the observed effects of the social models, participants were much more likely to indicate that their food intake was influenced by taste and hunger than by the behavior of the social models. Thus, social models appear to influence food intake by providing a norm of appropriate eating behavior, but people may be unaware of the influence of a social model on their behavior.

  16. Using Teacher Praise and Opportunities to Respond to Promote Appropriate Student Behavior

    Science.gov (United States)

    Moore Partin, Tara C.; Robertson, Rachel E.; Maggin, Daniel M.; Oliver, Regina M.; Wehby, Joseph H.

    2010-01-01

    Teachers' successful provision of levels of support to prevent and reduce problem classroom behaviors requires skillful application of research-based classroom and behavior management strategies. Among others, 2 teacher-centered strategies have been shown to decrease students' inappropriate behaviors and increase their appropriate behaviors: the…

  17. Teaching Appropriate Play to Replace Stereotypy Using a Treatment Package with Students Having Autism

    Science.gov (United States)

    Greenberg, Jeremy H.; Lau, Wendy; Lau, Sandy

    2016-01-01

    Students with special education needs such as autism tend to have difficulty with appropriate play skills and leisure time skills. A lack of play may lead to inappropriate behaviors such as stereotypy or passivity. When students have a limited community of reinforcers it may be difficult for educators to find motivators that can be used to teach…

  18. Extreme daily precipitation in Western Europe with climate change at appropriate spatial scales

    NARCIS (Netherlands)

    Booij, Martijn J.

    2002-01-01

    Extreme daily precipitation for the current and changed climate at appropriate spatial scales is assessed. This is done in the context of the impact of climate change on flooding in the river Meuse in Western Europe. The objective is achieved by determining and comparing extreme precipitation from

  19. Passport to Digital Citizenship: Journey toward Appropriate Technology Use at School and at Home

    Science.gov (United States)

    Ribble, Mike

    2009-01-01

    Technology has changed people's lives. In fewer than 30 years, people have gone from barely hearing about cell phones, laptops, and MP3 players to almost not being able to live without them. Digital citizenship describes the norms of appropriate, responsible behavior with regard to technology use. In this article, the author presents nine elements…

  20. Narrative self-appropriation: embodiment, alienness, and personal responsibility in the context of borderline personality disorder.

    Science.gov (United States)

    Køster, Allan

    2017-12-01

    It is often emphasised that persons diagnosed with borderline personality disorder (BPD) show difficulties in understanding their own psychological states. In this article, I argue that from a phenomenological perspective, BPD can be understood as an existential modality in which the embodied self is profoundly saturated by an alienness regarding the person's own affects and responses. However, the balance of familiarity and alienness is not static, but can be cultivated through, e.g., psychotherapy. Following this line of thought, I present the idea that narrativising experiences can play an important role in processes of appropriating such embodied self-alienness. Importantly, the notion of narrative used is that of a scalar conception of narrativity as a variable quality of experience that comes in degrees. From this perspective, narrative appropriation is a process of gradually attributing the quality of narrativity to experiences, thereby familiarising the moods, affects, and responses that otherwise govern 'from behind'. Finally, I propose that the idea of a narrative appropriation of embodied self-alienness is also relevant to the much-debated question of personal responsibility in BPD, particularly as this question plays out in psychotherapeutic contexts where a narrative self-appropriation may facilitate an increase in sense of autonomy and reduce emotions of guilt and shame.

  1. Teaching Young Children about the Civil Rights Movement: Applying Effective & Developmentally Appropriate Strategies

    Science.gov (United States)

    Foster, Janet E.; Root, Tonja L.; Lee, Seungyoun

    2015-01-01

    Considering the importance of the Civil Rights Movement, children need to be introduced to the related concepts early in their school experiences, and teachers need to consider students' developmental needs and curriculum standards in order to provide appropriate content and methods of instruction. The purpose of this article is to introduce a…

  2. The Right to Appropriate and Meaningful Education for Children with ASD

    Science.gov (United States)

    Marshall, David; Goodall, Craig

    2015-01-01

    This paper will explore from a "child's rights perspective" the "right" of children with autistic spectrum disorder (ASD) to appropriate and meaningful education. Human "rights" principles within international law will be evaluated in relation to how they have been interpreted and applied in relation to achieving this…

  3. How Building Principals Made Sense of Free and Appropriate Public Education in the Least Restrictive Environment

    Science.gov (United States)

    Sumbera, Meagan J.; Pazey, Barbara L.; Lashley, Carl

    2014-01-01

    Confusion among school leaders regarding how to interpret and implement special education legislation, and specific federal and state policies and mandates such as a free and appropriate public education (FAPE), in the least restrictive environment (LRE) at the school-site level has existed since the 1970s and continues to exist. This…

  4. Amy and Drew: Two Children Who Helped Determine What Free Appropriate Public Education Means

    Science.gov (United States)

    Hammel, Alice M.

    2018-01-01

    Two Supreme Court cases have served to frame our legal rights and responsibilities regarding a Free Appropriate Public Education for students in our music classrooms and ensembles. This article serves as record of the two cases and their merits, according to the Supreme Court, as well as the actions recommended based on the court decisions.

  5. How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

    NARCIS (Netherlands)

    Janssen, Jolien; Koekkoek, Paula S.; Moll van Charante, Eric P.; Jaap Kappelle, L.; Biessels, Geert Jan; Rutten, Guy E. H. M.

    2017-01-01

    Background: Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive

  6. Using Video Modeling to Teach Young Children with Autism Developmentally Appropriate Play and Connected Speech

    Science.gov (United States)

    Scheflen, Sarah Clifford; Freeman, Stephanny F. N.; Paparella, Tanya

    2012-01-01

    Four children with autism were taught play skills through the use of video modeling. Video instruction was used to model play and appropriate language through a developmental sequence of play levels integrated with language techniques. Results showed that children with autism could successfully use video modeling to learn how to play appropriately…

  7. Appropriate Choice of Plate for the Posterior Malleolus: Computed Tomography Study of 122 Chinese Adult Patients

    Directory of Open Access Journals (Sweden)

    Li Churk-Hang Charles

    2017-12-01

    Conclusion: Our study demonstrated the importance of understanding the anatomy of the PM for safe and effective plating of PM fractures. It provided estimations for appropriate width of plate and the method to evaluate the correctness by comparing with the width of the tibia.

  8. Innovation, systemic appropriation and prevention in the granite mining sector: The case of humidification.

    Science.gov (United States)

    Mendes, R W B; Pueyo, V; Béguin, P; Duarte, F J C M

    2017-01-01

    This research was conducted in the Brazilian granite mining sector. After epidemiological studies, it was established that professional pneumoconiosis is related to the inhalation of dust. Therefore, the Brazilian mining health and safety regulatory standard made it compulsory to provide humidification throughout the extraction and mineral treatment processes. To develop the concept of systemic appropriation of the technological innovations that aim to protect the worker's health. Until now, appropriation has usually been presented in its individual dimensions. In this article, the focus is placed on the collective and organizational aspects of this appropriation. Two methodological approaches were used: interviews with the different individuals involved in order to report the history of the implementation of technical devices which meet the humidification norm; and ergonomic analysis of the work of the operators who used these devices. The appropriation of the technical devices occurred at two distinct levels: 1) Individual, related to the direct contact of the operator with the instrument; 2) Systemic, as the effects of the innovation propagated through the system affecting interdependent tasks, adaptation of the work organization and new production strategies. The implementation of prevention norms require innovations which are necessarily accompanied by transformations in the companies' techniques, work and management.

  9. 26 CFR 1.42-8 - Election of appropriate percentage month.

    Science.gov (United States)

    2010-04-01

    ... Section 1.42-8 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-8 Election of appropriate percentage month. (a) Election under section... previously placed in service under section 42(e). (5) Amount allocated. The housing credit dollar amount...

  10. The Association between Preschool Teachers' Beliefs and Practices about Developmentally Appropriate Practices

    Science.gov (United States)

    Mohamed, Ahmed Hassan Hemdan; Al-Qaryouti, Ibrahim Amin

    2016-01-01

    The purpose of this study was to explore whether preschool teachers' self-reported beliefs could predict their self-reported practices about developmentally appropriate practices (DAP). A related purpose was to examine whether classroom size and teachers' experience are significant predictors of their self-reported beliefs and practices. A total…

  11. Beyond Polar Descriptions of Developmentally Appropriate Practice: A Reply to Bredekamp.

    Science.gov (United States)

    Fowell, Nancy; Lawton, Joseph

    1993-01-01

    Addresses four concerns raised by Bredekamp in her commentary on an earlier article by Fowell and Lawton. The earlier article proposed an alternative view of developmentally appropriate practices to that expressed in a position paper of the National Association for the Education of Young Children. (BB)

  12. Youth as Design Partners: Age-Appropriate Websites for Middle and High School Students

    Science.gov (United States)

    Chow, Anthony S.; Smith, Kathelene McCarty; Sun, Katherine

    2012-01-01

    This study explored the impact of using best practices identified in previous studies in designing age-appropriate websites for middle and high school youth. Utilizing a mixed-method approach, 31 middle and 22 high school youth took part in six focus groups across four states. Participants were introduced to a website specifically designed for…

  13. Wiffle Ball: Turning a Backyard Favorite into an Appropriate Physical Education Unit

    Science.gov (United States)

    Layne, Todd E.

    2017-01-01

    Wiffle ball is a game that has been played for many years (Santora, 2003). Unfortunately, implementation in physical education has been inconsistent at best. The sport education model outlined in this article provides an appropriate method for teaching skills associated with wiffle ball for a variety of ages. Students can develop appropriate…

  14. On Iranian EFL Learners' Pragmatic Competence and Appropriate Use of "Request" in English Contexts

    Science.gov (United States)

    Aliakbari, Mohammad; Gheitasi, Mojtaba

    2014-01-01

    This paper investigated the extent to which Iranian EFL students are aware of the appropriate use of request speech act in English speaking contexts in terms of formality, politeness and indirectness. A researcher made discourse completion test (DCT) including 16 scenarios was distributed among 130 advanced students in private English institutes…

  15. The Making of Practical Optics : Mathematical Practitioners’ Appropriation of Optical Knowledge between Theory and Practice

    NARCIS (Netherlands)

    Dupré, S.; Cormack, L.B.; Walton, S.A.; Schuster, J.A.

    2017-01-01

    The discussion of the differing practices of mathematical practitioners’ appropriation of the optical tradition in this essay brings out a variety among mathematical practitioners and within the tradition of practical mathematics. This diversity is difficult to grasp in accounts of practical

  16. Japanese Nursery and Kindergarten Teachers' Beliefs and Practices Regarding Developmentally Appropriate Practices

    Science.gov (United States)

    Hegde, Archana V.; Sugita, Chisato; Crane-Mitchell, Linda; Averett, Paige

    2014-01-01

    This study explored Japanese day nursery and kindergarten teachers' beliefs and practices regarding developmentally appropriate practices. Data were collected using in-depth interviews. Teacher interviews provided insights into the merger of the childcare and education systems of Japan. Six themes emerged from the analysis of the day nursery and…

  17. Giants in the Nursery: A Biographical History of Developmentally Appropriate Practice

    Science.gov (United States)

    Elkind, David

    2015-01-01

    "Giants in the Nursery" examines the evolution of developmentally appropriate practice in this biographical history of early childhood education. This book, from David Elkind, explores the theory's progression--from its beginnings in writings of sixteenth- and seventeenth-century philosophers, its experimental implementation by…

  18. Catching Fish and Avoiding Sharks: Investigating Factors That Influence Developmentally Appropriate Measurement of Preschoolers' Inhibitory Control

    Science.gov (United States)

    Howard, Steven J.; Okely, Anthony D.

    2015-01-01

    Although researchers agree that the first 5 years of life are critical for children's developing executive functions (EFs), further advances are hindered by a lack of consensus on the design and selection of developmentally appropriate EF tasks for young children. Given this debate, well-established adult measures of EF routinely have been adapted…

  19. Identification of appropriate low flow forecast model for the Meuse River.

    NARCIS (Netherlands)

    Demirel, M.C.; Booij, Martijn J.; Cluckie, Ian; Chen, Yangbo; Babovic, Vladan; Konikow, Lenny; Mynett, Arthur; Demuth, Siegfried; Savic, Dragan A.

    2009-01-01

    This study investigates the selection of an appropriate low flow forecast model for the Meuse River based on the comparison of output uncertainties of different models. For this purpose, three data driven models have been developed for the Meuse River: a multivariate ARMAX model, a linear regression

  20. The Role of Environmental Hazard in Mothers' Beliefs about Appropriate Supervision

    Science.gov (United States)

    Damashek, Amy; Borduin, Charles; Ronis, Scott

    2014-01-01

    Understanding factors that influence mothers' beliefs about appropriate levels of supervision for their children may assist in efforts to reduce child injury rates. This study examined the interaction of child (i.e. age, gender, and injury risk behavior) and maternal perception of environmental hazard (i.e. hazard level, injury likelihood,…

  1. 5 CFR 532.211 - Criteria for establishing appropriated fund wage areas.

    Science.gov (United States)

    2010-01-01

    ... minimum of 100 wage employees of one agency subject to the regular schedule and the agency involved... rates in each of the potential survey areas. (e) Appropriated fund wage and survey area definitions are... fund wage areas. 532.211 Section 532.211 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL...

  2. Implementation of an antibiotic checklist increased appropriate antibiotic use in the hospital on Aruba

    NARCIS (Netherlands)

    van Daalen, Frederike Vera; Lagerburg, Anouk; de Kort, Jaclyn; Sànchez Rivas, Elena; Geerlings, Suzanne Eugenie

    2017-01-01

    No interventions have yet been implemented to improve antibiotic use on Aruba. In the Netherlands, the introduction of an antibiotic checklist resulted in more appropriate antibiotic use in nine hospitals. The aim of this study was to introduce the antibiotic checklist on Aruba, test its

  3. Do Social Factors Predict Appropriate Treatment of Child Diarrheal Disease in Peru?

    Science.gov (United States)

    Volpicelli, Kathryn; Buttenheim, Alison M

    2016-11-01

    Objectives Diarrheal disease is a significant cause of morbidity among children in Peru. Oral rehydration therapy (ORT) is a cost-effective evidence-based approach to treat diarrhea in young children, yet many Peruvian children in poorer households do not receive this life-saving treatment. This study investigates the social determinants of care-seeking behavior and utilization of appropriate home treatment for diarrheal episodes. Methods We used the nationally-representative 2008 Peru Demographic and Health Survey to: (1) describe the burden of non-bloody diarrheal disease among children <5 years old; and (2) identify socioeconomic correlates of care-seeking behavior and utilization/appropriateness of treatment among mothers of children with recent non-bloody diarrheal episodes (N = 1365). For the former, we reported descriptive statistics; for the latter, we utilized logistic regression to generate odds ratios. Results 2-week period prevalence of diarrheal disease was almost twice as high among poor (17 %) compared with wealthier (10 %) children, higher among children aged 12-23 months old (22 %), and higher among children from households that do not have an improved source of drinking water (16 %) compared with those that have an improved source (12 %). Interestingly, rural residence was a significant predictor of seeking care for diarrhea. Furthermore, although widely available, few mothers (15 %) used appropriate treatment for a recent diarrheal episode. Water source, mother's education, and wealth were significant predictors of appropriate home treatment. Conclusions Mothers in rural areas-typically with less access to care-were more likely to seek care for diarrheal disease in their children, even when adjusting for other variables. However, this increase in care seeking behavior did not extend to appropriate home treatment. Innovative behavior change strategies to reduce barriers to access and appropriate home treatment for diarrheal disease are

  4. Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

    Science.gov (United States)

    Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

    2017-08-31

    The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

  5. Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?

    Science.gov (United States)

    Pouwels, K B; Van Kleef, E; Vansteelandt, S; Batra, R; Edgeworth, J D; Smieszek, T; Robotham, J V

    2017-05-01

    Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy. To evaluate these associations while adjusting for potential time-varying confounding using methods from the causal inference literature. Patients who stayed more than two days in two general ICUs in England between 2002 and 2006 were included in this cohort study. Marginal structural models with inverse probability weighting were used to estimate the mortality and discharge associated with Enterobacteriaceae bacteraemia and the impact of appropriate empiric antibiotic therapy on these outcomes. Among 3411 ICU admissions, 195 (5.7%) ICU-acquired Enterobacteriaceae bacteraemia cases occurred. Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU death [cause-specific hazard ratio (HR): 1.48; 95% confidence interval (CI): 1.10-1.99] and a reduced daily risk of ICU discharge (HR: 0.66; 95% CI: 0.54-0.80). Appropriate empiric antibiotic therapy did not significantly modify ICU mortality (HR: 1.08; 95% CI: 0.59-1.97) or discharge (HR: 0.91; 95% CI: 0.63-1.32). ICU-acquired Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU mortality. Furthermore, the daily discharge rate was also lower after acquiring infection, even when adjusting for time-varying confounding using appropriate methodology. No evidence was found for a beneficial modifying effect of appropriate empiric antibiotic therapy on ICU mortality and discharge. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  6. An Evaluation of Industry Relationships Among Contributors to AAOS Clinical Practice Guidelines and Appropriate Use Criteria.

    Science.gov (United States)

    Checketts, Jake X; Cook, Courtney; Vassar, Matt

    2018-01-17

    A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development. We retrieved clinical practice guidelines and their corresponding appropriate use criteria from the American Academy of Orthopaedic Surgery that were published or revised between 2013 and 2016. We extracted industry payments received by physicians using the Centers for Medicare & Medicaid Services Open Payments database. We then evaluated the value and types of these payments. We also used these data to determine whether disclosure statements were accurate and whether guideline development was in adherence with the Institute of Medicine's (IOM's) standards. Of the 106 physicians that were evaluated, 85 (80%) received at least 1 industry payment, 56 (53%) accepted >$1,000, and 35 (33%) accepted >$10,000. Financial payments amounted to a mean of $93,512 per physician. Total reimbursement for the 85 clinical practice guideline and appropriate use criteria contributors was $9,912,309. We found that disclosure statements disagreed with the Open Payments data and that the IOM standards were not completely enforced. Clinical practice guideline and appropriate use criteria contributors received substantial payments from industry, many disclosure statements were inaccurate, and the IOM standards were not completely met. Clinical practice guidelines and appropriate use criteria are critical for practicing evidence-based medicine. If financial conflicts of interest are present during their development, it is possible that patient care may be compromised.

  7. [Classification and monitoring of the appropriateness of emergency admissions in a tertiary hospital].

    Science.gov (United States)

    López-Picazo Ferrer, J J; Tomás García, N; Cubillana Herrero, J D; Gómez Company, J A; de Dios Cánovas García, J

    2014-01-01

    To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements. A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated. There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours. AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  8. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    Directory of Open Access Journals (Sweden)

    Hanna T

    2014-03-01

    Full Text Available Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG by three expert researchers. Results: In seven of nine scenarios (78%, the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency in the majority of scenarios. Due to this, only 47% (76/162 of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162 of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

  9. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    Science.gov (United States)

    Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

    Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

  10. Direct costs associated with the appropriateness of hospital stay in elderly population

    Directory of Open Access Journals (Sweden)

    Sánchez-García Sergio

    2009-08-01

    Full Text Available Abstract Background Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. Methods Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP. Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS, in Mexico City. Results The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8 of hospital stay, of which 12.4% (n = 90 were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7. The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89. The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4, while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3, (p Conclusion Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

  11. The characteristics and prognosis of patients fulfilling the Appropriateness Evaluation Protocol in a medical admission unit; a prospective observational study

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Knudsen, Torben; Hallas, Jesper

    2011-01-01

    To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria.......To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria....

  12. Value of Serial Heart Rate Variability Measurement for Prediction of Appropriate ICD Discharge in Patients with Heart Failure

    NARCIS (Netherlands)

    ten Sande, Judith N.; Damman, Peter; Tijssen, Jan G. P.; de Groot, Joris R.; Knops, Reinoud E.; Wilde, Arthur A. M.; van Dessel, Pascal F. H. M.

    2014-01-01

    HRV and Appropriate ICD Shock in Heart Failure Introduction Decreased heart rate variability (HRV) is associated with adverse outcomes in patients with heart failure. Our objective was to examine whether decreased HRV predicts appropriate implantable cardioverter defibrillator (ICD) shocks. Methods

  13. What is the evidence status of Appropriate Use Criteria (AUC)? Insight from a matching exercise with the guidelines for echocardiography.

    Science.gov (United States)

    Fonseca, R; Negishi, K; Marwick, T H

    2015-08-01

    There is interest in adapting the American Appropriate Use Criteria (AUC) for transthoracic echocardiography to Australian practice. We matched 90 of 98 AUC with the guidelines (53 appropriate, 12 sometimes appropriate, 25 rarely appropriate), but eight lacked any match. Among the matched criteria, 76 (82%) indications were concordant with the guidelines. A stronger evidence base would be desirable to settle these discrepancies before Australian adoption of AUC. © 2015 Royal Australasian College of Physicians.

  14. Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

    Science.gov (United States)

    Vilar-Palop, Jorge; Hernandez-Aguado, Ildefonso; Pastor-Valero, María; Vilar, José; González-Alvarez, Isabel; Lumbreras, Blanca

    2018-01-01

    Objectives To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. Design Cross-sectional retrospective study. Setting Two Spanish public tertiary hospitals. Participants 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. Primary and secondary outcome measures Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. Results Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. Conclusion There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on

  15. Comparing appropriateness and equivalence of email interviews to phone interviews in qualitative research on reproductive decisions.

    Science.gov (United States)

    Hershberger, Patricia E; Kavanaugh, Karen

    2017-10-01

    Despite an increasing use of qualitative email interviews by nurse researchers, there is little understanding about the appropriateness and equivalence of email interviews to other qualitative data collection methods, especially on sensitive topics research. The purpose is to describe our procedures for completing asynchronous, email interviews and to evaluate the appropriateness and equivalency of email interviews to phone interviews in two qualitative research studies that examined reproductive decisions. Content analysis guided the methodological appraisal of appropriateness and equivalency of in-depth, asynchronous email interviews to single phone interviews. Appropriateness was determined by: (a) participants' willingness to engage in email or phone interviews, (b) completing data collection in a timely period, and (c) participants' satisfaction with the interview. Equivalency was evaluated by: (a) completeness of the interview data, and (b) insight obtained from the data. Of the combined sample in the two studies (N=71), 31% of participants chose to participate via an email interview over a phone interview. The time needed to complete the email interviews averaged 27 to 28days and the number of investigator probe-participant response interchanges was 4 to 5cycles on average. In contrast, the phone interviews averaged 59 to 61min in duration. Most participants in both the email and phone interviews reported they were satisfied or very satisfied with their ability to express their true feelings throughout the interview. Regarding equivalence, 100% of the email and phone interviews provided insight into decision processes. Although insightful, two of the email and one phone interview had short answers or, at times, underdeveloped responses. Participants' quotes and behaviors cited within four published articles, a novel evaluation of equivalency, revealed that 20% to 37.5% of the citations about decision processes were from email participants, which is

  16. Predicting Appropriate Admission of Bronchiolitis Patients in the Emergency Department: Rationale and Methods.

    Science.gov (United States)

    Luo, Gang; Stone, Bryan L; Johnson, Michael D; Nkoy, Flory L

    2016-03-07

    In young children, bronchiolitis is the most common illness resulting in hospitalization. For children less than age 2, bronchiolitis incurs an annual total inpatient cost of $1.73 billion. Each year in the United States, 287,000 emergency department (ED) visits occur because of bronchiolitis, with a hospital admission rate of 32%-40%. Due to a lack of evidence and objective criteria for managing bronchiolitis, ED disposition decisions (hospital admission or discharge to home) are often made subjectively, resulting in significant practice variation. Studies reviewing admission need suggest that up to 29% of admissions from the ED are unnecessary. About 6% of ED discharges for bronchiolitis result in ED returns with admission. These inappropriate dispositions waste limited health care resources, increase patient and parental distress, expose patients to iatrogenic risks, and worsen outcomes. Existing clinical guidelines for bronchiolitis offer limited improvement in patient outcomes. Methodological shortcomings include that the guidelines provide no specific thresholds for ED decisions to admit or to discharge, have an insufficient level of detail, and do not account for differences in patient and illness characteristics including co-morbidities. Predictive models are frequently used to complement clinical guidelines, reduce practice variation, and improve clinicians' decision making. Used in real time, predictive models can present objective criteria supported by historical data for an individualized disease management plan and guide admission decisions. However, existing predictive models for ED patients with bronchiolitis have limitations, including low accuracy and the assumption that the actual ED disposition decision was appropriate. To date, no operational definition of appropriate admission exists. No model has been built based on appropriate admissions, which include both actual admissions that were necessary and actual ED discharges that were unsafe. The

  17. Evaluation of the appropriateness of imipenem/cilastatin prescription and dosing in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kabbara WK

    2015-03-01

    Full Text Available Wissam K Kabbara, George T Nawas, Wijdan H RamadanDepartment of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon Background: Imipenem/cilastatin is an antibacterial agent of the carbapenem class of β-lactams that is known to have an extremely wide spectrum of activity against Gram-positive, Gram-negative, aerobic, anaerobic, and even multidrug-resistant strains. The objective of this study was to evaluate the appropriate use of imipenem/cilastatin in a local tertiary care hospital. The study assessed the indication both empirically and after the culture results were available, the dose and dose adjustment in renal failure, as well as the incidence of seizure in hospitalized patients receiving imipenem/cilastatin. Methods: This observational study was conducted in a tertiary care hospital over a 3-month period. The treatment of 100 patients with imipenem/cilastatin was evaluated both empirically and after culture results were available. Analysis of the appropriateness of imipenem/cilastatin indication, dose, and monitoring of seizure frequency was based on the package insert, updated published guidelines, and clinical judgment. Results: Patients from internal medicine and intensive care units comprised approximately 50% of the population in the study. The patients received imipenem/cilastatin mainly for urinary tract infections (27% or for sepsis of an unknown focus (22%. The use of imipenem/cilastatin empirically was appropriate in 97.2% (n=69/71 of the cases, and its use postculture in 86% of the cases. There were 29% of the patients who were not started on imipenem/cilastatin empirically. Four patients out of the 29 patients (13.8% who were not started on imipenem/cilastatin empirically inappropriately received imipenem/cilastatin post-culture results. Thirty-three patients (33% were not dosed appropriately, 30 of whom had renal impairment and creatinine clearance fluctuations. Only one patient developed a

  18. Appropriateness of hospitalization for CAP-affected pediatric patients: report from a Southern Italy General Hospital

    Directory of Open Access Journals (Sweden)

    Antonelli Fabio

    2009-09-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population. Methods We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status. Results In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01, and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration more frequently than "not at risk" population

  19. Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis.

    Science.gov (United States)

    Vilar-Palop, Jorge; Hernandez-Aguado, Ildefonso; Pastor-Valero, María; Vilar, José; González-Alvarez, Isabel; Lumbreras, Blanca

    2018-03-16

    To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. Cross-sectional retrospective study. Two Spanish public tertiary hospitals. 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient's clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test

  20. 32 CFR 37.200 - What are my responsibilities as an agreements officer for ensuring the appropriate use of TIAs?

    Science.gov (United States)

    2010-07-01

    ... officer for ensuring the appropriate use of TIAs? 37.200 Section 37.200 National Defense Department of... agreements officer for ensuring the appropriate use of TIAs? You must ensure that you use TIAs only in appropriate situations. To do so, you must conclude that the use of a TIA is justified based on: (a) The...

  1. Exegesis seeking appropriation; appropriation seeking exegesis: Re-reading 2 Samuel 13:1−22 in search of redemptive masculinities

    Directory of Open Access Journals (Sweden)

    Gerald West

    2013-09-01

    Full Text Available Exegesis in the traditional sense is concerned with generating as much (scientific detail about a biblical text as possible. Whilst the two primary modes of biblical exegesis � socio-historical and literary-semiotic � do this differently, they share a common concern for the detail of the text as an ancient artefact. Critical distance is a key concept here, with the exegetes bracketing (for a moment their own contexts and concerns. However, such bracketing is impossible to sustain, and so the exegetes� interests (shaped by their contexts and concerns �leak� into the act of exegesis. Most exegetes today recognise this leakage, and whilst some still view such leakage as contaminating the exegesis, others, including the tradition of African biblical scholarship, actively identify the contextual concerns they bring to the task of exegesis, both respecting the detail of the text and desiring to be accountable to their contexts in which the Bible is a significant text. This article explored some of the dimensions of forms of exegesis that actively seek appropriation, using 2 Samuel 13:1�22 as an example. In this case, the article analysed the contextual shift from a focus on women as the victims of sexual violence to an emerging emphasis on masculinities. Reading the same text from these different contextual concerns �activates� particular details of the text, and so both draw on different elements of the text and thus guides the gaze of exegesis.

  2. Appropriate technology for domestic wastewater management in under-resourced regions of the world

    Science.gov (United States)

    Oladoja, Nurudeen Abiola

    2017-11-01

    Centralized wastewater management system is the modern day waste management practice, but the high cost and stringent requirements for the construction and operation have made it less attractive in the under-resourced regions of the world. Considering these challenges, the use of decentralized wastewater management system, on-site treatment system, as an appropriate technology for domestic wastewater treatment is hereby advocated. Adopting this technology helps save money, protects home owners' investment, promotes better watershed management, offers an appropriate solution for low-density communities, provides suitable alternatives for varying site conditions and furnishes effective solutions for ecologically sensitive areas. In the light of this, an overview of the on-site treatment scheme, at the laboratory scale, pilot study stage, and field trials was conducted to highlight the operational principles' strength and shortcomings of the scheme. The operational requirements for the establishing and operation of the scheme and best management practice to enhance the performance and sustenance were proffered.

  3. Masculinity (in magazine: appropriations, negotiations and resistance among readers of Men’s Health

    Directory of Open Access Journals (Sweden)

    Filipe Bordinhão dos Santos

    2012-04-01

    Full Text Available This article analyzes the process of identity construction male readers from the appropriation of representations on masculinity at the Men’s Health magazine. Then, was realized study of reception with six assiduous readers of the magazine. Were applied in-depth interviews, structured from categories that correspond to the contemporary construction of masculinity (beauty/sexuality, consumption, work and family. It tried to be noted different forms of appropriation and resistance to this discourse hegemonic masculinity on the construction of identity of these individuals. In conclusion, it was noticed that the media still takes on the role in identity formation of their receptors –which, in time, ranging from upgrading the standard of masculinity of the “new man” to the maintenance of traditional values.

  4. Echocardiography Practice: Insights into Appropriate Clinical Use, Technical Competence and Quality Improvement Program

    Science.gov (United States)

    Kossaify, Antoine; Grollier, Gilles

    2014-01-01

    Echocardiography accounts for nearly half of all cardiac imaging techniques. It is a widely available and adaptable tool, as well as being a cost-effective and mainly a non-invasive test. In addition, echocardiography provides extensive clinical data, which is related to the presence or advent of different modalities (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, contrast echo, etc.), different approaches (transesophageal, intravascular, etc.), and different applications (ie, heart failure/resynchronization studies, ischemia/stress echo, etc.). In view of this, it is essential to conform to criteria of appropriate use and to keep standards of competence. In this study, we sought to review and discuss clinical practice of echocardiography in light of the criteria of appropriate clinical use, also we present an insight into echocardiographic technical competence and quality improvement project. PMID:24516342

  5. Determination of appropriate condition on replacing methane from hydrate with carbon dioxide

    International Nuclear Information System (INIS)

    Zhou Xitang; Fan Shuanshi; Liang Deqing; Du Jianwei

    2008-01-01

    This paper is intended to determine the appropriate conditions for replacing CH 4 from NGH with CO 2 . By analyzing the hydration equilibrium graphs and geotherms, the HSZs of NGH and CO 2 hydrate, both in permafrost and under deep sea, were determined. Based on the above analysis and experimental results, it is found that to replace CH 4 from NGH with gaseous CO 2 , the appropriate experimental condition should be in the area surrounded by four curves: the geotherm, (H-V) CO2 , (L-V) CO2 and (H-V) CH4 , and to replace CH 4 from NGH with liquid CO 2 , the condition should be in the area surrounded by three curves: (L-V) CO2 , (H-L) CO2 and (H-V) CH4 . For conditions in other areas, either CO 2 can not form a hydrate or CH 4 can release little from its hydrate, which are not desirable results

  6. NAMAs and the carbon market. Nationally appropriate mitigation actions of developing countries

    Energy Technology Data Exchange (ETDEWEB)

    Holm Olsen, K.; Fenhann, J.; Hinostroza, M.

    2009-07-01

    The role of carbon markets in scaling up mitigation actions in developing countries in the post-2012 climate regime is the topic of Perspectives 2009: NAMAs and the Carbon Market - Nationally Appropriate Mitigation Actions of Developing Countries. The eight papers presented explore how mitigation actions in developing countries, in the context of sustainable development, may be supported by technology, finance and capacity development in a measurable, reportable and verifiable manner. Key issues discussed are the pros and cons of market and non-market mechanisms in raising private and public finance, and the appropriate governance structures at the international and national levels. The aim of this publication is to present possible answers to these questions, with a specific focus on the role of existing and emerging carbon markets to finance NAMAs. (LN)

  7. A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

    DEFF Research Database (Denmark)

    Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume

    2014-01-01

    Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed...... a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND....... The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors...

  8. Selection of an Appropriate Mechanized Mining Technical Process for Thin Coal Seam Mining

    Directory of Open Access Journals (Sweden)

    Chen Wang

    2015-01-01

    Full Text Available Mechanized mining technical process (MMTP related to the control method of the shearer is a vital process in thin coal seam mining operations. An appropriate MMTP is closely related to safety, productivity, labour intensity, and efficiency. Hence, the evaluation of alternative MMTP is an important part of the mining design. Several parameters should be considered in MMTP evaluation, so the evaluation is complex and must be compliant with a set of criteria. In this paper, two multiple criteria decision-making (MCDM methods, Analytic Hierarchy Process (AHP and Preference Ranking Organization Method for Enrichment Evaluation (PROMETHEE, were adopted for this evaluation. Then, the most appropriate MMTP for a thin coal seam working face was selected in China.

  9. The right to appropriate and meaningful education for children with ASD.

    Science.gov (United States)

    Marshall, David; Goodall, Craig

    2015-10-01

    This paper will explore from a 'child's rights perspective' the 'right' of children with autistic spectrum disorder (ASD) to appropriate and meaningful education. Human 'rights' principles within international law will be evaluated in relation to how they have been interpreted and applied in relation to achieving this 'right'. The International Convention of the Rights of the Child (United Nations in Convention on the rights of the child, office of the high commissioner, United Nations, Geneva, 1989) and the convention on the rights of the person with disability (United Nations in Convention on the rights of person's with disabilities and optional protocol, office of the high commissioner, United Nations, Geneva, 2006) amongst others will be utilised to argue the case for 'inclusive' educational opportunities to be a 'right' of every child on the autistic spectrum. The efficacy of mainstream inclusion is explored, identifying the position that a 'one size fits all' model of education is not appropriate for all children with ASD.

  10. Fret not thyself: The persuasive effect of anger expression and the role of perceived appropriateness.

    Science.gov (United States)

    Van't Riet, Jonathan; Schaap, Gabi; Kleemans, Mariska

    2018-01-01

    Anger expression is increasingly prevalent in Western mass media, particularly in messages that aim to persuade the audience of a certain point of view. There is a dearth of research, however, investigating whether expressing anger in mediated messages is indeed effective as a persuasive strategy. In the present research, the results of four experiments showed that expressing anger in a persuasive message was perceived as less socially appropriate than expressing non-emotional disagreement. There was also evidence that perceived appropriateness mediated a negative persuasive effect of anger expression (Study 2-4) and that anger expression resulted in perceptions of the persuasive source as unfriendly and incompetent (Studies 1 and 2). In all, the findings suggest that politicians and other public figures should be cautious in using anger as a persuasive instrument.

  11. Cognition-Enhancing Drugs and Their Appropriateness for Aviation and Ground Troops: A Meta-Analysis

    Science.gov (United States)

    2010-12-01

    succinct summary of the legal aspects, appropriateness, and controversy concerning off-label use in his bioethics column. The FDA acknowledges that it...2008) acknowledges that the military’s use of “cognitive performance enhancers” has often received negative attention and argument from media and...Environmental Medicine. 78: 871-877. Mehlman, M. J. 2010. Bioethics : Off-label prescribing. Retrieved from http://www.thedoctorwillseeyounow.com

  12. Effect of Appropriate Marketing Mix Strategies on Iranian Protein Products Export Performance

    OpenAIRE

    Hossein Rezaie Dolatabadi; Mohammad Hossein Forghani; Seyed Mehdi Tabatabaee; Fatemeh Faghani

    2013-01-01

    The purpose of the present paper is to examine effect of effect of appropriate marketing mix strategies on Iranian protein products export performance. 4P (Price, Product, Place, Promotion) were selected as marketing strategies. The data used to test the hypotheses were collected through an online standard questionnaire. The respondents were asked to rate on the scale between strongly agree and strongly Disagree. Reliability of questionnaire was measured using Cronbach Coefficient Alpha. The ...

  13. Stakeholder involvement in development and design of appropriate emergency preparedness routines in Slovakia

    International Nuclear Information System (INIS)

    Duranova, T.; Kusovska, Z.; Metke, E.; Sladek, V.; Sokolikova, A.

    2009-01-01

    The paper presents the process of stakeholder involvement in development and implementation of appropriate emergency preparedness routines in Slovakia in last five years. The paper presents the discussion of good practices, which made the work undertaken valuable and effective. The paper reflects the lessons learned during the course representing five years of stakeholder involvement effort. The paper gives detailed information on used practices and real process taken place in Slovakia. (authors)

  14. Stakeholders' perceptions of appropriate management methods: the case of A. youth-village undergoing change

    OpenAIRE

    Bilu, Shabtay S.

    2015-01-01

    The research examined employees and stakeholders' perceptions of a significant educational reform conducted at the A. Youth-Village. The reform aimed at transforming an out-dated agriculture school into a technological-scientific education centre that would be able to train its pupils to meet the challenges of the 21st century. This study investigated the employees and stakeholders' perceptions of the appropriateness of methods used during the organisational change of A. Youth-Village. The st...

  15. Appropriate nominal stresses for use with ASME Code pressure-loading stress indices for nozzles

    International Nuclear Information System (INIS)

    Rodabaugh, E.C.

    1976-06-01

    This program is part of a cooperative effort with industry to develop and verify analytical methods for assessing the safety of nuclear pressure-vessel and piping-system design. The study of nominal stresses and stress indices described is part of a continuing study of design rules for nozzles in pressure vessels being coordinated by the PVRC Subcommittee on Reinforced Openings and External Loadings. Results from these studies are used by appropriate ASME Code groups in drafting new and improved design rules

  16. Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia

    Science.gov (United States)

    Kabbara, Wissam K; Ramadan, Wijdan H; Rahbany, Peggy; Al-Natour, Souhaila

    2015-01-01

    Background Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged. Objective The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia) in diabetic and nondiabetic patients. Methods A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin) were identified. Patients were mainly recruited from internal medicine floors and intensive care units. Results The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%), followed by levofloxacin (42.4%) and moxifloxacin (7.6%). Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%), followed by ciprofloxacin (39.0%) and moxifloxacin (33.3%). In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was more common with moxifloxacin (11.1%) and levofloxacin (6.0%). Conclusion The major clinical interventions for the future will adjust the dose and duration of therapy with commonly prescribed fluoroquinolones. The incidence of hypoglycemia was less common than hyperglycemia. PMID:25960658

  17. Appropriateness and diagnostic yield of referrals for oesophagogastroduodenoscopy at the Korle Bu Teaching Hospital.

    Science.gov (United States)

    Tachi, K; Nkrumah, K N

    2011-01-01

    Increasing endoscopy workload in open-access services necessitates adoption of appropriateness criteria to check abuse and improve yield. To assess the appropriateness of referrals for oesophagogastroduodenoscopy (OGD) and its relationship to yield at Korle-Bu Teaching Hospital (KBTH), Accra. Referrals, signs, and symptoms of 375 consecutive patients for diagnostic oesophagogastroduodenoscopy were evaluated over four months. Indications were categorized as appropriate or inappropriate using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and endoscopic findings (yield) categorized as positive or negative. The relationship between these was analyzed and the diagnostic accuracy of the guidelines determined. There were 209 (55.7%) females, and 316 (84.3%) open-access procedures. Mean age was 46±17 years. Dyspepsia, 272 (72.5%) and epigastric tenderness, 192 (41.4 %) were the commonest symptom and sign respectively. Only 133 (35.5%) reported alarm symptoms. Appropriate referrals constituted 221(58.9%). Inappropriate referral rate was similar for endoscopists and non-endoscopists. Positive yield was 62.7%. Male sex, age > 45 years, haematemesis, persistent vomiting, gastroenterologists' referrals and epigastric tenderness were the best predictors of positive yield. Gastritis, 121 (32.3%), duodenal ulcer, 48 (12.5%) and oesophagitis, 36 (9.6%) were the leading endoscopy diagnoses. Carcinomas were reported only after 45 years and 18 (81.8%) of the cases had alarm symptoms. Inappropriate referral for OGD rate is high in Accra. Yield is improved by adherence to the ASGE guidelines but its accuracy as a screening tool for OGD at Korle- Bu Teaching Hospital is too low to recommend it for adoption.

  18. Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study

    OpenAIRE

    Davis, Marion E.; Liu, Tsai-Ling; Taylor, Yhenneko J.; Davidson, Lisa; Schmid, Monica; Yates, Traci; Scotton, Janice; Spencer, Melanie D.

    2017-01-01

    In the outpatient setting, estimates suggest that 30% of the antibiotics prescribed are unnecessary. This study explores patient knowledge and awareness of appropriate use of antibiotics and expectations regarding how antibiotics are used for their treatment in outpatient settings. A survey was administered to a convenience sample of patients, parents, and caregivers (n = 190) at seven primary care clinics and two urgent care locations. Fisher’s exact tests compared results by patient charact...

  19. “Crossing over”: appropriate private sector principles, to operate more reliable public sector water services

    OpenAIRE

    Kevin Wall

    2008-01-01

    Private sector institutions utilise many different business methods, some of which can selectively be adapted for use by organisations outside the private sector, to the benefit of their service delivery responsibilities. But the best of the appropriate practices from the private sector have often “not crossed over”. The Water Research Commission (WRC) of South Africa, working in collaboration with the Council for Scientific and Industrial Research (CSIR), finds that the concept of franch...

  20. Appropriability, Technological Opportunity, Market Demand, and Technical Change - Empirical Evidence from Switzerland

    OpenAIRE

    Harabi, Najib

    1992-01-01

    The purpose of this paper is to analyze both theoretically and empirically those factors which underlay the - empirically observable - inter-industry differences in technical progress. At the theoretical level economists agree more and more that technical progress can be explained at the industry level by the following three factors: (1) the technological opportunities, (2) the appropriability conditions, meaning the ability to capture and protect the results of technical innovations and (3) ...

  1. Nature Appropriation and Associations with Population Health in Canada’s Largest Cities

    Directory of Open Access Journals (Sweden)

    Timothy Jason

    2013-03-01

    Full Text Available Earth is a finite system with a limited supply of resources. As the human population grows, so does the appropriation of Earth’s natural capital, thereby exacerbating environmental concerns such as biodiversity loss, increased pollution, deforestation and global warming. Such concerns will negatively impact human health although it is widely believed that improving socio-economic circumstances will help to ameliorate environmental impacts and improve health outcomes. However, this belief does not explicitly acknowledge the fact that improvements in socio-economic position are reliant on increased inputs from nature. Gains in population health, particularly through economic means, are disconnected from the appropriation of nature to create wealth so that health gains become unsustainable. The current study investigated the sustainability of human population health in Canada with regard to resource consumption or “ecological footprints” (i.e., the resources required to sustain a given population. Ecological footprints of the 20 largest Canadian cities, along with several important determinants of health such as income and education, were statistically compared with corresponding indicators of human population health outcomes. A significant positive relationship was found between ecological footprints and life expectancy, as well as a significant negative relationship between ecological footprints and the prevalence of high blood pressure. Results suggest that increased appropriation of nature is linked to improved health outcomes. To prevent environmental degradation from excessive appropriation of natural resources will require the development of health promotion strategies that are de-coupled from ever-increasing and unsustainable resource use. Efforts to promote population health should focus on health benefits achieved from a lifestyle based on significantly reduced consumption of natural resources.

  2. Dosing of Appropriate Antibiotics and Time to Administration of First Doses in the Pediatric Emergency Department.

    Science.gov (United States)

    Bailey, Abby M; Stephan, Maria; Weant, Kyle A; Justice, Stephanie Baker

    2015-01-01

    Emergency department (ED) providers are faced with the challenge of diagnosing and treating patients in a timely fashion given many obstacles including limited patient information, complex disease states, and high patient turnover. Time delays in administration or selection of appropriate drug therapies have been associated with negative outcomes in severe infections. This study was conducted to assess the impact of an emergency medicine pharmacist (EPh) on the selection of appropriate antibiotics and the timeliness of administration in pediatric patients in the ED. Patients younger than 18 years were evaluated who were admitted through the ED and received 1 dose of intravenous antibiotic for the following conditions: community-acquired pneumonia, complicated skin and soft tissue infection (SSTI), meningitis, and sepsis. To evaluate the impact of the presence of an EPh, patients with orders placed during the EPh's hours of 1 pm and 11 pm were compared to those with an order placed between 11 pm and 1 pm. A total of 142 patients were included in the study. Patients seen during EPh hours received an appropriate first antibiotic 93.4% of the time (p = 0.157) and second antibiotic 96.8% of the time (p = 0.023). Time from order to verification was significantly shorter for the first 2 antimicrobials in the EPh group (10.5 minutes [p = 0.003] and 11.4 minutes [p = 0.047], respectively). The days from discharge to return to readmission to the ED were also significantly different (17.5 days vs. 62.4 days, p = 0.008). The available data suggest that patients are more likely to receive appropriate doses of antimicrobials, and in a more timely fashion, whenever the EPh is present. Areas for future investigation include whether the presence of EPhs at the bedside has the potential to impact areas of patient care, including readmission rates, drug costs, and medication errors.

  3. Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions.

    Science.gov (United States)

    Abel, Gregory A; Chen, Kun; Taback, Nathan; Hassett, Michael J; Schrag, Deborah; Weeks, Jane C

    2013-03-01

    Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness. Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate. Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months. DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes. Copyright © 2012 American Cancer Society.

  4. Appropriateness guidelines and predictive rules to select patients for upper endoscopy: a nationwide multicenter study.

    Science.gov (United States)

    Buri, Luigi; Hassan, Cesare; Bersani, Gianluca; Anti, Marcello; Bianco, Maria Antonietta; Cipolletta, Livio; Di Giulio, Emilio; Di Matteo, Giovanni; Familiari, Luigi; Ficano, Leonardo; Loriga, Pietro; Morini, Sergio; Pietropaolo, Vincenzo; Zambelli, Alessandro; Grossi, Enzo; Intraligi, Marco; Buscema, Massimo

    2010-06-01

    Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models. A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled. Before EGD, the endoscopist assessed referral appropriateness according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, also collecting clinical and demographic variables. Outcomes of the study were detection of relevant findings and new diagnosis of malignancy at EGD. The accuracy of the following clinical strategies and predictive rules was compared: (i) ASGE appropriateness guidelines (indicated vs. not indicated), (ii) simplified rule (>or=45 years or alarm features vs. <45 years without alarm features), (iii) logistic regression model, and (iv) ANN models. A total of 8,252 patients were enrolled in 57 centers. Overall, 3,803 (46%) relevant findings and 132 (1.6%) new malignancies were detected. Sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the simplified rule were similar to that of the ASGE guidelines for both relevant findings (82%/26%/0.55 vs. 88%/27%/0.52) and cancer (97%/22%/0.58 vs. 98%/20%/0.58). Both logistic regression and ANN models seemed to be substantially more accurate in predicting new cases of malignancy, with an AUC of 0.82 and 0.87, respectively. A simple predictive rule based on age and alarm features is similarly effective to the more complex ASGE guidelines in selecting patients for EGD. Regression and ANN models may be useful in identifying a relatively small subgroup of patients at higher risk of cancer.

  5. Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya.

    Science.gov (United States)

    Kawakatsu, Yoshito; Tanaka, Junichi; Ogawa, Kazuya; Ogendo, Kenneth; Honda, Sumihisa

    2017-02-16

    The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area's CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Factors significantly associated with a lower prevalence of diarrhea among children under five were the child's increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on

  6. Toward Appropriate Missiology for Post-Soviet Evangelicals: Global Missiological Trends and Local Realities

    OpenAIRE

    CHERENKOV, Michael

    2011-01-01

    The future of missions in post-Soviet countries is tied to the formation/development of an appropriate, indigenous, authentic, effective, comprehensive missiological paradigm, which is based on Biblical principles, opens up into a holistic theoretical system, synthesizes the historical experience of churches and various theological approaches, takes into account the local context, and is oriented towards the needs and issues of local communities. Each of these requirements is presented as nec...

  7. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

    OpenAIRE

    Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L.

    2014-01-01

    Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions w...

  8. TECHNOLOGIES IN HIGHER EDUCATION: PUBLIC POLICIES AND SOCIAL APPROPRIATION OF THEIR IMPLEMENTATION

    OpenAIRE

    Melo Fiallos, Diego Fernando; Silva Chávez, Judith Alexandra; Indacochea Mendoza, Luis Rene; Núñez Campaña, Jorge Humberto

    2017-01-01

    This paper presents an analysis of the implementation of information and communication technologies in higher education with the aim to contribute knowledge on trends regarding their social appropriation. To that effect, documents of public policies and scientific literature containing guidelines developed by international organizations and explaining different alternatives to guide the process of integrating technologies in education were reviewed. Then, some research works on problems deriv...

  9. Pediatric Biopharmaceutical Classification System: Using Age-Appropriate Initial Gastric Volume.

    Science.gov (United States)

    Shawahna, Ramzi

    2016-05-01

    Development of optimized pediatric formulations for oral administration can be challenging, time consuming, and financially intensive process. Since its inception, the biopharmaceutical classification system (BCS) has facilitated the development of oral drug formulations destined for adults. At least theoretically, the BCS principles are applied also to pediatrics. A comprehensive age-appropriate BCS has not been fully developed. The objective of this work was to provisionally classify oral drugs listed on the latest World Health Organization's Essential Medicines List for Children into an age-appropriate BCS. A total of 38 orally administered drugs were included in this classification. Dose numbers were calculated using age-appropriate initial gastric volume for neonates, 6-month-old infants, and children aging 1 year through adulthood. Using age-appropriate initial gastric volume and British National Formulary age-specific dosing recommendations in the calculation of dose numbers, the solubility classes shifted from low to high in pediatric subpopulations of 12 years and older for amoxicillin, 5 years, 12 years and older for cephalexin, 9 years and older for chloramphenicol, 3-4 years, 9-11 and 15 years and older for diazepam, 18 years and older (adult) for doxycycline and erythromycin, 8 years and older for phenobarbital, 10 years and older for prednisolone, and 15 years and older for trimethoprim. Pediatric biopharmaceutics are not fully understood where several knowledge gaps have been recently emphasized. The current biowaiver criteria are not suitable for safe application in all pediatric populations.

  10. The Appropriateness of Trade Liberalization in the Industrial Sector of the Russian Federation

    OpenAIRE

    Ilyasova, Tatiana

    2003-01-01

    This article seeks to investigate the appropriateness of implementation of trade liberalization in Russia by analyzing the current performance of the Russian industrial sector and evaluating its nominal and effective protection levels. The estimation of the effective level of protection is performed through the calculation of effective rates of protection for each industrial sector. Effective rates of protection are estimated with the simple Corden Method to examine the difference in protecti...

  11. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

    Science.gov (United States)

    Vaz Patto, Maria Carlota; Rubiales, Diego

    2014-01-01

    Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance (NHR) responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus) and two inappropriate (U. viciae-fabae and U. lupinicolus) rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However, responses to different inappropriate rust species also showed some specificity, suggesting a combination of non-specific and specific responses underlying this legume NHR to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and NHR mechanisms to breed for broad-spectrum resistance to rust in legume species. PMID:25426128

  12. Are the Exiting Quality of Life Measures Appropriate for Muslim Patients with Cancer?

    Directory of Open Access Journals (Sweden)

    Susana Widyaningsih

    2014-01-01

    Full Text Available Purpose: This article aims to review the appropriateness of five general quality of life (QoL measures for the Muslim patients with cancer.Method: The literatures related to QoL in patients with cancer, published between 1981 and 2011 were critically reviewed. Several database databases including CINAHL, MEDLINE as well as PUBMED, ProQuest, Elsevier, Google scholar and reference list were included. There were 25 articles best fit the inclusion criteria. Books and journal articles addressing Islamic principles were also reviewed.Result: QoL is a complex, multidimensional, and subjective phenomenon. It has been defined differently but overlapping by many scholars in the field. The patient’s QoL is important since it is one of the indicators of quality cancer care. The EORTC QLQ C30, FLIC, McGill QoL are the examples of widely used QoL measures which are appropriate to be applied in Muslim cancer population, while the FACT-G and CARES SF need to be revised in some of their items. Issues related to Islamic principles are discussed to support needs of further revision of these QoL measures.Conclusion: Most of the QoL measures’ items are not conflicting with the Islamic principles, except some items. Psychometric properties of the revised measures appropriate for Muslim cancer population should be further examined so that applying these measures can provide valid findings. Furthermore future cross cultural study may be possible.

  13. Appropriate technology of infrastructure like support at the production agricultural of the peasant

    International Nuclear Information System (INIS)

    Salamanca Vargas, L.A.

    2001-01-01

    It refers to the Center of Appropriate Technology - CENTA, like an alternative for the improvement of the conditions of life and the production of the rural families. Since 1972 is described up to 1987, beginning as infrastructure section, routine of reparation of the rural housing and finally CENTA, with the purpose of to generate and to transfer technology of low cost in reparation of the housing. It discusses the reparation concept and the environmental conditions that affect the rural family supported in surveys made by the Planning National Department DNP. The characterization of the environmental reparation is indicated for the formulation of reparation programs. The methodology is carried out for the execution of routine of reparation of the rural housing through demonstrative centers. The results of the participation of the ICA are mentioned in the routine of reparation of the rural housing. It is analyzed the concept of appropriate technology and the principles that govern their development and their adoption. The Projects of the Section Center of appropriate Technology and the main realizations are enunciated carried out until 1987

  14. Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults.

    Science.gov (United States)

    Hammond, Drayton A; Killingsworth, Catherine A; Painter, Jacob T; Pennick, Rose E; Chatterjee, Kshitij; Boye, Bradley; Meena, Nikhil

    2017-01-01

    Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB). Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST. A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests. Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively). Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

  15. Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults

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    Hammond DA

    2017-09-01

    Full Text Available Background: Acid suppression therapy (AST is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB. Objective: Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST. Methods: A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU at an academic medical center between January to June of 2014 (no intervention and January to June of 2015 (intervention was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests. Results: Patients in the intervention group (n=118 were 5 years older than patients in the no intervention group (n=101. AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012. Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively. Conclusion: Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

  16. Health Disparities Research Among Small Tribal Populations: Describing Appropriate Criteria for Aggregating Tribal Health Data.

    Science.gov (United States)

    Van Dyke, Emily R; Blacksher, Erika; Echo-Hawk, Abigail L; Bassett, Deborah; Harris, Raymond M; Buchwald, Dedra S

    2016-07-01

    In response to community concerns, we used the Tribal Participatory Research framework in collaboration with 5 American-Indian communities in Washington, Idaho, and Montana to identify the appropriate criteria for aggregating health data on small tribes. Across tribal sites, 10 key informant interviews and 10 focus groups (n = 39) were conducted between July 2012 and April 2013. Using thematic analysis of focus group content, we identified 5 guiding criteria for aggregating tribal health data: geographic proximity, community type, environmental exposures, access to resources and services, and economic development. Preliminary findings were presented to focus group participants for validation at each site, and a culminating workshop with representatives from all 5 tribes verified our final results. Using this approach requires critical assessment of research questions and study designs by investigators and tribal leaders to determine when aggregation or stratification is appropriate and how to group data to yield robust results relevant to local concerns. At project inception, tribal leaders should be consulted regarding the validity of proposed groupings. After regular project updates, they should be consulted again to confirm that findings are appropriately contextualized for dissemination. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea

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    Jong-Myon Bae

    2017-07-01

    Full Text Available In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.

  18. Establishing the Appropriate Attributes in Current Human Reliability Assessment Techniques for Nuclear Safety

    International Nuclear Information System (INIS)

    Bowie, Jane; Munley, Gary; Dang, Vinh; Wreathall, John; Bye, Andreas; Cooper, Susan; Marble, Julie; Peters, Sean; Xing, Jing; Fauchille, Veronique; Fiset, Jean Yves; Haage, Monica; Johanson, Gunnar; Jung, Won Dae; Kim, Jaewhan; Lee, Seung Jung; Kubicek, Jan; Le Bot, Pierre; Pesme, Helene; Preischl, Wolfgang; Salway, Alice; Amri, Abdallah; Lamarre, Greg; White, Andrew; )

    2015-03-01

    This report presents the results of a joint task of the Working Groups on Risk Assessment (WGRISK) and on Human and Organisational Factors (WGHOF) of the OECD/NEA CSNI, to identify desirable attributes of Human Reliability Assessment (HRA) methods, and to evaluate a range of HRA methods used in OECD member countries against those attributes. The purpose of this project is to provide information that will support regulators and operators of nuclear facilities when making judgements about the appropriateness of HRA methods for conducting assessments in support of Probabilistic Safety Assessments (PSA). The task was performed by an international team of Human Factors, HRA and PSA experts from a broad range of OECD member countries. As in other reviews of HRA methods, the study did not set out to recommend or promote the use of any particular HRA method. Rather the study aims to identify the strengths and limitations of commonly used and developing methods to aid those responsible for production of HRAs in selecting appropriate tools for specific HRA applications. The study also aims to assist regulators when making judgements on the appropriateness of the application of an HRA technique within nuclear-related probabilistic safety assessments. The report is aimed at practitioners in the field of human reliability assessment, human factors, and risk assessment more generally

  19. Acceptance of Addiction Prevention Exiting Methods and Presentation of Appropriate Model

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    Ali Asghar Savad-Kouhi

    2006-10-01

    Full Text Available Objective: The aim of this study is assessment of acceptance of addiction prevention existing methods and design and present of appropriate model. Materials & Methods: This research has done by survey and desariptive method by using questionnaire we assessed knowledge and belief of people about suggesting and existing methods of addiction prevention and their acceptence and finally design new and appropriate model of addiction prevention. For designing questionnaire, first exports and professors were openly interviewed and according their views final questionnaire was planned. We used questionnaire with 2 open ended and 61 close-ended tests for gathering data. The subjects of research were 2500 persons 13-35 years old that were selected by randomized sampling from 15 provinces. Results: The findings showed that according to people who were studied, they have positive beliefs about prevention methods and their effectiveness. According to findings a good model is inclusive model that able to do in four level: knowledge, change believe and attitude, control and change behavior. Conclusion: The people of study belive that acceptance of suggesting and existing methods of addiction prevention are effective direct and indirect to others, and appropriate model is inclusive model.

  20. On the Appropriateness of Incident Management Systems in Developing Countries: A Case from the UAE

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    Faouzi Kamoun

    2010-12-01

    Full Text Available Road traffic incidents are eliciting growing public concerns due to their devastating social, economical, and environmental impacts. The severity of these random events is particularly alarming in developing countries, where the situation is just worsening. Recently, Incident Management Systems (IMSs have been proposed as powerful tools to enhance the coordination and management of rescue operations during traffic accidents. However, most of the available commercial IMS solutions are designed for large metropolitan cities and within the contexts of developed nations. This paper explores the issues of appropriateness and customization of IMS solutions in developing countries through an exploratory inquiry consisting of a case study from the United Arab Emirates (UAE. The paper also explores the important issues related to managing the organizational changes that an IMS introduces to the operations of the command and control room. This contribution calls for the development of more comprehensive theoretical frameworks that can guide towards the implementation of appropriate IMS solutions in developing countries. Our research highlights the need for developing countries to acquire appropriate IMS solutions that are tailored to the local organizational work context in which these systems will be used. The experience reported herein can also inspire other public safety agencies in developing countries to consider the option of developing customized IMS solutions that best suit their needs.

  1. Appropriateness of mechanistic and non-mechanistic models for the application of ultrafiltration to mixed waste

    International Nuclear Information System (INIS)

    Foust, Henry; Ghosehajra, Malay

    2007-01-01

    This study asks two questions: (1) How appropriate is the use of a basic filtration equation to the application of ultrafiltration of mixed waste, and (2) How appropriate are non-parametric models for permeate rates (volumes)? To answer these questions, mechanistic and non-mechanistic approaches are developed for permeate rates and volumes associated with an ultrafiltration/mixed waste system in dia-filtration mode. The mechanistic approach is based on a filtration equation which states that t/V vs. V is a linear relationship. The coefficients associated with this linear regression are composed of physical/chemical parameters of the system and based the mass balance equation associated with the membrane and associated developing cake layer. For several sets of data, a high correlation is shown that supports the assertion that t/V vs. V is a linear relationship. It is also shown that non-mechanistic approaches, i.e., the use of regression models to are not appropriate. One models considered is Q(p) = a*ln(Cb)+b. Regression models are inappropriate because the scale-up from a bench scale (pilot scale) study to full-scale for permeate rates (volumes) is not simply the ratio of the two membrane surface areas. (authors)

  2. URBAN COMMUNITY RESPONSES TO VISUAL APPROPRIATE THEMATIC DESIGN, SUPER HERO PARK BANDUNG

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    Dian Duhita

    2017-06-01

    Full Text Available Parks is one of city public area that serves as a communal place for city community. On another perspective, parks is an architectural design that is designed with an aesthetic element to attract. Bandung, since a few years was to make improvements in various sectors, especially in the public space. Through the slogan Creative City, Bandung City Government revived communities part of the citizens by providing place for a activities, creation and production. Thematic Parks became one of the alternative approaches responsive design as part of creative cities development. Object of research study object is Super Hero park. The purpose of research is to analyzing the response of communities to design a thematic park. The study was conducted with a qualitative approach through participation observation method. The scope of the research includes visual appropriate and city community response. The conclussion obtain that visual appropriate are in accordance with the theme. Urban Community was able to respond well the identity of Super Hero park with visual appropriate design.

  3. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

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    Maria Carlota eVaz Patto

    2014-11-01

    Full Text Available Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus and two inappropriate (U. viciae-fabae and U. lupinicolus rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However responses to different inappropriate rust species also showed some specificity, suggesting a combination of non specific and specific responses underlying this legume nonhost resistance to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and nonhost resistance mechanisms to breed for broad-spectrum resistance to rust in legume species.

  4. Appropriate welding conditions of temper bead weld repair for SQV2A pressure vessel steel

    International Nuclear Information System (INIS)

    Mizuno, R.; Matsuda, F.; Brziak, P.; Lomozik, M.

    2004-01-01

    Temper bead welding technique is one of the most important repair welding methods for large structures for which it is difficult to perform the specified post weld heat treatment. In this study, appropriate temper bead welding conditions to improve the characteristics of heat affected zone (HAZ) are studied using pressure vessel steel SQV2A corresponding to ASTM A533 Type B Class 1. Thermal/mechanical simulator is employed to give specimens welding thermal cycles from single to quadruple cycle. Charpy absorbed energy and hardness of simulated CGHAZ by first cycle were degraded as compared with base metal. Improvability of these degradations by subsequent cycles is discussed and appropriate temper bead thermal cycles are clarified. When the peak temperature lower than Ac1 and near Ac1 in the second thermal cycle is applied to CGAHZ by first thermal cycle, the characteristics of CGHAZ improve enough. When the other peak temperatures (that is, higher than Ac1) in the second thermal cycle are applied to the CGHAZ, third or more thermal cycle temper bead process should be applied to improve the properties. Appropriate weld condition ranges are selected based on the above results. The validity of the selected ranges is verified by the temper bead welding test. (orig.)

  5. Method for Determining Appropriate Clustering Criteria of Location-Sensing Data

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    Youngmin Lee

    2016-08-01

    Full Text Available Large quantities of location-sensing data are generated from location-based social network services. These data are provided as point properties with location coordinates acquired from a global positioning system or Wi-Fi signal. To show the point data on multi-scale map services, the data should be represented by clusters following a grid-based clustering method, in which an appropriate grid size should be determined. Currently, there are no criteria for determining the proper grid size, and the modifiable areal unit problem has been formulated for the purpose of addressing this issue. The method proposed in this paper is applies a hexagonal grid to geotagged Twitter point data, considering the grid size in terms of both quantity and quality to minimize the limitations associated with the modifiable areal unit problem. Quantitatively, we reduced the original Twitter point data by an appropriate amount using Töpfer’s radical law. Qualitatively, we maintained the original distribution characteristics using Moran’s I. Finally, we determined the appropriate sizes of clusters from zoom levels 9–13 by analyzing the distribution of data on the graphs. Based on the visualized clustering results, we confirm that the original distribution pattern is effectively maintained using the proposed method.

  6. Latex allergy: assessment of knowledge, appropriate use of gloves and prevention practice among hospital healthcare workers.

    Science.gov (United States)

    Al-Niaimi, F; Chiang, Y Z; Chiang, Y N; Williams, J

    2013-01-01

    Healthcare workers and patients are often exposed to natural rubber latex (NRL) through contact with gloves and various healthcare products, which can potentially cause allergic reactions, with varying degrees of severity. In 2008, the Royal College of Physicians published their first evidence-based guidance on occupational health interventions for latex allergy, which emphasized the importance of healthcare workers having knowledge of latex allergy. This study aimed to survey the knowledge of healthcare workers (n = 156) about latex gloves and NRL allergy, routine prevention practice and the appropriate use of gloves in patient care. Healthcare workers in a large teaching hospital were surveyed using a standard questionnaire. We found that only 1% of healthcare workers were able to correctly match the appropriate gloves to the specifically designed procedure. More than half (n = 74.53%) were unable to recognize the presentation of type 1 allergy to NRL. Of the 156 participants, 131 (84%) considered that they would benefit from training about NRL allergy and the use of different types of gloves in clinical care. This survey indicates the importance of education regarding appropriate use of gloves and prevention of NRL allergy among healthcare workers, and dermatologists should play an important role in facilitating this. © The Author(s). CED © 2012 British Association of Dermatologists.

  7. Choosing Appropriate Theories for Understanding Hospital Reporting of Adverse Drug Events, a Theoretical Domains Framework Approach.

    Science.gov (United States)

    Shalviri, Gloria; Yazdizadeh, Bahareh; Mirbaha, Fariba; Gholami, Kheirollah; Majdzadeh, Reza

    2018-01-01

    Adverse drug events (ADEs) may cause serious injuries including death. Spontaneous reporting of ADEs plays a great role in detection and prevention of them; however, underreporting always exists. Although several interventions have been utilized to solve this problem, they are mainly based on experience and the rationale for choosing them has no theoretical base. The vast variety of behavioural theories makes it difficult to choose appropriate theory. Theoretical domains framework (TDF) is suggested as a solution. The objective of this study was to select the best theory for evaluating ADE reporting in hospitals based on TDF. We carried out three focus group discussions with hospital pharmacists and nurses, based on TDF questions. The analysis was performed through five steps including coding discussions transcript, extracting beliefs, selecting relevant domains, matching related constructs to the extracted beliefs, and determining the appropriate theories in each domain. The theory with the highest number of matched domains and constructs was selected as the theory of choice. A total of six domains were identified relevant to ADE reporting, including "Knowledge", "Skills", "Beliefs about consequences", "Motivation and goals", "Environmental context and resources" and "Social influences". We found theory of planned behavior as the comprehensive theory to study factors influencing ADE reporting in hospitals, since it was relevant theory in five out of six relevant domains and the common theory in 55 out of 75 identified beliefs. In conclusion, we suggest theory of planned behavior for further studies on designing appropriate interventions to increase ADE reporting in hospitals.

  8. The disconnect between the guidelines, the appropriate use criteria, and reimbursement coverage decisions: the ultimate dilemma.

    Science.gov (United States)

    Fogel, Richard I; Epstein, Andrew E; Mark Estes, N A; Lindsay, Bruce D; DiMarco, John P; Kremers, Mark S; Kapa, Suraj; Brindis, Ralph G; Russo, Andrea M

    Recently, the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society published appropriate use criteria (AUC) for implantable cardioverter-defibrillators and cardiac resynchronization therapy. These criteria were developed to critically review clinical situations that may warrant implantation of an implantable cardioverter-defibrillator or cardiac resynchronization therapy device, and were based on a synthesis of practice guidelines and practical experience from a diverse group of clinicians. When the AUC was drafted, the writing committee recognized that some of the scenarios that were deemed "appropriate" or "may be appropriate" were discordant with the clinical requirements of many payers, including the Medicare National Coverage Determination (NCD). To charge Medicare for a procedure that is not covered by the NCD may be construed as fraud. Discordance between the guidelines, the AUC, and the NCD places clinicians in the difficult dilemma of trying to do the "right thing" for their patients, while recognizing that the "right thing" may not be covered by the payer or insurer. This commentary addresses these issues. Options for reconciling this disconnect are discussed, and recommendations to help clinicians provide the best care for their patients are offered. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Accommodating the Mess: The Politics of Appropriation in It for Others (2013

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    Blair Paula

    2016-09-01

    Full Text Available In response to Chris Marker and Alain Resnais’s collaborative meditation on art and colonialism in Statues Also Die (1953, Duncan Campbell’s video installation It for Others (2013 takes a complex approach to presenting a Marxist criticism of the commoditization of art and culture. This article considers the intermedial and intertextual properties of It for Others as an example of convergence culture that transcends postmodern quotation and pastiche. While the film is apparently a bricolage of visual artefacts, it is in fact an intricately woven audiovisual essay concerned with the appropriation of not only colonized objects as its narration makes clear, but also of still images, moving images, written texts, sound samples, and the labour that produced them. The article examines how the film troubles notions of documentary realism and truth through its acts of appropriation that reflexively criticize the commercial appropriation and commoditization of artworks and histories. It also reflects on the film’s Marxist approach to related issues around authorship, ownership and access to artworks, particularly in the light of the film’s acknowledgement in prize culture.

  10. Appropriateness of the food-pics image database for experimental eating and appetite research with adolescents.

    Science.gov (United States)

    Jensen, Chad D; Duraccio, Kara M; Barnett, Kimberly A; Stevens, Kimberly S

    2016-12-01

    Research examining effects of visual food cues on appetite-related brain processes and eating behavior has proliferated. Recently investigators have developed food image databases for use across experimental studies examining appetite and eating behavior. The food-pics image database represents a standardized, freely available image library originally validated in a large sample primarily comprised of adults. The suitability of the images for use with adolescents has not been investigated. The aim of the present study was to evaluate the appropriateness of the food-pics image library for appetite and eating research with adolescents. Three hundred and seven adolescents (ages 12-17) provided ratings of recognizability, palatability, and desire to eat, for images from the food-pics database. Moreover, participants rated the caloric content (high vs. low) and healthiness (healthy vs. unhealthy) of each image. Adolescents rated approximately 75% of the food images as recognizable. Approximately 65% of recognizable images were correctly categorized as high vs. low calorie and 63% were correctly classified as healthy vs. unhealthy in 80% or more of image ratings. These results suggest that a smaller subset of the food-pics image database is appropriate for use with adolescents. With some modifications to included images, the food-pics image database appears to be appropriate for use in experimental appetite and eating-related research conducted with adolescents. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study.

    Science.gov (United States)

    Davis, Marion E; Liu, Tsai-Ling; Taylor, Yhenneko J; Davidson, Lisa; Schmid, Monica; Yates, Traci; Scotton, Janice; Spencer, Melanie D

    2017-10-31

    In the outpatient setting, estimates suggest that 30% of the antibiotics prescribed are unnecessary. This study explores patient knowledge and awareness of appropriate use of antibiotics and expectations regarding how antibiotics are used for their treatment in outpatient settings. A survey was administered to a convenience sample of patients, parents, and caregivers (n = 190) at seven primary care clinics and two urgent care locations. Fisher's exact tests compared results by patient characteristics. Although 89% of patients correctly believed that antibiotics work well for treating infections from bacteria, 53% incorrectly believed that antibiotics work well for treating viral infections. Patients who incorrectly believed that antibiotics work well for treating viral infections were more than twice as likely to expect a provider to give them an antibiotic when they have a cough or common cold. Patients who completed the survey also participated in semi-structured interviews (n = 4), which were analyzed using thematic analysis. Patients reported experiencing confusion about which illnesses may be treated by antibiotics and unclear communication from clinicians about the appropriate use of antibiotics. Development of easy to understand patient educational materials can help address patients' incorrect perceptions of appropriate antibiotic use and facilitate patient-provider communication.

  12. Appropriateness of using a symbol to identify dementia and/or delirium: a systematic review.

    Science.gov (United States)

    Hines, Sonia; Abbey, Jenny; Wilson, Jacinda; Sacre, Sandy

    2009-01-01

    Alzheimer's Australia contracted the Dementia Collaborative Research Centre - Consumers, Carers and Social Research to conduct a systematic review to explore the appropriateness of a symbol for dementia.The concept of a symbol for people with dementia was an outcome of the Alzheimer's Australia National Consumer Summit on Dementia held in Canberra in October 2005. People living with dementia and their carers identified that a national symbol would be helpful in order to encourage appropriate treatment of people with dementia.Funding was provided as part of the Australian Government's Dementia Initiative to Alzheimer's Australia to work in collaboration with the Queensland University of Technology and Catholic Health Australia to explore, through research, the viability and potential impact of such a symbol in a range of care settings. The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. A literature search was performed using the following databases: Ageline, APAIS Health, CINAHL, Dissertations and Theses Abstracts, Embase, MEDLINE, PsycEXTRAS, PsycINFO, PsycArticles, Current Contents, LegalTrac, Health and Society, Sociological Abstracts, Family and Society, CINCH, and Hein Online databases. The reference lists of articles retrieved were hand searched, as well as a range of literature from health, legal, ethical and emergency services. Grey literature was searched for using a number of Internet sites, and personal email communication with authors of relevant studies and known researchers in the field was initiated. Papers were retrieved if they provided information about attitudes or perceptions towards the appropriateness of symbols, identifiers or alerts used to inform others that someone has dementia, delirium and/or another medical

  13. A TOTAL MANUFACTURING SOLUTIONS TECHNIQUE TO SELECT APPROPRIATE IMPROVEMENT STRATEGY: CASE STUDY OF A FOOTWEAR FACTORY

    Directory of Open Access Journals (Sweden)

    Gezahegn Tesfaye

    2014-09-01

    Full Text Available The Government of Ethiopia is promoting the manufacturing sector to join the global market in a large scale. Due to its comparative advantages, the Ethiopian leather and leather products industry have been given due attention. To fully utilize such advantages, the country shifted its export items from hides/skins to footwear products. Nevertheless, the performance of the leather sector in general and footwear sub-sector in particular is far below the desired standards. The improvement strategies applied hitherto were mainly to tackle a small portion of their total problems. If the Ethiopian footwear companies have to become globally competitive, their entire business spectrum has to be assessed and appropriate improvement strategies must be selected. In this research, we used a Total manufacturing solutions (TMS technique to identify areas of improvement and improvement strategy of one of Ethiopian footwear companies. For this purpose, we conducted two surveys using structured questionnaire. The first survey was to test the TMS technique against the context of footwear industry. The result proved that the original TMS model can be used to measure the performance of footwear companies. The second survey was done to identify company's total problems, map its current position and select appropriate improvement strategy. The result revealed that the company has company-wide problems and its current position is a plodder. For plodders which have company-wide problems, the improvement strategy must include aggressive application of BPR; and the implementation of best practices to develop workers skills that encourages networking and promotion, a market-led manufacturing strategy, employee involvement and team work cultures. According to the findings of this research, we suggested that a BPR technique followed by a continuous improvement programme could be an appropriate improvement strategy for this company. The company requires long-term improvement

  14. Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

    Science.gov (United States)

    Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn

    2015-01-01

    Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. A qualitative study of psychological, social and behavioral barriers to appropriate food portion size control.

    Science.gov (United States)

    Spence, Michelle; Livingstone, M Barbara E; Hollywood, Lynsey E; Gibney, Eileen R; O'Brien, Sinéad A; Pourshahidi, L Kirsty; Dean, Moira

    2013-08-01

    Given the worldwide prevalence of overweight and obesity, there is a clear need for meaningful practical healthy eating advice - not only in relation to food choice, but also on appropriate food portion sizes. As the majority of portion size research to date has been overwhelmingly quantitative in design, there is a clear need to qualitatively explore consumers' views in order to fully understand how food portion size decisions are made. Using qualitative methodology this present study aimed to explore consumers' views about factors influencing their portion size selection and consumption and to identify barriers to appropriate portion size control. Ten focus groups with four to nine participants in each were formed with a total of 66 persons (aged 19-64 years) living on the island of Ireland. The semi-structured discussions elicited participants' perceptions of suggested serving size guidance and explored the influence of personal, social and environmental factors on their food portion size consumption. Audiotapes of the discussions were professionally transcribed verbatim, loaded into NVivo 9, and analysed using an inductive thematic analysis procedure. The rich descriptive data derived from participants highlight that unhealthy portion size behaviors emanate from various psychological, social and behavioral factors. These bypass reflective and deliberative control, and converge to constitute significant barriers to healthy portion size control. Seven significant barriers to healthy portion size control were apparent: (1) lack of clarity and irrelevance of suggested serving size guidance; (2) guiltless eating; (3) lack of self-control over food cues; (4) distracted eating; (5) social pressures; (6) emotional eating rewards; and (7) quantification habits ingrained from childhood. Portion size control strategies should empower consumers to overcome these effects so that the consumption of appropriate food portion sizes becomes automatic and habitual.

  16. Understanding decision-making in cardiac imaging: determinants of appropriate use.

    Science.gov (United States)

    Fonseca, Ricardo; Jose, Kim; Marwick, Thomas H

    2018-03-01

    Appropriate Use Criteria (AUC) for echocardiography were developed in 2007 to facilitate decision-making, reduce variability in test utilization, and encourage rational use of imaging. However, there is little evidence that the AUC have favourably influenced ordering behaviour. This study explores the factors that contribute to clinicians requesting echocardiograms with a focus on appropriate use. Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital. The interview guide included hypothetical clinical scenarios to better understand decision-making in ordering echocardiograms and the actions they could take when receiving test reports. Interviews underwent thematic analysis. Seventeen clinicians were interviewed, ten of whom were cardiologists. All participants ordered echocardiograms to support their clinical decision-making. Awareness of the AUC was low. The categorization of tests as 'appropriate' or 'inappropriate' was considered ineffective as it failed to reflect the decision-making process. The decision to request echocardiograms was influenced by a number of personal and systemic factors as well as guidelines and protocols. Training and experience, patients' expectations, and management of uncertainty were key personal factors. Systemic factors involved the accessibility of services and health insurance status of the patient. Factors that influenced the ordering of echocardiograms by clinicians at a tertiary care hospital did not appear to be amenable to control with AUC. Alternative approaches may be more effective than the AUC in addressing the overuse of echocardiography. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  17. Developing a culturally appropriate branding for a social and emotional wellbeing intervention in an Aboriginal community.

    Science.gov (United States)

    Donovan, Robert J; Murray, Lesley; Hicks, Jolleen; Nicholas, Amberlee; Anwar-McHenry, Julia

    2018-02-22

    An initial consultation process to implement a culturally appropriate social and emotional wellbeing campaign in an Aboriginal community indicated that the fundamental principles of the Act-Belong-Commit mental health promotion campaign were acceptable, but that a cultural adaptation of the branding should be sought. A competition was held inviting community members to design a brand logo for the campaign in their community. Local judges selected "winners" in various categories, and six of the submissions were selected for testing in the broader community via street intercept interviews. Respondents were asked which logo they liked best, their perceived meanings of the designs and the perceived appropriateness of the designs for a social and emotional wellbeing campaign. A convenience sample of N = 26 local Aboriginal people who lived and/or worked in Roebourne completed the questionnaire. There was a clear majority preference for logo "D," which communicated appropriate meanings of pride and strength in standing together, and reflected the underlying strengths and capacities of Aboriginal people which this project seeks to harness and support. The approach of using a logo competition to develop the campaign brand was highly successful and enabled further meaningful engagement with the community and other service providers in the town. The success of the competition process resulted from an emphasis on relationship building, listening to the local community and involving the community in decision-making. So what? By conforming to established, but not always adhered to, recommendations for community consultation, successful and more enduring outcomes are likely. © 2018 Australian Health Promotion Association.

  18. ACR Appropriateness Criteria® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer.

    Science.gov (United States)

    Slanetz, Priscilla J; Moy, Linda; Baron, Paul; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Niell, Bethany; Stuckey, Ashley R; Trikha, Sunita; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

    2017-11-01

    Patients with locally advanced invasive breast cancers are often treated with neoadjuvant chemotherapy prior to definitive surgical intervention. The primary aims of this approach are to: 1) reduce tumor burden thereby permitting breast conservation rather than mastectomy; 2) promptly treat possible metastatic disease, whether or not it is detectable on preoperative staging; and 3) potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response. Accurate radiological assessment permits optimal management and planning in this population. However, assessment of tumor size and response to treatment can vary depending on the modality used, the measurement technique (such as single longest diameter, 3-D measurements, or calculated tumor volume), and varied response of different tumor subtypes to neoadjuvant chemotherapy (such as concentric shrinkage or tumor fragmentation). As discussed in further detail, digital mammography, digital breast tomosynthesis, US and MRI represent the key modalities with potential to help guide patient management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. Motivation and mobile devices: exploring the role of appropriation and coping strategies

    Directory of Open Access Journals (Sweden)

    Ann Jones

    2007-12-01

    Full Text Available There has been interest recently in how mobile devices may be motivating forces in the right contexts: for example, one of the themes for the IADIS International Conference on Mobile Learning in 2007 was ‘Affective Factors in Learning with Mobile Devices' (http://www.mlearningconf.org. The authors have previously proposed six aspects of learning with mobile devices in informal contexts that might be motivating: control over learners' goals, ownership, fun, communication, learning-in-context and continuity between contexts. How do these motivational features relate to theoretical accounts of what motivates people to use mobile devices and learn in technology- rich contexts? In this exploratory paper we consider two different candidates for such theoretical approaches. One is technology appropriation–the process by which technology or particular technological artefacts are adopted and shaped in use. Two different approaches to technology appropriation are discussed in order to explore the relationship between the different aspects of appropriation and motivation; that of Carroll et al. and that of Waycott. Both appropriation frameworks have been developed in the context of using mobile devices, but neither has a specific focus on learning. By contrast, the second theoretical approach is Järvelä et al.'s model of coping strategies, which is specifically concerned with learning with technologies, although not with mobile technologies in particular. The paper draws on case-study data in order to illustrate and discuss the extent to which these two approaches are helpful in informing our understanding of the motivating features of using mobile devices for informal learning.

  20. Coronary CT angiography: How should physicians use it wisely and when do physicians request it appropriately?

    International Nuclear Information System (INIS)

    Sun Zhonghua; Aziz, Yang Faridah Abdul; Ng, Kwan-Hoong

    2012-01-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.

  1. Interdisciplinary Cooperation in the Exploration of appropriate sites for the Radioactive Waste Deposition

    Directory of Open Access Journals (Sweden)

    Jozef Slavkovský

    2007-01-01

    Full Text Available The article deals with the interdisciplinary cooperation in the processes of exploration of appropriate sites for radioactive waste deposits. This work is based on trends in the environmental laws for radioactive wastes. For the exploration, a knowledge about the geological structures, properties of rocks and safety manipulation with radioactive wastes are necessary. The interdisciplinary cooperation is needed with geophysics to define the particularly hazardous areas of an earthquake shaking. In this article, a method of the seismic analysis by Ricker impuls and Gabor´s function are presented.

  2. A neutron time of flight spectrometer appropriate for D-T plasma diagnostics

    International Nuclear Information System (INIS)

    Elevant, T.

    1984-02-01

    A neutron time-of-flight spectrometer with 2 m flight path for diagnostics of deuterium plasmas in JET is presently under construction. An upgrade of this spectrometer to make it appropriate for 14-MeV neutron spectroscopy is presented here. It is suggested to use backscattering in a deuterium based scintillator. The flight path length is 1-2 m and the efficiency is of the order of 2.10 -5 cm -5 . Results from test of principle are presented with estimates for neutron and gamma backgrounds

  3. On framing the research question and choosing the appropriate research design.

    Science.gov (United States)

    Parfrey, Patrick S; Ravani, Pietro

    2015-01-01

    Clinical epidemiology is the science of human disease investigation with a focus on diagnosis, prognosis, and treatment. The generation of a reasonable question requires definition of patients, interventions, controls, and outcomes. The goal of research design is to minimize error, to ensure adequate samples, to measure input and output variables appropriately, to consider external and internal validities, to limit bias, and to address clinical as well as statistical relevance. The hierarchy of evidence for clinical decision-making places randomized controlled trials (RCT) or systematic review of good quality RCTs at the top of the evidence pyramid. Prognostic and etiologic questions are best addressed with longitudinal cohort studies.

  4. The snow vole (Chionomys nivalis) as an appropriate environmental bioindicator in alpine ecosystems

    International Nuclear Information System (INIS)

    Metcheva, Roumiana; Beltcheva, Michaela; Chassovnikarova, Tsenka

    2008-01-01

    The snow vole (Chionomys nivalis, Martins, 1842) is a common species in the Bulgarian high mountains. Its populations are distributed in different altitudes, regions, and keep stable population density. This is the reason the species has been tested as a bioindicator for environmental quality in alpine ecosystems. The cumulative environmental impact in snow vole populations was evaluated using cytogenetical, hematological, ecotoxicological, radiometrical, ecophysiological, and morphophysiological indices. Standard karyotype, chromosomal aberrations, and other diversions have been observed. These investigations reveal that the snow vole is one of the most appropriate species that can be used as a biomonitor for environmental assessment in mountain areas

  5. Determining level of care appropriateness in the patient journey from acute care to rehabilitation

    Science.gov (United States)

    2011-01-01

    Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including

  6. [How to choose appropriate surgical approach in removal of the eyeball].

    Science.gov (United States)

    Ye, Juan; Ning, Qingyao

    2014-08-01

    We often consult patients with non-functional eye caused by trauma, intraocular malignancy, absolute stage of glaucoma and other diseases who need to remove the eyeball in our clinical work. Eye removal is an irreversibly destructive procedure, which mainly include enucleation and evisceration. There are various surgical techniques which are still controversial. Both of the two procedures have their own advantages, disadvantages, indications and contraindications. The ophthalmologists should comprehensively consider the disease situations, medical conditions and the requirements of the patients when choosing appropriate surgical approach to remove the eyeball.

  7. [The listening doctor; appropriate care in the last phase of life].

    Science.gov (United States)

    Molenaar, Jan C

    2015-01-01

    In his report 'Everything that can be done should not necessarily be done. Appropriate care in the last phase of life', the chairman of the steering committee of the Royal Dutch Medical Association says: 'I wish that doctors would listen to their patients.' This wish sets the tone of the report, which signals overtreatment in patients' last years of life and advocates a more restrained approach by doctors in this phase. The message is, however, that for this to take place a complete U-turn in modern medical thinking and management is needed.

  8. Monitoring strategies and scale appropriate hydrologic and biogeochemical modelling for natural resource management

    DEFF Research Database (Denmark)

    Bende-Michl, Ulrike; Volk, Martin; Harmel, Daren

    2011-01-01

    This short communication paper presents recommendations for developing scale-appropriate monitoring and modelling strategies to assist decision making in natural resource management (NRM). These ideas presented here were discussed in the session (S5) ‘Monitoring strategies and scale...... and communication between researcher and model developer on the one side, and natural resource managers and the model users on the other side to increase knowledge in: 1) the limitations and uncertainties of current monitoring and modelling strategies, 2) scale-dependent linkages between monitoring and modelling...

  9. Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia

    Directory of Open Access Journals (Sweden)

    Kabbara WK

    2015-04-01

    Full Text Available Wissam K Kabbara,1 Wijdan H Ramadan,1 Peggy Rahbany,2 Souhaila Al-Natour3 1Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon; 2Children’s National Medical Center, Washington, DC, USA; 3Medex Pharmaceutical Company, Beirut, Lebanon Background: Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged.Objective: The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia in diabetic and nondiabetic patients.Methods: A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin were identified. Patients were mainly recruited from internal medicine floors and intensive care units.Results: The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%, followed by levofloxacin (42.4% and moxifloxacin (7.6%. Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%, followed by ciprofloxacin (39.0% and moxifloxacin (33.3%. In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was

  10. The 1995 forum on appropriate criteria and methods for seismic design of nuclear piping

    International Nuclear Information System (INIS)

    Slagis, G.C.

    1996-01-01

    A record of the 1995 Forum on Appropriate Criteria and Methods for Seismic Design of Nuclear Piping is provided. The focus of the forum was the earthquake experience data base and whether the data base demonstrates that seismic inertia loads will not cause failure in ductile piping systems. This was a follow-up to the 1994 Forum when the use of earthquake experience data, including the recent Northridge earthquake, to justify a design-by-rule method was explored. Two possible topics for the next forum were identified--inspection after an earthquake and design for safe-shutdown earthquake only

  11. Measuring, Reporting, Verifying. A Primer on MRV for Nationally Appropriate Mitigation Actions

    DEFF Research Database (Denmark)

    Lütken, Søren; Aalders, Edwin; Pretlove, Bente

    This publication is intended to enable national policy makers and other stakeholders, such as the private sector and technical experts, to acquaint themselves with the concept of NAMA. It aims to provide a comprehensive overview of the Nationally Appropriate Mitigation Action (NAMA) concept...... and enhance the understanding of NAMAs by explaining the underlying decisions of the Conference of the Parties in layman’s terms. The first chapter describes how the concept of NAMA emerged in the context of the negotiations on climate change. The chapter gives an overview of how the concepts of NAMA...

  12. A Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China.

    Science.gov (United States)

    Zhu, Changtai; Gao, Yulu; Li, Zhiqiang; Li, Qinyun; Gao, Zongshuai; Liao, Yanqiu; Deng, Zhifeng

    2015-12-01

    The issue of the clinical appropriateness of blood transfusion has become a focus of transfusion medicine worldwide. In China, irrational uses of blood have often been reported in recent years. However, to date there lacks a systematic review of the rational uses of blood. This study aimed to determine the clinical appropriateness of blood transfusion in China. We searched PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, WanFang Database, and Chinese BioMedical Literature Database, and the retrieval cut-off date was June 31, 2015. SPSS 17.0 and MetaAnalyst 3.13 were employed as the statistics tools in this review. A pooled rate of clinical inappropriateness of transfusion was analyzed by DerSimonian-Laird method. In this study, a total of 39 observational studies were included, which related to 75,132 cases of blood transfusion. According to the meta-analysis results, the overall incidence of clinical inappropriateness of transfusion in China was estimated to be 37.3% (95% confidence interval [CI] [32.1, 42.8]). The subgroup analyses revealed that the pooled rates of clinical inappropriateness of transfusion of plasma, red blood cells (RBCs), cryoprecipitate, and platelets were 56.3% (95% CI [45.8, 66.2]), 30.9% (95% CI [27.1, 35.0]), 25.2% (95% CI [13.2, 42.7]), and 14.1% (95% CI [8.8, 21.9]), respectively. However, the pooled incidence of inappropriateness of transfusion in operative departments was 47.5% (95% CI [36.8, 58.3]), which was significantly higher than that in nonoperative departments, 25.8% (95% CI [18.7, 34.4], P  0.05). In conclusion, China has suffered from a disadvantage in the clinical appropriateness of blood transfusion, especially in plasma and RBC use. In future, comprehensive measures should be implemented in order to improve the clinical appropriateness of blood transfusion.

  13. Are factor analytical techniques used appropriately in the validation of health status questionnaires?

    DEFF Research Database (Denmark)

    de Vet, Henrica C W; Adér, Herman J; Terwee, Caroline B

    2005-01-01

    Factor analysis is widely used to evaluate whether questionnaire items can be grouped into clusters representing different dimensions of the construct under study. This review focuses on the appropriate use of factor analysis. The Medical Outcomes Study Short Form-36 (SF-36) is used as an example...... of the results and conclusions was often incomplete. Some of our results are specific for the SF-36, but the finding that both the application and the reporting of factor analysis leaves much room for improvement probably applies to other health status questionnaires as well. Optimal reporting and justification...

  14. Human Dignity and the Commercial Appropriation of Personality: Towards a Cosmopolitan Consensus in Publicity Rights?

    Directory of Open Access Journals (Sweden)

    Olaf Weber

    2004-03-01

    Full Text Available This article is concerned with the commercial appropriation of human personality and its regulation in different legal systems. Where accepted, so called “publicity rights” allow for the exclusive commercial exercise of a persona’s publicity values. A tradable worth can be found in many personal characteristics such as voice, signature or pseudonym. Predominantly, however, it accrues to one’s name and likeness. It is argued that such potential rights are inherent in every human being.

  15. Features for culturally appropriate avatars for behavior-change promotion in at-risk populations

    Directory of Open Access Journals (Sweden)

    Lisetti C

    2009-09-01

    Full Text Available We explore how avatars can be used as social orthotics defined as therapeutic computer-based social companions aimed at promoting healthy behaviors. We review some of the health interventions deployed in helping at-risk populations along with some of the unique advantages that computer-based interventions can add to face-to-face interventions. We posit that artificial intelligence has rendered possible the creation of culturally appropriate dialog-agents for interventions and we identify specific features for social avatars that are important - if not necessary - when applied to the domain of social orthotic systems for health promotion.

  16. Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya

    Directory of Open Access Journals (Sweden)

    Yoshito Kawakatsu

    2017-02-01

    Full Text Available Abstract Background The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW. The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. Methods The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS. In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Results Factors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Conclusions Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate

  17. The snow vole (Chionomys nivalis) as an appropriate environmental bioindicator in alpine ecosystems

    Energy Technology Data Exchange (ETDEWEB)

    Metcheva, Roumiana [Institute of Zoology, Bulgarian Academy of Science, 1, Tzar Osvoboditel blvd., Sofia, 1000 Bulgaria (Bulgaria)], E-mail: rummech@yahoo.com; Beltcheva, Michaela; Chassovnikarova, Tsenka [Institute of Zoology, Bulgarian Academy of Science, 1, Tzar Osvoboditel blvd., Sofia, 1000 Bulgaria (Bulgaria)

    2008-03-01

    The snow vole (Chionomys nivalis, Martins, 1842) is a common species in the Bulgarian high mountains. Its populations are distributed in different altitudes, regions, and keep stable population density. This is the reason the species has been tested as a bioindicator for environmental quality in alpine ecosystems. The cumulative environmental impact in snow vole populations was evaluated using cytogenetical, hematological, ecotoxicological, radiometrical, ecophysiological, and morphophysiological indices. Standard karyotype, chromosomal aberrations, and other diversions have been observed. These investigations reveal that the snow vole is one of the most appropriate species that can be used as a biomonitor for environmental assessment in mountain areas.

  18. Overview of hypertext and hypermedia systems and tools appropriate for structural and materials engineering

    International Nuclear Information System (INIS)

    Arents, H.C.; Bogaerts, W.F.L.

    1991-01-01

    After a concise description of the operational characteristics and the information consultation potential of hypertext and hypermedia systems, we discuss in detail the key system characteristics one has to look at when selecting commercially available hypertext and hypermedia products which are appropriate for structural and materials engineering. We then compare a number of PC-based, Macintosh-based and workstation-based hypertext and hypermedia systems and tools, highlighting the key features of each product. Finally, we briefly point to an existing materials engineering hypermedia application and discuss how hypermedia systems might be combined with expert systems to achieve added functionality and reliability. (orig./DG)

  19. Determining level of care appropriateness in the patient journey from acute care to rehabilitation

    Directory of Open Access Journals (Sweden)

    Bashford Guy

    2011-10-01

    Full Text Available Abstract Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days. Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients and 33% (other patients, from the time of referral. Most inappropriate days in acute care were due to delays in processes/scheduling (45% or being more appropriate for rehabilitation or lower level of care (30%. On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively. From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of

  20. Statistics corner: A guide to appropriate use of correlation coefficient in medical research.

    Science.gov (United States)

    Mukaka, M M

    2012-09-01

    Correlation is a statistical method used to assess a possible linear association between two continuous variables. It is simple both to calculate and to interpret. However, misuse of correlation is so common among researchers that some statisticians have wished that the method had never been devised at all. The aim of this article is to provide a guide to appropriate use of correlation in medical research and to highlight some misuse. Examples of the applications of the correlation coefficient have been provided using data from statistical simulations as well as real data. Rule of thumb for interpreting size of a correlation coefficient has been provided.

  1. A combined method to estimate the appropriate age value of closed uraniun-lead system

    International Nuclear Information System (INIS)

    Malakhov, S.S.

    1982-01-01

    A new method is proposed for obtaining the appropriate age values of closed uranium-lead systems taking into account total indeependent information delivered as a result of spectral and isotope-lead analyses. A simple mathematical apparatus which permits to perform a geochronological interpretation of samples using miniature computers is considered and suggested. A simple estimation formula for determining the age of uranium-lead systems under the assumption of model development of isotope ratios of ordinary lead is derived and tested basing on the facts

  2. Cost-appropriateness of whole body vs limited bone imaging for suspected focal sports injuries

    International Nuclear Information System (INIS)

    Nagle, C.E.

    1986-01-01

    Bone imaging has been recognized as a useful diagnostic tool in detecting the presence of focal musculoskeletal injury when radiographs are normal. A retrospective review of bone images in a small number of amateur athletes indicates that secondary injuries were commonly detected at sites different from the site of musculoskeletal pain being evaluated for injury. While a larger study will be necessary to confirm the data, this review suggests that it is medically justified and cost-appropriate to perform imaging of the entire skeleton as opposed to imaging limited to the anatomic site of pain and suspected injury

  3. ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI.

    Science.gov (United States)

    Lingenfelter, Erin; Drapkin, Zachary; Fritz, Kelly; Youngquist, Scott; Madsen, Troy; Fix, Megan

    2016-08-01

    We sought to determine whether an emergency department (ED) pharmacist could aid in the monitoring and correction of inappropriate empiric antibiotic selection for urinary tract infections in an outpatient ED population. Urine cultures with greater than 100 000 CFU/mL bacteria from the University of Utah Emergency Department over 1 year (October 2011-Sept 2012) were identified using our electronic medical record system. Per ED protocol, an ED pharmacist reviews all cultures and performs a chart review of patient symptoms, diagnosis, and discharge antibiotics to determine whether the treatment was appropriate. A retrospective review of this process was performed to identify how often inappropriate treatment was recognized and intervened on by an ED pharmacist. Of the 180 cultures included, a total of 42 (23%) of empiric discharge treatments were considered inappropriate and required intervention. In 35 (83%) of 42 patients, the ED pharmacist was able to contact the patient and make appropriate changes; the remaining 7 patients were unable to be contacted, and no change could be made in their treatment. A chart review of all urine cultures with greater than 100 000 CFU/mL performed by an ED pharmacist helped identify inappropriate treatment in 23% of patients discharged to home with the diagnosis of urinary tract infection. Of these patients who had received inappropriate treatment, an ED pharmacist was able to intervene in 83% of cases. These data highlight the role of ED pharmacists in improving patient care after discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The disconnect in the appropriation of new technologies into students’ everyday lives. A three country comparison.

    Directory of Open Access Journals (Sweden)

    André H. Caron

    2011-12-01

    Full Text Available There is little doubt that students eagerly appropriate new technologies into their lives.  However, the authors wanted to explore what steps would be needed to ensure a proper appropriation of new technologies when applied to academic settings.  This paper presents a 3-country comparison of students reporting on their academic activities and technology use in everyday life. Though the numbers vary slightly within each country, the final results show an overall disconnect between the amount of time students allot to technology use and academic activities. Overall, the findings shed some much needed statistical light on the current reality of students’ technological and academic habits. The authors propose possible next steps to take in order to better understand this phenomenon. Ultimately, this study urges educators and students alike to gather more information about the role social media plays in students’ lives. A better understanding of the situation could eventually lead to the successful integration of new technologies in academia.

  5. Put on that colour, it fits your emotion: Colour appropriateness as a function of expressed emotion.

    Science.gov (United States)

    Dael, Nele; Perseguers, Marie-Noëlle; Marchand, Cynthia; Antonietti, Jean-Philippe; Mohr, Christine

    2016-01-01

    People associate affective meaning with colour, and this may influence decisions about colours. Hue is traditionally considered the most salient descriptor of colour and colour-affect associations, although colour brightness and saturation seem to have particularly strong affective connotations. To test whether colour choices can be driven by emotion, we investigated whether and how colour hue, brightness, and saturation are systematically associated with bodily expressions of positive (joy) and negative (fear) emotions. Twenty-five non-colour-blind participants viewed videos of these expressions and selected for each video the most appropriate colour using colour sliders providing values for hue, brightness, and saturation. The overall colour choices were congruent with the expressed emotion--that is, participants selected brighter and more saturated colours for joy expressions than for fear expressions. Also, colours along the red-yellow spectrum were deemed more appropriate for joy expressions and cyan-bluish hues for fear expressions. The current study adds further support to the role of emotion in colour choices by (a) showing that emotional information is spontaneously used in an unconstrained choice setting, (b) extending to ecologically valid stimuli occurring in everyday encounters (dressed bodies), and (c) suggesting that all colour parameters are likely to be important when processing affective nonverbal person information, though not independently from each other.

  6. Computing a ground appropriateness index for route selection in permafrost regions

    Directory of Open Access Journals (Sweden)

    Chi Zhang

    2017-10-01

    Full Text Available The reasonable calculation of ground appropriateness index in permafrost region is the precondition of highway route design in permafrost region. The theory of knowledge base and fuzzy mathematics are applied, and the damage effect of permafrost is considered in the paper. Based on the idea of protecting permafrost the calculation method of ground appropriateness index is put forward. Firstly, based on the actual environment conditions, the paper determines the factors affecting the road layout in permafrost areas by qualitative and quantitative analysis, including the annual slope, the average annual ground temperature of permafrost, the amount of ice in frozen soil, and the interference engineering. Secondly, based on the knowledge base theory and the use of Delphi method, the paper establishes the knowledge base, the rule base of the permafrost region and inference mechanism. The method of selecting the road in permafrost region is completed and realized by using the software platform. Thirdly, taking the Tuotuo River to Kaixin Mountain section of permafrost region as an example, the application of the method is studied by using an ArcGIS platform. Results show that the route plan determined by the method of selecting the road in permafrost region can avoid the high temperature and high ice content area, conform the terrain changes and evade the heat disturbance among the existing projects. A reasonable route plan can be achieved, and it can provide the basis for the next engineering construction.

  7. Hypnosis control based on the minimum concentration of anesthetic drug for maintaining appropriate hypnosis.

    Science.gov (United States)

    Furutani, Eiko; Nishigaki, Yuki; Kanda, Chiaki; Takeda, Toshihiro; Shirakami, Gotaro

    2013-01-01

    This paper proposes a novel hypnosis control method using Auditory Evoked Potential Index (aepEX) as a hypnosis index. In order to avoid side effects of an anesthetic drug, it is desirable to reduce the amount of an anesthetic drug during surgery. For this purpose many studies of hypnosis control systems have been done. Most of them use Bispectral Index (BIS), another hypnosis index, but it has problems of dependence on anesthetic drugs and nonsmooth change near some particular values. On the other hand, aepEX has an ability of clear distinction between patient consciousness and unconsciousness and independence of anesthetic drugs. The control method proposed in this paper consists of two elements: estimating the minimum effect-site concentration for maintaining appropriate hypnosis and adjusting infusion rate of an anesthetic drug, propofol, using model predictive control. The minimum effect-site concentration is estimated utilizing the property of aepEX pharmacodynamics. The infusion rate of propofol is adjusted so that effect-site concentration of propofol may be kept near and always above the minimum effect-site concentration. Simulation results of hypnosis control using the proposed method show that the minimum concentration can be estimated appropriately and that the proposed control method can maintain hypnosis adequately and reduce the total infusion amount of propofol.

  8. Tracer methodology: an appropriate tool for assessing compliance with accreditation standards?

    Science.gov (United States)

    Bouchard, Chantal; Jean, Olivier

    2017-10-01

    Tracer methodology has been used by Accreditation Canada since 2008 to collect evidence on the quality and safety of care and services, and to assess compliance with accreditation standards. Given the importance of this methodology in the accreditation program, the objective of this study is to assess the quality of the methodology and identify its strengths and weaknesses. A mixed quantitative and qualitative approach was adopted to evaluate consistency, appropriateness, effectiveness and stakeholder synergy in applying the methodology. An online questionnaire was sent to 468 Accreditation Canada surveyors. According to surveyors' perceptions, tracer methodology is an effective tool for collecting useful, credible and reliable information to assess compliance with Qmentum program standards and priority processes. The results show good coherence between methodology components (appropriateness of the priority processes evaluated, activities to evaluate a tracer, etc.). The main weaknesses are the time constraints faced by surveyors and management's lack of cooperation during the evaluation of tracers. The inadequate amount of time allowed for the methodology to be applied properly raises questions about the quality of the information obtained. This study paves the way for a future, more in-depth exploration of the identified weaknesses to help the accreditation organization make more targeted improvements to the methodology. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Pharmaceutical assistance in the enteral administration of drugs: choosing the appropriate pharmaceutical formulation

    Directory of Open Access Journals (Sweden)

    Gisele de Lima

    2009-03-01

    Full Text Available Objective: To study solid medications for oral delivery on the formulary of Hospital Israelita Albert Einstein (HIAE, investigating the  possibility of using these drugs through enteral feeding tubes, and recommending appropriate administration. Methods: Study carried out through survey of solid medications for oral delivery included on the formulary of HIAE, literature review, and analysis of medication monographs, manufacturer information and pharmacotechnical data of active ingredients and excipients. It was observed the factors that might hinder or complicate the administration of these drugs though enteral tubes, and was drawn an information chart with recommendations about drug administration in this context. Rresults: The study evaluated 234 medications; and the main problems of administering these drugs through enteral feeding tubes were as follows: changes in drug pharmacokinetics (38; gastrointestinal damage (9; risk of obstruction (40, drug-nutrient interactions (7; biological hazards (5 and no information (33. Cconclusions: Compiling this information helps the healthcare team to choose the appropriate pharmaceutical formulation for medications administered through enteral tubes, and may help identify adverse events related to this technique.

  10. The appropriation of contents in the subject Technology of Masonry in Technical and Professional Education

    Directory of Open Access Journals (Sweden)

    Felix Noel Hernández Torres

    2017-07-01

    Full Text Available In technical and professional education, the study on how to make teaching and learning more efficient is a preponderant place. In this sense, the purpose of the work was to base basic aspects of the process of appropriation of contents in the subject of Masonry Technology, during the training of the qualified worker of this specialty for his competent insertion in the labor world. The research process was carried out on a dialectical-materialist basis and methods were used from the theoretical level, from the empirical level and statistical-mathematical, such as the system approach, modeling, analysis and synthesis, observation, interview and documentary analysis and from the descriptive statistics the percentage analysis, which allowed the diagnosis of the educational reality and the evidence of the practical validity of the work. The level of appropriation of content was based on the extent to which students were able to show the skills required during the solution, in practice, of the dissimilar problems that in the constructive scope arose in the context school-business.

  11. Exact and conceptual repetition dissociate conceptual memory tests: problems for transfer appropriate processing theory.

    Science.gov (United States)

    McDermott, K B; Roediger, H L

    1996-03-01

    Three experiments examined whether a conceptual implicit memory test (specifically, category instance generation) would exhibit repetition effects similar to those found in free recall. The transfer appropriate processing account of dissociations among memory tests led us to predict that the tests would show parallel effects; this prediction was based upon the theory's assumption that conceptual tests will behave similarly as a function of various independent variables. In Experiment 1, conceptual repetition (i.e., following a target word [e.g., puzzles] with an associate [e.g., jigsaw]) did not enhance priming on the instance generation test relative to the condition of simply presenting the target word once, although this manipulation did affect free recall. In Experiment 2, conceptual repetition was achieved by following a picture with its corresponding word (or vice versa). In this case, there was an effect of conceptual repetition on free recall but no reliable effect on category instance generation or category cued recall. In addition, we obtained a picture superiority effect in free recall but not in category instance generation. In the third experiment, when the same study sequence was used as in Experiment 1, but with instructions that encouraged relational processing, priming on the category instance generation task was enhanced by conceptual repetition. Results demonstrate that conceptual memory tests can be dissociated and present problems for Roediger's (1990) transfer appropriate processing account of dissociations between explicit and implicit tests.

  12. Analysis of volatile organic compounds in compost samples: A potential tool to determine appropriate composting time.

    Science.gov (United States)

    Zhu, Fengxiang; Pan, Zaifa; Hong, Chunlai; Wang, Weiping; Chen, Xiaoyang; Xue, Zhiyong; Yao, Yanlai

    2016-12-01

    Changes in volatile organic compound contents in compost samples during pig manure composting were studied using a headspace, solid-phase micro-extraction method (HS-SPME) followed by gas chromatography with mass spectrometric detection (GC/MS). Parameters affecting the SPME procedure were optimized as follows: the coating was carbon molecular sieve/polydimethylsiloxane (CAR/PDMS) fiber, the temperature was 60°C and the time was 30min. Under these conditions, 87 compounds were identified from 17 composting samples. Most of the volatile components could only be detected before day 22. However, benzenes, alkanes and alkenes increased and eventually stabilized after day 22. Phenol and acid substances, which are important factors for compost quality, were almost undetectable on day 39 in natural compost (NC) samples and on day 13 in maggot-treated compost (MC) samples. Our results indicate that the approach can be effectively used to determine the composting times by analysis of volatile substances in compost samples. An appropriate composting time not only ensures the quality of compost and reduces the loss of composting material but also reduces the generation of hazardous substances. The appropriate composting times for MC and NC were approximately 22days and 40days, respectively, during the summer in Zhejiang. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.

    Science.gov (United States)

    Georgopoulou, Antonia-Panagiota; Savva, Athina; Giamarellos-Bourboulis, Evangelos J; Georgitsi, Marianna; Raftogiannis, Maria; Antonakos, Nicolaos; Apostolidou, Efterpi; Carrer, Dionyssia-Pinelopi; Dimopoulos, George; Economou, Aggelos; Efthymiou, George; Galanakis, Nearchos; Galani, Labrini; Gargalianos, Panagiotis; Karaiskos, Ilias; Katsenos, Chrisostomos; Kavatha, Dimitra; Koratzanis, Evangelos; Labropoulos, Panagiotis; Lada, Malvina; Nakos, George; Paggalou, Evgenia; Panoutsopoulos, George; Paraschos, Michael; Pavleas, Ioannis; Pontikis, Konstantinos; Poulakou, Garyfallia; Prekates, Athanassios; Sybardi, Styliani; Theodorakopoulou, Maria; Trakatelli, Christina; Tsiaoussis, Panagiotis; Gogos, Charalambos; Giamarellou, Helen; Armaganidis, Apostolos; Meisner, Michael

    2011-06-01

    The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. The teaching media in the process of appropriation of professional content

    Directory of Open Access Journals (Sweden)

    Yudelsi Morales Paez

    2018-01-01

    Full Text Available This article refers to the need to improve the appropriation of the professional contents of the subject of Food Conservation in the third year students of Food Technology of CP Rigoberto Fuentes Pérez of Pinar del Río. An analysis of the background and conditions that led to its emergence is shown. By means of these antecedents it is possible to declare the need to improve this process of appropriation through the use of previously conceived teaching methods, which will greatly favour the solution to professional problems and a better professional performance during the work practice. The objective proposed for this article was directed to the elaboration of a deep diagnosis that will corroborate the detected social problem, based on the results of a group of instruments such as observation to classes, the documentary review, the interview to the professors, the survey and the pedagogical test. The research has as a methodological basis the dialectical-materialist method, with the use of methods of the theoretical, empirical and statistical techniques. The use of teaching aids where the situations observed by the students coincide with the practical activity is a process that is an essential way to increase knowledge, the creation of professional skills and the formation of values in the subsequent professional performance of the graduates of the Food Conservation specialty.

  15. Developing Criteria for Lumbar Spine Magnetic Resonance Imaging (MRI) Using RAND Appropriateness Method (RAM)

    International Nuclear Information System (INIS)

    Keshtkaran, Ali; Bagheri, Mohammad Hadi; Ostovar, Rahim; Salari, Hedayat; Farokhi, Majid Reza; Esfandiari, Atefeh; Yousefimanesh, Hossein

    2012-01-01

    Studies show that a large proportion of healthcare offered may be inappropriate or unnecessary. Magnetic resonance imaging (MRI) is a new and expensive diagnostic technology which has been increasingly used all over the world. Moreover, this trend has been more rapidly increasing in Iran. Low back pain is a common disorder all over the world and MRI technique is one of the several ways to assess its cause. The present study aims to develop scenarios for lumbar spine MRI. In the present study, the RAND Appropriateness Method (RAM) was used in order to reach consensus regarding developing scenarios for lumbar spine MRI. We generated scenarios from valid clinical guidelines as well as the experts’ opinion. The panel members included nine specialists from various medical specialties that had scored scenarios in two rounds, the first of which was without interaction, while the second one was with interaction. We extracted 97 scenarios for the lumbar spine MRI in the scenario extracting phase of the study and the panel members added 18 scenarios. After implementation of two rounds, the scenarios were categorized into three ranges. Sixty seven (58%) of the scenarios were considered as appropriate, 45 (39%) as uncertain, and three (2.6%) as inappropriate. RAM is useful for identifying stakeholder views in settings with limited resources. Since RAM has precise instructions for consensus developing, a large number of scenarios were considered as uncertain. Therefore, more research has to be conducted on the issue

  16. Appropriate Urban Livability Indicators for Metropolitan Johor, Malaysia via Expert-Stakeholder Approach: a Delphi technique

    Directory of Open Access Journals (Sweden)

    Dario Gallares Pampanga

    2015-11-01

    Full Text Available Metro Johor is one of the fast emerging metropolitan urban centers where its current progress and spatial transformation have made it a key player in the economic growth of Malaysia. The recent creation of the Iskandar Malaysia, an economic strategy which aims to be a global player as potential destination for high-value investments, has certainly added social, environmental and economic stress to its urban citizens. This paper intends to develop urban livability indicators for Metropolitan Johor anchored on the changing urban complexion in the face of climate change, economic, governance, social and cultural dynamics, among others. The urban livability conundrum of Metro Johor illustrates that indicators are imperative, especially policy-based indicators, which would aid to scale-up the desired progress according to urban livability metrics. The study involves iterative 3-rounds of Delphi blind survey with Likert scale’s degree of agreement, and finally assigning weightings to each sub-indicator. Thus, with the expert-stakeholders involvement, constituting broad-sectoral community representation, a robust and appropriate urban livability index for Metro Johor was generated - a comprehensive framework yet prospective benchmark in appropriating timely policy decisions that would redound to the benefit of urban citizens ensuring a livable Metropolitan Johor.

  17. Determining the Appropriate Economic Strategy to Conserve Groundwater Resources in Qazvin Plain

    Directory of Open Access Journals (Sweden)

    Abozar Parhizkari

    2016-02-01

    Full Text Available Qazvin plain is one of the capable plains in Iran to produce of agricultural goods. Unfortunately, due to inordinate shafts digging and irregular use of groundwater the level of groundwater has been decreased during two last decades so that water balance is negative now. To conserve the groundwater resources in this plain, strategies and appropriate policies are needed and this requires a better understanding of farmers’ behavior. Therefore, in the present study in order to investigate farmers' behavior in using of groundwater and determine appropriate strategies to conserve of groundwater resources in Qazvin plain, positive mathematical programming and production function with constant elasticity of substitution were used. The investigated strategies included increase in water price, decrease in water availability and deficit irrigation strategy and were investigated under various scenarios. The required data were registered information related to 2011-2012 collected from relevant departments in Qazvin province. The model was solved using GAMS 23/9 software. The results showed that all the investigated strategies led to water saving however the average gross profit changes decreased by 3.13, 8.61 and 5.54 percent with increasing water price, decrease in water availability and deficit irrigation, respectively. Finally, considering the less reduction in average gross profit, the irrigation water pricing and then deficit irrigation strategies were proposed to conserve groundwater resources in Qazvin plain.

  18. Water and the human culture of appropriation: the Vaal River up to 1956

    Directory of Open Access Journals (Sweden)

    Johann W.N. Tempelhoff

    2006-04-01

    Full Text Available There is discernable evidence of the human presence having historically appropriated the 1300 kilometer long Vaal River of South Africa as it extends itself from the Drakensberg Plateau into the arid Karoo region. This hard-working tributary of the Orange River, which was instrumental as a supply of water to the Witwatersrand, in the era of the region’s gold mines, has been used by humans in a variety of ways. First it was used as a route of communications, then as a borderline demarcating the territorial spaces of states and colonies. Later it was used for purposes of economic development. In the study the objective is to point towards the manner in which humans have influenced the river and its hinterland, particularly from the nineteenth century, up to the 1950s. The process of appropriation, it is argued, has had a different effect when humans laid claim to the river and its environment for social, economic and political purposes.

  19. H.R. 2605: Energy and Water Development Appropriations Act, 2000

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    Appropriations are made for the following purposes: (1) Corps of Engineers for general investigations, construction, flood control, operation and maintenance, regulatory program, general expenses, revolving fund, and administrative provision; (2) Dept. of the Interior for the central Utah project, Bureau of Reclamation, water and related resources, Central Valley project restoration fund, California Bay-Delta restoration, and administrative provisions; (3) Dept. of Energy for energy supply, non-defense environmental management, uranium enrichment decontamination and decommissioning fund, science, nuclear waste disposal, and departmental administration; (4) Atomic Energy Defense activities for weapon activities, defense environmental restoration and waste management, defense environmental management privatization, and defense nuclear waste disposal; (5) Power marketing administrations for Bonneville Power Administration fund, operation and maintenance of the Southeastern Power Administration, the Southwestern Power Administration, the Western Area Power Administration, Falcon and Amistad operating and maintenance fund, and salaries and expenses for FERC; (6) Independent agencies including Appalachian Regional Commission, Denali Commission, Defense Nuclear Facilities Safety Board, Nuclear Regulatory Commission, Office of Inspector General, Nuclear Waste Technical Review Board, and the Tennessee Valley Authority fund. Certain appropriations are also rescinded.

  20. Mapping an appropriate health promotion approach for crèches in an informal settlement.

    Science.gov (United States)

    Brijlal, P; Gordon, N

    2005-02-01

    People living in informal settlements in South Africa experience the double burden of poverty and ill health. Wallacedene, an informal settlement was highlighted in the media as being a socially and otherwise deprived community, with many accompanying health problems. It was against this background that this study was conducted to gain a better understanding of the health and oral health status of children attending crèches in Wallacedene. It was designed to inform the mapping of an appropriate approach to develop a health promotion programme for crèches. Baseline data were collected through oral and general health examinations, site observations, a structured questionnaire and interviews with key people working with the children at two crèches. The results indicate poor oral and general health. Gingival inflammation (82.8%), caries (81.5%), and moderate to abundant plaque deposits (95.7%), fungal infections (33.9%), runny nose (51.4%), lymphadenopathy (45.7%) and itchy skin (5.7%) were found. Caregivers were not well informed about oral health. However, they were enthusiastic to engage in new interventions. The community was impoverished; public health interventions were limited with minimal resources such as health centres and voluntary service providers. The limited resources were not coordinated and did not adequately address the health and educational needs of the children. A multi-sectoral approach focusing on community development is an appropriate approach to address the needs of crèche children in this community.

  1. Catalog of CERCLA applicable or relevant and appropriate requirements (ARARs) - fact sheets

    Energy Technology Data Exchange (ETDEWEB)

    1990-07-01

    Section 121(d) of the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA), requires attainment of federal and state applicable or relevant and appropriate requirements (ARARs). Subpart E, Section 300.400(g) {open_quotes}Identification of applicable or relevant and appropriate requirements{close_quotes} of the National Oil and Hazardous Substances Pollution Contingency Plan (NCP)(55 FR 8666, March 8, 1990) describes the process for attaining ARARs. The purpose of this catalog is to provide DOE Program Offices and Field Organizations with all of the {open_quotes}Quick Reference Fact Sheets{close_quotes} on attaining ARARS. These fact sheets provide overviews of ARARs for CERCLA cleanup actions pertinent to DOE environmental restoration activities. All of the fact sheets in this catalog were prepared by the Environmental Protection Agency`s Office of Solid Waste and Emergency Response. Fact sheets 1-7 discuss land disposal restrictions (LDRs) and their applicability. LDRs may pertain to a number of CERCLA response actions at DOE facilities. Fact Sheets 8-13 are based on the CERCLA Compliance with Other Laws Manual: Parts I and II and provide an overview of many other CERCLA ARARs. Overview of ARARs-Focus on ARAR Waivers (fact sheet 11), provides a good introduction to ARARS. The last two fact sheets, 14 and 15, are periodic reports that describe additional fact sheets and clarify issues.

  2. Evaluation of Appropriate Reference Genes for Gene Expression Normalization during Watermelon Fruit Development.

    Directory of Open Access Journals (Sweden)

    Qiusheng Kong

    Full Text Available Gene expression analysis in watermelon (Citrullus lanatus fruit has drawn considerable attention with the availability of genome sequences to understand the regulatory mechanism of fruit development and to improve its quality. Real-time quantitative reverse-transcription PCR (qRT-PCR is a routine technique for gene expression analysis. However, appropriate reference genes for transcript normalization in watermelon fruits have not been well characterized. The aim of this study was to evaluate the appropriateness of 12 genes for their potential use as reference genes in watermelon fruits. Expression variations of these genes were measured in 48 samples obtained from 12 successive developmental stages of parthenocarpic and fertilized fruits of two watermelon genotypes by using qRT-PCR analysis. Considering the effects of genotype, fruit setting method, and developmental stage, geNorm determined clathrin adaptor complex subunit (ClCAC, β-actin (ClACT, and alpha tubulin 5 (ClTUA5 as the multiple reference genes in watermelon fruit. Furthermore, ClCAC alone or together with SAND family protein (ClSAND was ranked as the single or two best reference genes by NormFinder. By using the top-ranked reference genes to normalize the transcript abundance of phytoene synthase (ClPSY1, a good correlation between lycopene accumulation and ClPSY1 expression pattern was observed in ripening watermelon fruit. These validated reference genes will facilitate the accurate measurement of gene expression in the studies on watermelon fruit biology.

  3. Working with culture: culturally appropriate mental health care for Asian Americans.

    Science.gov (United States)

    Park, Mijung; Chesla, Catherine A; Rehm, Roberta S; Chun, Kevin M

    2011-11-01

    The aim of this study is to describe how mental healthcare providers adapted their practice to meet the unique needs of Asian Americans. As the number of ethnic minorities and multicultural patients and families rapidly increases, cultural competency becomes an essential skill for all healthcare providers. The lack of knowledge about how healthcare providers grapple with diverse cultures and cultural competency limits the ability of others to deliver patient-centred care across cultural lines. Interpretive phenomenology guided the design and conduct of this study. Twenty mental healthcare providers who treated Asian Americans were recruited. Narrative data were collected through face-to-face, in-depth interviews between 2006 and 2007. Three characteristics of culturally appropriate care for Asian Americans were identified. Cultural brokering: providers addressed issues stemming from cultural differences via bicultural skills education. Asian American patients generally received broader education than current literature recommended. Supporting families in transition: providers assisted Asian American families during transition from and to professional care. Using cultural knowledge to enhance competent care: providers' knowledge of Asian culture and flexible attitudes affected the care that they provided. Culturally competent providers were able to identify cultural issues that were relevant to the specific situation, and incorporated cultural solutions into the care provided. Culturally appropriate care is nuanced and context specific. Thus, more sophisticated and broader conceptualizations are necessary to prepare nurses for such complex practice. © 2011 Blackwell Publishing Ltd.

  4. Primary Care Perspectives on Hepatitis C Virus Screening, Diagnosis and Linking Patients to Appropriate Care.

    Science.gov (United States)

    Lebovics, Edward; Torres, Richard; Porter, Lucinda K

    2017-02-01

    Enormous progress has been made in recent years toward effectively treating and curing patients with chronic hepatitis C (CHC). However, at least half of the possible 7 million individuals infected with hepatitis C virus (HCV) in the US remain undiagnosed. The formidable task of increasing the number of patients diagnosed, and subsequently linked to appropriate care has fallen to primary care clinicians, who are mandated by some US States to offer screening to individuals born between 1945 and 1965 (the Baby Boomer Generation). This peer-reviewed video roundtable discussion http://hepcresource.amjmed.com/Content/jplayer/video_roundtable.html#video0 addresses the challenges encountered by primary care clinicians faced with the increasing societal need to screen for HCV, make appropriate diagnoses, and subsequently link infected patients to appropriate care. Discussion in this roundtable initially focuses on the offering of HCV screening to patients in primary care settings. Roundtable participants discuss the need for primary care clinicians to ask appropriate risk factor-based questions of their patients, especially if the ongoing HCV epidemic is to be curtailed. The participants note, however, that the majority of patients currently infected with HCV in the US are Baby Boomers, and USPTF guidelines require this population to be tested for HCV regardless of any past risk-taking behaviors. So while asking the right questions is important, the failure of a Baby Boomer to recall risk-taking behavior does not preclude HCV screening. In fact, clinicians should proactively screen all persons in this birth cohort, and be more sensitive and open to screening requests from these individuals. Roundtable participants also discuss how HCV screening results should be communicated to patients, and how physicians can keep patients engaged and not lost to follow-up after an initial positive HCV antibody test. Patients screened and found to be HCV antibody positive require a follow

  5. Appropriate design of auctions for renewable energy support – Prequalifications and penalties

    International Nuclear Information System (INIS)

    Kreiss, Jan; Ehrhart, Karl-Martin; Haufe, Marie-Christin

    2017-01-01

    Auctions are a promising tool to accomplish renewable energy support (RES). However, they involve diverse risks for the auctioneer and the bidders. The major risk for the auctioneer – with respect to the expansion target and the acceptance of auctions for RES in general – is the risk of non-realization: awarded bidders do not realize their projects. The main reasons are bidders' uncertainties concerning their project costs. The auctioneer can reduce the non-realization risk by taking various measures. The most discussed and implemented measures are financial and physical prequalifications and penalties. An evaluation of these measures has relevant implications for an appropriate auctions design for RES. The non-realization option induces lower bids. A suitable combination of financial and physical prequalifications can reduce the non-realization risk significantly, however, involves sunk costs. Counterintuitively, first-price auction and second-price auction lead to different expected award prices and different realization probabilities. Penalties bear a high risk of inefficient auction outcomes. The appropriate parametrization and combination of the measures is challenging. Under consideration of all implications, we recommend high financial and adjusted physical prequalifications to achieve a sufficiently high realization rate while maintaining efficiency. - Highlights: • The non-realization risk is a major problem of auctions for RES. • Designated measures are financial and physical prequalifications and penalties. • Prequalifications and penalties have different effects on auction outcome. • The non-realization option violates the revenue equivalence theorem. • We recommend high financial and adjusted physical prequalifications.

  6. Evaluation of Appropriate Reference Genes for Gene Expression Normalization during Watermelon Fruit Development.

    Science.gov (United States)

    Kong, Qiusheng; Yuan, Jingxian; Gao, Lingyun; Zhao, Liqiang; Cheng, Fei; Huang, Yuan; Bie, Zhilong

    2015-01-01

    Gene expression analysis in watermelon (Citrullus lanatus) fruit has drawn considerable attention with the availability of genome sequences to understand the regulatory mechanism of fruit development and to improve its quality. Real-time quantitative reverse-transcription PCR (qRT-PCR) is a routine technique for gene expression analysis. However, appropriate reference genes for transcript normalization in watermelon fruits have not been well characterized. The aim of this study was to evaluate the appropriateness of 12 genes for their potential use as reference genes in watermelon fruits. Expression variations of these genes were measured in 48 samples obtained from 12 successive developmental stages of parthenocarpic and fertilized fruits of two watermelon genotypes by using qRT-PCR analysis. Considering the effects of genotype, fruit setting method, and developmental stage, geNorm determined clathrin adaptor complex subunit (ClCAC), β-actin (ClACT), and alpha tubulin 5 (ClTUA5) as the multiple reference genes in watermelon fruit. Furthermore, ClCAC alone or together with SAND family protein (ClSAND) was ranked as the single or two best reference genes by NormFinder. By using the top-ranked reference genes to normalize the transcript abundance of phytoene synthase (ClPSY1), a good correlation between lycopene accumulation and ClPSY1 expression pattern was observed in ripening watermelon fruit. These validated reference genes will facilitate the accurate measurement of gene expression in the studies on watermelon fruit biology.

  7. Appropriate Objective Functions for Quantifying Iris Mechanical Properties Using Inverse Finite Element Modeling.

    Science.gov (United States)

    Pant, Anup D; Dorairaj, Syril K; Amini, Rouzbeh

    2018-07-01

    Quantifying the mechanical properties of the iris is important, as it provides insight into the pathophysiology of glaucoma. Recent ex vivo studies have shown that the mechanical properties of the iris are different in glaucomatous eyes as compared to normal ones. Notwithstanding the importance of the ex vivo studies, such measurements are severely limited for diagnosis and preclude development of treatment strategies. With the advent of detailed imaging modalities, it is possible to determine the in vivo mechanical properties using inverse finite element (FE) modeling. An inverse modeling approach requires an appropriate objective function for reliable estimation of parameters. In the case of the iris, numerous measurements such as iris chord length (CL) and iris concavity (CV) are made routinely in clinical practice. In this study, we have evaluated five different objective functions chosen based on the iris biometrics (in the presence and absence of clinical measurement errors) to determine the appropriate criterion for inverse modeling. Our results showed that in the absence of experimental measurement error, a combination of iris CL and CV can be used as the objective function. However, with the addition of measurement errors, the objective functions that employ a large number of local displacement values provide more reliable outcomes.

  8. Principles for the development of Aboriginal health interventions: culturally appropriate methods through systemic empathy.

    Science.gov (United States)

    Kendall, Elizabeth; Barnett, Leda

    2015-01-01

    To increase Aboriginal participation in mainstream health services, it is necessary to understand the factors that influence health service usage. This knowledge can contribute to the development of culturally appropriate health services that respect Aboriginal ways of being. We used a community-based participatory approach to examine the reasons for underutilization of health services by Aboriginal Australians. Based on three focus groups and 18 interviews with Aboriginal health professionals, leaders, and community members in rural, regional, and urban settings, we identified five factors that influenced usage, including (1) negative historical experiences, (2) cultural incompetence, (3) inappropriate communication, (4) a collective approach to health, and (5) a more holistic approach to health. Given that these factors have shaped negative Aboriginal responses to health interventions, they are likely to be principles by which more appropriate solutions are generated. Although intuitively sensible and well known, these principles remain poorly understood by non-Aboriginal health systems and even less well implemented. We have conceptualized these principles as the foundation of an empathic health system. Without empathy, health systems in Australia, and internationally, will continue to face the challenge of building effective services to improve the state of health for all minority populations.

  9. TECHNO – ECONOMIC ACCEPTABILITY ANALISYS OF WASTE DISPOSAL BY INJECTION INTO APPROPRIATE FORMATION

    Directory of Open Access Journals (Sweden)

    Vladislav Brkić

    2013-12-01

    Full Text Available During exploration and production of oil and natural gas, various types of waste must be disposed in a permanent and safe way. There is a range of methods for processing and disposal of waste, such as disposal into landfills, solidification, namely chemical stabilization, thermal processing, appropriate formation injections uncovered by a deep well, disposal into salt domes and bioremediation. The method of waste disposal into appropriate formations is a method where strict geological and technical criteria must be satisfied when applied. A fundamental scientific hypothesis has been formulated whereby economic acceptability of the waste injection method, as a main method for waste disposal, is to be shown by an economic evaluation. The results of this research are relevant since there has been an intention in Croatia and worldwide to abandon wells permanently due to oil and gas reservoirs depletion and therefore it is essential to estimate economic impacts of the waste injection method application. In that way, profitability of using existing wells for waste disposal in oil industry has been increased, leading to the improvement of petroleum company’s business activities (the paper is published in Croatian.

  10. What is appropriate to post on social media? Ratings from students, faculty members and the public.

    Science.gov (United States)

    Jain, Anuja; Petty, Elizabeth M; Jaber, Reda M; Tackett, Sean; Purkiss, Joel; Fitzgerald, James; White, Casey

    2014-02-01

    The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook(®) . The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patient's confidence in that student's clinical abilities. An online survey was designed to investigate the perceptions of University of Michigan medical students, attending physicians and non-health care university-wide employees (that serves as a subset of the public) regarding mock medical students' Facebook(®) profile screenshots. For each screenshot, respondents used a 5-point Likert scale to rate 'appropriateness' and whether they would be 'comfortable' having students posting such content as their future doctors. Compared with medical students, faculty members and public groups rated images as significantly less appropriate (p public' have different thresholds of what is acceptable on a social networking site. Our findings will prove useful for students to consider the perspectives of patients and faculty members when considering what type of content to post on their social media sites. In this way, we hope that our findings provide insight for discussions, awareness and the development of guidelines related to online professionalism for medical students. © 2014 John Wiley & Sons Ltd.

  11. Appropriate antibiotic therapy improves Ureaplasma sepsis outcome in the neonatal mouse.

    Science.gov (United States)

    Weisman, Leonard E; Leeming, Angela H; Kong, Lingkun

    2012-11-01

    Ureaplasma causes sepsis in human neonates. Although erythromycin has been the standard treatment, it is not always effective. No published reports have evaluated Ureaplasma sepsis in a neonatal model. We hypothesized that appropriate antibiotic treatment improves Ureaplasma sepsis in a neonatal mouse model. Two ATCC strains and two clinical strains of Ureaplasma were evaluated in vitro for antibiotic minimum inhibitory concentration (MIC). In addition, FVB albino mice pups infected with Ureaplasma were randomly assigned to saline, erythromycin, or azithromycin therapy and survival, quantitative blood culture, and growth were evaluated. MICs ranged from 0.125 to 62.5 µg/ml and 0.25 to 1.0 µg/ml for erythromycin and azithromycin, respectively. The infecting strain and antibiotic selected for treatment appeared to affect survival and bacteremia, but only the infecting strain affected growth. Azithromycin improved survival and bacteremia against each strain, whereas erythromycin was effective against only one of four strains. We have established a neonatal model of Ureaplasma sepsis and observed that treatment outcome is related to infecting strain and antibiotic treatment. We speculate that appropriate antibiotic selection and dosing are required for effective treatment of Ureaplasma sepsis in neonates, and this model could be used to further evaluate these relationships.

  12. Preservice Teachers' Perspectives on 'Appropriate' K-8 Climate Change and Environmental Science Topics

    Science.gov (United States)

    Ford, D. J.

    2013-12-01

    With the release of the Next Generation Science Standards (NRC, 2013), climate change and related environmental sciences will now receive greater emphasis within science curricula at all grade levels. In grades K-8, preparation in foundational content (e.g., weather and climate, natural resources, and human impacts on the environment) and the nature of scientific inquiry will set the groundwork for later learning of climate change in upper middle and high school. These rigorous standards increase pressure on elementary and middle school teachers to possess strong science content knowledge, as well as experience supporting children to develop scientific ideas through the practices of science. It also requires a set of beliefs - about children and the science that is appropriate for them - that is compatible with the goals set out in the standards. Elementary teachers in particular, who often have minimal preparation in the earth sciences (NSF, 2007), and entrenched beliefs about how particular topics ought to be taught (Holt- Reynolds, 1992; Pajares, 1992), including climate change (Bryce & Day, 2013; Lambert & Bleicher, 2013), may face unique challenges in adjusting to the new standards. If teachers hold beliefs about climate change as controversial, for example, they may not consider it an appropriate topic for children, despite its inclusion in the standards. On the other hand, those who see a role for children in efforts to mitigate human impacts on the environment may be more enthusiastic about the new standards. We report on a survey of preservice K-8 teachers' beliefs about the earth and environmental science topics that they consider to be appropriate and inappropriate for children in grades K-3, 4-5, and 6-8. Participants were surveyed on a variety of standards-based topics using terminology that signals publicly and scientifically neutral (e.g. weather, ecosystems) to overtly controversial (evolution, global warming) science. Results from pilot data

  13. Partial improvements in the flavor quality of soybean seeds using intercropping systems with appropriate shading.

    Science.gov (United States)

    Liu, Jiang; Yang, Cai-qiong; Zhang, Qing; Lou, Ying; Wu, Hai-jun; Deng, Jun-cai; Yang, Feng; Yang, Wen-yu

    2016-09-15

    The profiles of isoflavone and fatty acids constitute important quality traits in soybean seeds, for making soy-based functional food products, due to their important contributions to the flavor and nutritional value of these products. In general, the composition of these constituents in raw soybeans is affected by cultivation factors, such as sunlight; however, the relationship of the isoflavone and fatty acid profiles with cultivation factors is not well understood. This study evaluated the isoflavone and fatty acid profiles in soybeans grown under a maize-soybean relay strip intercropping system with different row spacings, and with changes in the photosynthetic active radiation (PAR) transmittance. The effects of PAR on the isoflavone and fatty acid contents were found to be quadratic. Appropriate intercropping shading may reduce the bitterness of soybeans caused by soy aglycone and could improve their fatty acid composition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. [The research protocol VI: How to choose the appropriate statistical test. Inferential statistics].

    Science.gov (United States)

    Flores-Ruiz, Eric; Miranda-Novales, María Guadalupe; Villasís-Keever, Miguel Ángel

    2017-01-01

    The statistical analysis can be divided in two main components: descriptive analysis and inferential analysis. An inference is to elaborate conclusions from the tests performed with the data obtained from a sample of a population. Statistical tests are used in order to establish the probability that a conclusion obtained from a sample is applicable to the population from which it was obtained. However, choosing the appropriate statistical test in general poses a challenge for novice researchers. To choose the statistical test it is necessary to take into account three aspects: the research design, the number of measurements and the scale of measurement of the variables. Statistical tests are divided into two sets, parametric and nonparametric. Parametric tests can only be used if the data show a normal distribution. Choosing the right statistical test will make it easier for readers to understand and apply the results.

  15. The Yerkes-Dodson law and appropriate stimuli for conditioned taste aversion in Lymnaea.

    Science.gov (United States)

    Ito, Etsuro; Yamagishi, Miki; Takigami, Satoshi; Sakakibara, Manabu; Fujito, Yutaka; Lukowiak, Ken

    2015-02-01

    The pond snail Lymnaea stagnalis can learn conditioned taste aversion and then consolidate it into long-term memory (LTM). A high-voltage electric shock was used as the unconditioned stimulus, where we have previously used KCl. We varied the strength of both the conditioned and unconditioned stimuli to determine whether the so-called Yerkes-Dodson law prevailed. This is an empirical relationship between the state of arousal and LTM formation, showing that there is an optimal level of arousal leading to memory formation. However, too little or too much arousal results in poorer LTM. We found here that the most appropriate stimuli to use in taste aversion training in Lymnaea were a 10 mmol l(-1) sucrose solution as the conditioned stimulus and a 3 s electric shock as the unconditioned stimulus. © 2015. Published by The Company of Biologists Ltd.

  16. Appropriate Use of FDG-PET for the Management of Cancer Patients

    International Nuclear Information System (INIS)

    2010-01-01

    The use of PET (positron emission tomography) has become the standard quality of care for optimal management of patients with cancer. The availability of the hybrid PET/CT (positron emission tomography/computed tomography) scanner has further improved the utility of PET scanning and provides additional benefits both to patients and to the health system. This publication addresses the important issue of appropriateness of the application of PET/CT procedures in different clinical scenarios for many cancers. It is a resource for specialists in nuclear medicine and oncology, and aims to make reliable information widely available to those Member States where PET programmes are still in their planning phase or where the use of PET scanning is limited.

  17. Computed tomography measurements of the acetabulum in adult dysplastic hips: Which level is appropriate

    Energy Technology Data Exchange (ETDEWEB)

    Anda, S.; Kvistad, K.A. (Dept. of Radiology, Trondheim Univ. (Norway)); Terjesen, T. (Dept. of Orthopedic Surgery, Trondheim Univ. (Norway))

    1991-05-01

    A study has been performed to evaluate whether one or several levels are needed with comuted tomography (CT) study to provide sufficient information regarding anteversion and acetabular support to the femoral head. A total of 23 hips in 14 adults with uni- or bilateral congenital hip dysplasia (center-edge angle less than 20deg) were assessed by obtaining 5-mm contiguous CT slices and performing acetabular measurements at four levels. Both anterior and posterior acetabular supports as quantified by the anterior and posterior acetabular sector angles were significantly lower than normal at all levels. The sector angles increased in the proximal cuts, whereas the acetabular anteversin increased caudally. Because no important additional information was gained by measuring at different levels, we conclude that CT study at one level is sufficient for acetabular measurements and suggest that the slice through the center of the femoral head is the most appropriate one. (orig.).

  18. Appropriate technology for rural India - solar decontamination of water for emergency settings and small communities.

    Science.gov (United States)

    Kang, Gagandeep; Roy, Sheela; Balraj, Vinohar

    2006-09-01

    A commercial solar water heating system was evaluated for its effectiveness in decontaminating drinking water with a view to use in emergency situations. A total of 18 seeding experiments carried out over 6 months with 10(5) to 10(7)Escherichia coli/ml showed that the solar heater produced 125 l of bacteriologically safe water in 4 h when the ambient temperature was above 30 degrees C, with a holding time of at least 2 h. The solar water heating system is inexpensive, easy to transport and set up and could provide safer drinking water for 50 people a day. It would be effective in the decrease and prevention of waterborne disease in emergency situations, and is appropriate for use in small communities.

  19. The research protocol VI: How to choose the appropriate statistical test. Inferential statistics

    Directory of Open Access Journals (Sweden)

    Eric Flores-Ruiz

    2017-10-01

    Full Text Available The statistical analysis can be divided in two main components: descriptive analysis and inferential analysis. An inference is to elaborate conclusions from the tests performed with the data obtained from a sample of a population. Statistical tests are used in order to establish the probability that a conclusion obtained from a sample is applicable to the population from which it was obtained. However, choosing the appropriate statistical test in general poses a challenge for novice researchers. To choose the statistical test it is necessary to take into account three aspects: the research design, the number of measurements and the scale of measurement of the variables. Statistical tests are divided into two sets, parametric and nonparametric. Parametric tests can only be used if the data show a normal distribution. Choosing the right statistical test will make it easier for readers to understand and apply the results.

  20. The Alternative Peer Group: A Developmentally Appropriate Recovery Support Model for Adolescents.

    Science.gov (United States)

    Nash, Angela; Collier, Crystal

    2016-01-01

    Recovery as the goal for substance use disorder treatment has been a key component of the Substance Abuse and Mental Health Services Administration's mission for the past decade. Consistent with their mission, there is a call for research and development of recovery-oriented systems of care to support affected individuals through all stages of the recovery process. Evidence is emerging to support recovery practice and research for adults, but recovery-oriented models for adolescents are scant. The Alternative Peer Group (APG) is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice. Employing APG participants' own words, this article will describe the essential elements and three theoretical frameworks underlying the APG model to illustrate how the APG serves as a developmentally appropriate recovery support service for adolescents with substance use disorder.