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Sample records for current international guidelines

  1. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder?

    DEFF Research Database (Denmark)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A

    2016-01-01

    and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). RESULTS: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD...... a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. METHODS: The International Society of Bipolar Disorders OABD task force compiled...... and mostly not informed by specific research evidence. CONCLUSIONS: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited...

  2. Informed consent in human subject research: a comparison of current international and Nigerian guidelines.

    Science.gov (United States)

    Fadare, Joseph O; Porteri, Corinna

    2010-03-01

    Informed consent is a basic requirement for the conduct of ethical research involving human subjects. Currently, the Helsinki Declaration of the World Medical Association and the International Ethical Guidelines for Biomedical Research of the Council for International Organizations of Medical Sciences (CIOMS) are widely accepted as international codes regulating human subject research and the informed consent sections of these documents are quite important. Debates on the applicability of these guidelines in different socio-cultural settings are ongoing and many workers have advocated the need for national or regional guidelines. Nigeria, a developing country, has recently adopted its national guideline regulating human subject research: the National Health Research Ethics Committee (NHREC) code. A content analysis of the three guidelines was done to see if the Nigerian guidelines confer any additional protection for research subjects. The concept of a Community Advisory Committee in the Nigerian guideline is a novel one that emphasizes research as a community burden and should promote a form of "research friendship" to foster the welfare of research participants. There is also the need for a regular update of the NHREC code so as to address some issues that were not considered in its current version.

  3. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report.

    Science.gov (United States)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A; Rej, Soham; Tsai, Shang-Ying; Gildengers, Ariel G; Almeida, Osvaldo P; Shulman, Kenneth I; Sajatovic, Martha

    2016-12-01

    Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. The Investigators' Brochure: a comparison of the draft international conference on harmonisation guideline with current Food and Drug Administration requirements.

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    Cocchetto, D M

    1995-12-01

    For several years, the United States Food and Drug Administration (FDA) has participated in a collaborative effort to harmonize the technical procedures for development and regulatory approval of human pharmaceuticals in multiple countries. This harmonization effort is the work of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). At this point, ICH focuses on achieving harmonization of technical requirements in three major regions of the world, i.e., the United States, European Union, and Japan. One area for which harmonization is being sought is the format and content of the Investigators' Brochure. On October 27, 1993, the ICH Steering Committee agreed that the ICH draft guideline on the Investigators' Brochure should be made available for public comment. On August 9, 1994, the FDA published the draft guideline for the format and content of the Investigators' Brochure. This draft guideline was prepared by the Efficacy Expert Working Group of the ICH. FDA solicited written comments on this draft guideline until October 11, 1994. Ultimately, FDA intends to adopt the ICH Steering Committee's final guidelines on Investigators' Brochures as part of a larger document on good clinical practices. Therefore, the content of this draft guideline warrants careful attention. In this paper, ICH's proposed information for inclusion in the Investigators' Brochure is reviewed and compared with current regulatory requirements of FDA. The expanded contents of the Investigators' Brochure proposed by ICH, which represent potential new requirements beyond current FDA regulations, are highlighted. The major controversial elements of this draft guideline are summarized.

  5. International CPR guidelines - perspectives in CPR.

    Science.gov (United States)

    Nolan, Jerry P

    2013-09-01

    The International Liaison Committee on Resuscitation (ILCOR) co-ordinates regular reviews of cardiopulmonary resuscitation (CPR) science and publishes consensus on science statements and treatment recommendations. These outputs are used by international resuscitation organisations to generate clinical guidelines. This review will outline the history behind the development of international CPR guidelines and will provide a detailed description of the current guideline generating process. A perspective is provided on the future of this process and the prospects for completely unified international CPR guidelines.

  6. Guidelines International Network: toward international standards for clinical practice guidelines.

    Science.gov (United States)

    Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

    2012-04-03

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

  7. The emergence of international food safety standards and guidelines: understanding the current landscape through a historical approach.

    Science.gov (United States)

    Ramsingh, Brigit

    2014-07-01

    Following the Second World War, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) teamed up to construct an International Codex Alimentarius (or 'food code') which emerged in 1963. The Codex Committee on Food Hygiene (CCFH) was charged with the task of developing microbial hygiene standards, although it found itself embroiled in debate with the WHO over the nature these standards should take. The WHO was increasingly relying upon the input of biometricians and especially the International Commission on Microbial Specifications for Foods (ICMSF) which had developed statistical sampling plans for determining the microbial counts in the final end products. The CCFH, however, was initially more focused on a qualitative approach which looked at the entire food production system and developed codes of practice as well as more descriptive end-product specifications which the WHO argued were 'not scientifically correct'. Drawing upon historical archival material (correspondence and reports) from the WHO and FAO, this article examines this debate over microbial hygiene standards and suggests that there are many lessons from history which could shed light upon current debates and efforts in international food safety management systems and approaches.

  8. Study of quality assurance regulations for linear accelerators in Korea: A comparison study between the current status in Korea and the international guidelines

    CERN Document Server

    Lee, Hyunho; Jo, Yunhui; Yoon, Myonggeun

    2015-01-01

    Quality assurance (QA) for medical linear accelerators is indispensable for appropriate cancer treatment. Some international organizations and western advanced countries provide QA guidelines for linear accelerators. Currently, QA regulations for linear accelerators in Korean hospitals specify a system in which each hospital stipulates its independent hospital-based protocols for QA procedures (HP_QAPs) and conducts QA based on these HP_QAPs while regulatory authorities verify whether items under these HP_QAPs have been performed. However, because this regulatory method cannot guarantee the quality of universal treatment, and QA items with tolerance criteria are different in many hospitals, the presentation of standardized QA items and tolerance criteria is essential. In this study, QA items in HP_QAPs from various hospitals and those presented by international organizations. Concordance rates between QA items for linear accelerators that were presented by the aforementioned organizations and those currently ...

  9. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  10. Current Cervical Carcinoma Screening Guidelines

    Directory of Open Access Journals (Sweden)

    Megan J. Schlichte

    2015-05-01

    Full Text Available A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP and the American Society for Clinical Pathology (ASCP in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG. The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV testing, as well as possible future screening strategies.

  11. Guidelines International Network: toward international standards for clinical practice guidelines.

    NARCIS (Netherlands)

    Qaseem, A.; Forland, F.; Macbeth, F.; Ollenschlager, G.; Phillips, S.; Wees, P.J. van der

    2012-01-01

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. In

  12. Genomic testing in international guidelines

    Directory of Open Access Journals (Sweden)

    Peter Kern

    2013-10-01

    Full Text Available Human breast cancer was solely classified based on clinical and immunohistochemical (IHC findings in the past. A growing body of evidence suggests that these categorisations are rendered more precisely by intrinsic subtyping with the aim of an introduction of personalised medicine. Especially in breast cancer with the uncertain potential of disease spread, such as T1-2, Grade 2 and oestrogen receptor-positive (ER+ve tumours, the value of chemotherapy applied to every patient has been questioned and the need for additional information on the tumour´s specific risk of recurrence is overt. It is estimated that the average risk for recurrence is 15% at 10 years in hormone-receptor-positive breast cancer. Thus, a relatively small proportion of these patients would need chemotherapy, and the main task is to stratify which patients of this cohort are at high-risk and will benefit from cytotoxic agents. Ki67, as a proliferation marker classifying high-risk tumours, has been demonstrated as a continuous marker, but not as a clear cut risk-defining instrument in recent publications. Thus, the difficulties are perceived especially at the threshold of the low to high-risk area of this marker. Reproducibility of Ki67 is to some extent uncertain considering there is inter and intra-institutional variability of up to 30% of the results. Several multi gene arrays, such as MammaPrint®, Oncotype DX®, Endopredict®, and PAM50 have demonstrated clinical utility and experienced validation. The aim of this review is the description of the implementation of genomic testing in international guidelines (North American and European, with regard to incorporation of multigene arrays into the decision-making process in different clinical settings (including tumor size and IHC status. Data cut-off was 1st October, 2013. It seems that North America and some European countries have initiated a shift towards a personalised medicine with multigene arrays based on RT-PCR or

  13. International Geoscience Programme(IGCP) Guidelines

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ 2006 Call for Project Proposals (31 July 2006) The International Geoscience Programme (IGCP) is launching its 2006 call/or project proposals. The proposal guidelines and application forms were updated in order to bring them in line with the requirements of the strategic plan of UNESCO and IUGS (International Union of Geological Sciences), the two co-sponsoring partners.

  14. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines.

    Science.gov (United States)

    Schünemann, Holger J; Al-Ansary, Lubna A; Forland, Frode; Kersten, Sonja; Komulainen, Jorma; Kopp, Ina B; Macbeth, Fergus; Phillips, Susan M; Robbins, Craig; van der Wees, Philip; Qaseem, Amir

    2015-10-06

    Conflicts of interest (COIs) have been defined by the American Thoracic Society as "a divergence between an individual's private interests and his or her professional obligations such that an independent observer might reasonably question whether the individual's professional actions or decisions are motivated by personal gain, such as direct financial, academic advancement, clinical revenue streams, or community standing." In the context of guideline development, the concerns are not simply about identifying and disclosing direct financial or indirect COIs. Despite this recognition, the management of COIs in guidelines is often unsatisfactory. In response to requests from its international membership and informed by existing syntheses of the evidence and policies of international organizations, the Guidelines International Network Board of Trustees developed guidance on the disclosure of interests and management of COIs. Current approaches are relatively similar throughout the guideline development community, with an increasing recognition of the importance of disclosing and managing indirect COIs. Although there are differences in detail among the approaches, the similarities allow for the formulation of 9 core principles for managing COIs. In formulating these principles, the Guidelines International Network Board of Trustees recognizes that COIs cannot be totally avoided when panel members are being chosen for certain guidelines or in certain settings; thus, the important issue is the management of COIs in a fair, judicious, transparent manner.

  15. Invisalign: current guidelines for effective treatment.

    Science.gov (United States)

    Kuncio, Daniel A

    2014-03-01

    Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples.

  16. Orthopaedic thromboprophylaxis: limitations of current guidelines

    DEFF Research Database (Denmark)

    Warwick, D.; Dahl, O.E.; Fisher, W.D.

    2008-01-01

    research into 'evidence-based' advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive...

  17. The Development of International Guidelines on Test Use: The International Test Commission Project.

    Science.gov (United States)

    Bartram, Dave

    2001-01-01

    Describes the development of the International Guidelines for Test Use through the International Test Commission (ITC) project. These guidelines are designed to provide an international view of areas in which there is consensus on what constitutes good practice in testing. Describes why such guidelines are needed, and discusses their use. (SLD)

  18. Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis.

    Science.gov (United States)

    Gupta, Samir; Paolucci, Emily; Kaplan, Alan; Boulet, Louis-Philippe

    2016-01-01

    Background. Several international groups develop asthma guidelines. Conflicting recommendations across guidelines have been described in several disease areas and may contribute to practice variability. Accordingly, we compared the latest Canadian Thoracic Society (CTS) asthma guideline with contemporaneous international asthma guidelines to evaluate conflicting recommendations and their causes. Methods. We identified the latest CTS asthma guideline update (2012) and the following societies which also updated their guidelines in 2012: the British Thoracic Society and Scottish Intercollegiate Guidelines Network and the Global Initiative for Asthma. We compared these three guidelines on (1) key methodological factors and (2) adult pharmacotherapy recommendations. Results. Methods used and documentation provided for literature search strategy and dates, evidence synthesis, outcomes considered, evidence appraisal, and recommendation formulation varied between guidelines. Criteria used to define suboptimal asthma control varied widely between guidelines. Inhaled corticosteroid dosing recommendations diverged, as did recommendations surrounding use of budesonide/formoterol as a reliever and controller and recommendations in the subsequent step. Conclusions. There are important differences between recommendations provided in contemporaneous asthma guidelines. Causes include differences in methods used for interpreting evidence and formulating recommendations. Adopting a common set of valid and explicit methods across international societies could harmonize recommendations and facilitate guideline implementation.

  19. Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis

    Directory of Open Access Journals (Sweden)

    Samir Gupta

    2016-01-01

    Full Text Available Background. Several international groups develop asthma guidelines. Conflicting recommendations across guidelines have been described in several disease areas and may contribute to practice variability. Accordingly, we compared the latest Canadian Thoracic Society (CTS asthma guideline with contemporaneous international asthma guidelines to evaluate conflicting recommendations and their causes. Methods. We identified the latest CTS asthma guideline update (2012 and the following societies which also updated their guidelines in 2012: the British Thoracic Society and Scottish Intercollegiate Guidelines Network and the Global Initiative for Asthma. We compared these three guidelines on (1 key methodological factors and (2 adult pharmacotherapy recommendations. Results. Methods used and documentation provided for literature search strategy and dates, evidence synthesis, outcomes considered, evidence appraisal, and recommendation formulation varied between guidelines. Criteria used to define suboptimal asthma control varied widely between guidelines. Inhaled corticosteroid dosing recommendations diverged, as did recommendations surrounding use of budesonide/formoterol as a reliever and controller and recommendations in the subsequent step. Conclusions. There are important differences between recommendations provided in contemporaneous asthma guidelines. Causes include differences in methods used for interpreting evidence and formulating recommendations. Adopting a common set of valid and explicit methods across international societies could harmonize recommendations and facilitate guideline implementation.

  20. Introductional presentation of international guidelines for test-use

    Directory of Open Access Journals (Sweden)

    Staša Bučar Markič

    2000-09-01

    Full Text Available The causes for origin, the development the and main structure of the International Guidelines for test-use are presented. They were developed by Dave Bartram for the International Test Commission. The Guidelines should be considered as an aid for developing specific local standards, and to ensure consistency between different countries. The Guidelines are not relevant only for psychological testing, but also for testing in other fields (education, employment etc., as well as for other types of assessment.

  1. Standard guidelines for electrosurgery with radiofrequency current

    Directory of Open Access Journals (Sweden)

    Mutalik Sharad

    2009-08-01

    Full Text Available Definition: Radiofrequency (RF induces thermal destruction of the targeted tissue by an electrical current at a frequency of 0.5 MHz (RF. As the electrode tip is not heated, there is minimal thermal damage to the surrounding tissues, producing good esthetic results. Therefore, RF ablation is also known as cold ablation or "coblation." Modality: It has three modes of operation: (a Cut, (b cut and coagulate and (c coagulate. Therefore, it can be used for various purposes like incision, ablation, fulguration, shave excision and coagulation. Because of the coagulation facility, hemostasis can be achieved and operation becomes easier and faster. Indications: It is effective in treating various skin conditions like dermatosis papulosa nigra, warts, molluscum contagiosum, colloid milia, acquired junctional, compound and dermal melanocytic nevi, seborrheic keratosis, skin tags, granuloma pyogenicum, verrucous epidermal nevi, xanthelesma, rhinophyma, superficial basal cell carcinoma and telangiectasia. It can also be used for cosmetic indications such as resurfacing, earlobe repair and blepharoplasty. Anesthesia: The procedure is accomplished either under topical anesthesia eutactic mixture of local anesthetics or local injectable anesthesia, under all aseptic precautions. Procedure: While operating, only the tip of the electrode should come in contact with the tissue. Actual contact of the electrode with the tissue should be very brief in order to prevent excessive damage to the deeper tissues. This can be accomplished by moving the electrode quickly. Complications: Complications are uncommon and mainly occur due to an improper technique. The treating physician should be aware of the contraindications of the procedure as listed in these guidelines. Physician qualification: RF surgery may be performed by a dermatologist who has acquired adequate training during post-graduation or through recognized fellowships and workshops dedicated to RF surgery. He

  2. Management and prevention of neonatal anemia: current evidence and guidelines.

    Science.gov (United States)

    von Lindern, Jeannette S; Lopriore, Enrico

    2014-04-01

    Neonatal anemia is a common disorder, particularly in (very) preterm neonates. Management of neonatal anemia is based principally on red blood cell (RBC) transfusion. Although the use of blood products is nowadays widespread in neonatal medicine, evidence on the potential benefit is extremely limited. Recent studies suggest that RBC transfusions in newborns may be associated with an increased risk for necrotizing enterocolitis, transfer of infectious agents and negative effects on neurodevelopmental outcome. Whether the benefits of RBC transfusions outweigh the risks is controversial and requires further studies. In this review, we summarize the current evidence on the management of neonatal anemia and compare the various international guidelines. In addition, we discuss the various strategies to prevent neonatal anemia and reduce the need for RBC transfusions and discuss important trials currently enrolling patients to improve the management in neonatal anemia.

  3. [Update on Current Care Guideline: Insomnia].

    Science.gov (United States)

    Partinen, Markku; Huutoniemi, Anne; Kajaste, Soili; Lagerstedt, Rea; Markkula, Juha; Mäkinen, Erkki; Paakkari, Ilari; Partonen, Timo; Polo, Päivi; Saarenpää-Heikkilä, Outi; Seppälä, Maaria; Kukkonen-Harjula, Katriina; Tuunainen, Arja

    2016-01-01

    Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

  4. Occlusion on oral implants: current clinical guidelines.

    Science.gov (United States)

    Koyano, K; Esaki, D

    2015-02-01

    Proper implant occlusion is essential for adequate oral function and the prevention of adverse consequences, such as implant overloading. Dental implants are thought to be more prone to occlusal overloading than natural teeth because of the loss of the periodontal ligament, which provides shock absorption and periodontal mechanoreceptors, which provide tactile sensitivity and proprioceptive motion feedback. Although many guidelines and theories on implant occlusion have been proposed, few have provided strong supportive evidence. Thus, we performed a narrative literature review to ascertain the influence of implant occlusion on the occurrence of complications of implant treatment and discuss the clinical considerations focused on the overloading factors at present. The search terms were 'dental implant', 'dental implantation', 'dental occlusion' and 'dental prosthesis'. The inclusion criteria were literature published in English up to September 2013. Randomised controlled trials (RCTs), prospective cohort studies and case-control studies with at least 20 cases and 12 months follow-up interval were included. Based on the selected literature, this review explores factors related to the implant prosthesis (cantilever, crown/implant ratio, premature contact, occlusal scheme, implant-abutment connection, splinting implants and tooth-implant connection) and other considerations, such as the number, diameter, length and angulation of implants. Over 700 abstracts were reviewed, from which more than 30 manuscripts were included. We found insufficient evidence to establish firm clinical guidelines for implant occlusion. To discuss the ideal occlusion for implants, further well-designed RCTs are required in the future.

  5. International Group Work Research: Guidelines in Cultural Contexts

    Science.gov (United States)

    Guth, Lorraine J.; Asner-Self, Kimberly K.

    2017-01-01

    This article offers 10 guidelines for conducting international group work research. These guidelines include the importance of establishing relationships, conducting a needs assessment, co-constructing the research questions/design, determining the approach, choosing culturally relevant instruments, choosing culturally responsive group…

  6. National and international guidelines for rectal cancer

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Wille-Jørgensen, P

    2014-01-01

    concerning the definition of rectal cancer. Ten of the 11 guidelines use the TNM staging system and there was general agreement regarding the recommendation of MRI and CT in rectal cancer. There was consensus concerning a multidisciplinary approach, preoperative chemoradiotherapy (CRT) and total mesorectal...

  7. Guidelines for asthma management: a review and comparison of 5 current guidelines.

    Science.gov (United States)

    Myers, Timothy R

    2008-06-01

    The first clinical practice guidelines for the assessment and management of asthma were published over 20 years ago in New Zealand and Australia. During the same period, British and Scottish groups were collaborating on a United Kingdom version of asthma guidelines. Shortly after the introduction of the New Zealand and Canadian guidelines, the National Heart, Lung, and Blood Institute of the United States National Institutes of Health participated in 2 additional asthma guideline endeavors, which were published in the early 1990s. The National Heart, Lung, and Blood Institute formed the National Asthma Education and Prevention Program to develop asthma guidelines for the United States, and participated with an international task force to develop guidelines for the treatment of asthma in all countries, which resulted in the formation of the Global Initiative for Asthma in the mid-1990s. The asthma guidelines issued by professional societies and other groups prior to the late 1990s were primarily based on consensus or expert opinion in each guideline committee, though those opinions were based on the available studies. The early guidelines played a vital role in bridging the gap between various treatment options and recent discoveries in basic science, and served as the vehicle to implementation into daily clinical practice. Asthma guidelines have been published and revised in dozens of countries around the world and have become reputable directives or "road maps" in asthma diagnosis, treatment, and management for patients of all ages. The guidelines have similar formats. The dissemination and implementation of the early guidelines was inconsistent, and they were criticized for not being evidence-based. As the knowledge of asthma pathophysiology continues to expand, along with basic science research on asthma diagnosis, treatment, and management, as well as education of the asthma patient, it is essential that the asthma guidelines be frequently updated and based on

  8. [International guidelines of the Surviving Sepsis Campaign : update 2012].

    Science.gov (United States)

    Briegel, J; Möhnle, P

    2013-04-01

    An update of the international guidelines for therapy of sepsis was published in February 2012 by the Surviving Sepsis Campaign (SSC). The update includes a further development of the guidelines from 2004 and 2008. The guidelines are divided into three sections, sepsis-specific therapeutic measures, recommendations on general intensive care measures for sepsis and finally special features of sepsis in pediatric intensive care medicine are presented in detail. This article discusses the most important amendments in the first two sections and delving deeper into the guidelines.

  9. Applicability of the current hypertension guidelines in Latin America.

    Science.gov (United States)

    Alcocer, Luis; Meaney, Eduardo; Hernandez-Hernandez, Hector

    2015-08-01

    Recent research has focused on the development of evidence-based guidelines that are intended to regulate the conduct of physicians in the diagnosis and control of hypertension, with the goal of achieving greater effectiveness and equity at the lowest possible cost. In Latin America, guidelines are available for the management of hypertension at three levels: national, regional and international. The national and regional Latin American and Caribbean (LAC) guidelines are in fact adaptations of the international guidelines. The potential benefit of applying guidelines developed in other regions to local healthcare decision making is that it will enable decision makers to take advantage of existing analyses and transfer or adapt them to their local contexts. However, this adaptation precludes the assessment of their generalizability and potential transferability. In addition, this region is characterized by wide socioeconomic differences between its inhabitants, both among and within nations. Therefore, new guidelines for the LAC region must include recommendations that are common to all hypertensive patients in the region. Moreover, we advocate the inclusion of a specific section that makes comprehensive recommendations and provides strategies for implementation according to the socioeconomic conditions of particular groups. In addition to developing guidelines that are truly applicable to the LAC region, it seems sensible to consider information that is specific to this region. Furthermore, developing evidence-based guidelines is not enough to affect positively the burden of disease caused by hypertension. Therefore, professional programs are required for the implementation of such guidelines as well as the auditing of their results. Achieving these ambitious goals will require collaborative efforts by many groups including policymakers, international organizations, healthcare providers, universities and society.

  10. The current state of epilepsy guidelines: A systematic review.

    Science.gov (United States)

    Sauro, Khara M; Wiebe, Samuel; Dunkley, Colin; Janszky, Jozsef; Kumlien, Eva; Moshé, Solomon; Nakasato, Nobukazu; Pedley, Timothy A; Perucca, Emilio; Senties, Horacio; Thomas, Sanjeev V; Wang, Yuping; Wilmshurst, Jo; Jetté, Nathalie

    2016-01-01

    The International League Against Epilepsy (ILAE) Epilepsy Guidelines Task Force, composed of 14 international members, was established in 2011 to identify, using systematic review methodology, international epilepsy clinical care guidelines, assess their quality, and determine gaps in areas of need of development. A systematic review of the literature (1985-2014) was performed in six electronic databases (e.g. Medline, Embase) using a broad search strategy without initial limits to language or study design. Six gray literature databases (e.g., American Academy of Neurology [AAN], ILAE) were also searched to minimize publication bias. Two independent reviewers screened abstracts, reviewed full text articles, and performed data abstraction. Descriptive statistics and a meta-analysis were generated. The search identified 10,926 abstracts. Of the 410 articles selected for full text review, 63 met our eligibility criteria for a guideline. Of those included, 54 were in English and 9 were in other languages (French, Spanish, and Italian). Of all guidelines, 29% did not specify the target age groups, 27% were focused on adults, 22% included only children, and 6% specifically addressed issues related to women with epilepsy. Guidelines included in the review were most often aimed at guiding clinical practice for status epilepticus (n = 7), first seizure (n = 6), drug-resistant epilepsy (n = 5), and febrile seizures (n = 4), among others. Most of the guidelines were therapeutic (n = 35) or diagnostic (n = 16) in nature. The quality of the guidelines using a 1-7 point scale (7 = highest) varied and was moderate overall (mean = 4.99 ± 1.05 [SD]). We identified substantial gaps in topics (e.g., epilepsy in the elderly) and there was considerable heterogeneity in methodologic quality. The findings should offer a valuable resource for health professionals caring for people with epilepsy, since they will help guide the prioritization, development, and dissemination of future

  11. Measure Guideline. Internal Insulation of Masonry Walls

    Energy Technology Data Exchange (ETDEWEB)

    Straube, J. F. [Building Science Corporation (BSC), Somerville, MA (United States); Ueno, K. [Building Science Corporation (BSC), Somerville, MA (United States); Schumacher, C. J. [Building Science Corporation (BSC), Somerville, MA (United States)

    2012-07-01

    This measure guideline provides recommendations for interior insulation assemblies that control interstitial condensation and durability risks; recommendations for acceptable thermal performance are also provided. An illustrated guide of high-risk exterior details (which concentrate bulk water), and recommended remediation details is provided. This is followed by a recommended methodology for risk assessment of a masonry interior insulation project: a series of steps are suggested to assess the risks associated with this retrofit, with greater certainty with added steps.

  12. Measure Guideline: Internal Insulation of Masonry Walls

    Energy Technology Data Exchange (ETDEWEB)

    Straube, J. F.; Ueno, K.; Schumacher, C. J.

    2012-07-01

    This measure guideline provides recommendations for interior insulation assemblies that control interstitial condensation and durability risks; recommendations for acceptable thermal performance are also provided. An illustrated guide of high-risk exterior details (which concentrate bulk water), and recommended remediation details is provided. This is followed by a recommended methodology for risk assessment of a masonry interior insulation project: a series of steps are suggested to assess the risks associated with this retrofit, with greater certainty with added steps.

  13. DoD ADP Internal Control Guideline

    Science.gov (United States)

    1988-07-01

    D. Application Controls 6-33 E. Microcomputer Controls 6-51 APPENDIX - LIFE CYCLE MANAGEMENT -INTERNAL CONTROL TECNIQUES A. Need Justification (Phase 0...Defense is allocating about $8 billion annually on Automated Information Systems (AIS), is making AIS Life-Cycle Management (LCM) decision which involve...OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE WASHINGTON, DC 20301-1100 COMPTROLLER Information Resources Management FOREWORD The DoD is allocating

  14. Performance nutrition guidelines for international rugby sevens tournaments.

    Science.gov (United States)

    Dziedzic, Christine E; Higham, Dean G

    2014-06-01

    Rugby sevens is an abbreviated version of rugby union, played by teams of seven players over 7-min halves. International competitions are usually played in a tournament format. While shorter in duration, the movement demands of rugby sevens per min of match time are greater than rugby union, resulting in an accentuated load on players. This load can be repeated up to six times over a typical 2- or 3-day competition period. The potential cumulative effect of inadequate carbohydrate, protein and/or fluid intake over the course of a tournament is the greatest nutrition-related concern for players. Nutritional strategies before and during competition are suggested to replenish substrate stores, maintain fluid balance and promote recovery between matches. The use of ergogenic aids known to enhance intermittent, high-intensity activity and/or the execution of motor skills may be advantageous to rugby sevens performance and is discussed. This review provides a best-practice model of nutritional support for international rugby sevens competition based on our current understanding of the sport combined with pragmatic guidelines and considerations for the practitioner.

  15. Inspection and evaluation guidelines for light water reactor internals

    Energy Technology Data Exchange (ETDEWEB)

    Iizuka, N. [Tokyo Electric Power Co., Inc. (Japan); Taniguchi, K. [Kansai Electric Power Co., Inc., Osaka (Japan); Yoshinaga, T. [Japan Atomic Power Co., Tokyo (Japan)

    2002-12-01

    On February, 2000, in the Engineering Society of Thermal and Nuclear Power Generation, the 'Investigation Group on Inspection and Evaluation Guidelines for Nuclear Reactor Internals' was established. This group was started at moments of some damage cases on reactor internals on BWRs and PWRs in Japan and foreign countries and of finding out cracks based on a number of SCC (stress corrosion cracking) at Inconel alloy weldings of a shroud support of BWR internals in Tsuruga Nuclear Power Station Unit-1 of the Japan Nuclear Power Generation Co., Ltd. on December, 1999. Under these conditions, this group made some guidelines for rational inspection with clear technical foundation, and so on as well as arrangements on structural functions, importance at safety, and so on of the reactor internals, promoted some investigations aiming at wide general proposal on how to carry out future internal inspections on LWR in Japan, and completed almost all of the investigations on March, 2002. Here were described basic indications of the guideline development and summaries of the developed guideline. (G.K.)

  16. Understanding the Current International Order

    Science.gov (United States)

    2016-01-01

    Andrew, “Taking Preferences Seriously: A Liberal Theory of International Politics,” International Organization, Vol. 51, No. 4, Autumn 1997, pp...296. Snyder, Quddus Z., “Integrating Rising Powers: Liberal Systemic Theory and the Mechanism of Cooperation,” Review of International Studies, Vol. 39...institutions, bilateral and regional security organizations, and liberal political norms; these ordering mechanisms are often collectively referred to as

  17. CURRENT TRENDS IN INTERNATIONAL BUSINESS

    Directory of Open Access Journals (Sweden)

    Evgeny V. Ryabinin

    2015-01-01

    Full Text Available The methodological bases of researchof international business are stated in the article. The great attention is focused on analysis of main trends in development of international. The comparison of competitiveness to of most used forms ofinternational business, as well as identified the main problems and barriers of theinternational business structures.

  18. CURRENT TRENDS IN INTERNATIONAL BUSINESS

    OpenAIRE

    Evgeny V. Ryabinin

    2015-01-01

    The methodological bases of researchof international business are stated in the article. The great attention is focused on analysis of main trends in development of international. The comparison of competitiveness to of most used forms ofinternational business, as well as identified the main problems and barriers of theinternational business structures.

  19. Management of asthma: the current US and European guidelines.

    Science.gov (United States)

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

    Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines.

  20. An Exposition of Current Mobile Learning Design Guidelines and Frameworks

    Science.gov (United States)

    Teall, Ed; Wang, Minjuan; Callaghan, Vic; Ng, Jason W. P.

    2014-01-01

    As mobile devices with wireless access become more readily available, learning delivered via mobile devices of all types must be designed to ensure successful learning. This paper first examines three questions related to the design of mobile learning: 1) what mobile learning (m-learning) guidelines can be identified in the current literature, 2)…

  1. An Exposition of Current Mobile Learning Design Guidelines and Frameworks

    Science.gov (United States)

    Teall, Ed; Wang, Minjuan; Callaghan, Vic; Ng, Jason W. P.

    2014-01-01

    As mobile devices with wireless access become more readily available, learning delivered via mobile devices of all types must be designed to ensure successful learning. This paper first examines three questions related to the design of mobile learning: 1) what mobile learning (m-learning) guidelines can be identified in the current literature, 2)…

  2. The updating of clinical practice guidelines: insights from an international survey

    Directory of Open Access Journals (Sweden)

    Solà Ivan

    2011-09-01

    Full Text Available Abstract Background Clinical practice guidelines (CPGs have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods. Methods We developed a questionnaire (28 items based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee. Results Forty-four institutions answered the questionnaire (42% response rate. In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92% reported that they update their guidelines. Thirty-one institutions (86% have a formal procedure for updating their guidelines, and 19 (53% have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36% or acknowledge that it could certainly be more rigorous (36%. Twenty-two institutions (61% alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64% support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46% have plans to design a protocol to improve their guideline-updating process, and 21 (54% are willing to share resources with other organizations. Conclusions Our study is the first to describe the process of updating CPGs among prominent

  3. INTERNATIONAL LABOUR LAW PRINCIPLES AS GUIDELINES TO FOSTEREMPLOYMENT RELATIONS

    Directory of Open Access Journals (Sweden)

    Aniko Noemi TURI

    2017-06-01

    Full Text Available Contemporary human resource management practices often ignore very important values of international labour law; however there is a wide floor for improvements in this area. In this sense the main guidelines are arising from the legal acts of the International organizations. The social responsibility, professional ethics and management are categories which have the intense relation with the legal system. Some historically developed degree of social responsibility and professional ethics may be considered as an important resource of values which are the starting point for building the legal system and also international regulations. The international labour law principles are significant elements in employment relations. The paper represents how the principles of the international labour law can positively influence managerial strategies through the social dialogue. Social dialogue provides a communication platform between social partners and by that it is actually creating a socio-economic and social development. Furthermore social dialogue is a key instrument in planning social development, harmonizing different interests, prevent and resolve disputes between the management and labour. International law shows many ways how to strengthen the principle of ethics in the employment relations. The values, arising from the existing international legal documents may be the significant guideline for the development of “good practices of managers”.

  4. EXTRACTION OF INTERNAL TIDE FROM CURRENT

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    In order to extract the internal tidal current from the current data which is not measured from the sea surface to the bottom, a data processing method is developed. It is based on the fact that the internal wave currents above and below the sharp thermocline are inverse in direction. This method is a practical extension to that proposed by Shu (1985) that can be only used to quite ideal current data. The ADCP data collected on the South China Sea is then processed by this method. The internal tidal current is successfully extracted.

  5. ESPEN guidelines on nutritional support for polymorbid internal medicine patients.

    Science.gov (United States)

    Gomes, Filomena; Schuetz, Philipp; Bounoure, Lisa; Austin, Peter; Ballesteros-Pomar, María; Cederholm, Tommy; Fletcher, Jane; Laviano, Alessandro; Norman, Kristina; Poulia, Kalliopi-Anna; Ravasco, Paula; Schneider, Stephane M; Stanga, Zeno; Weekes, C Elizabeth; Bischoff, Stephan C

    2017-07-24

    Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds. From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations. Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical

  6. Economic evaluation guidelines in Latin America: a current snapshot.

    Science.gov (United States)

    Augustovski, Federico; Garay, Osvaldo Ulises; Pichon-Riviere, Andres; Rubinstein, Adolfo; Caporale, Joaquín E

    2010-10-01

    Economic evaluation guidelines are widespread in developed countries with fourth hurdle systems but as of yet not in Latin America. In the present article, a systematic search was conducted in order to retrieve regional guidelines in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and the gray literature. Four national guidelines were found: Brazil, Colombia, Cuba and Mexico. We report a thorough review of these documents, as well as a comparison among them. We conclude that, despite some differences found, they are broadly similar, and are broadly in accordance with international documents. The existence of these documents, together with other experiences in the region that explicitly use economic evaluation information for health decision making clearly shows that this global tendency is gaining momentum in Latin America, although there is still a long way to go. In the near future we will be able to see if these documents were successfully used and applied for transparent and evidence-based decision making.

  7. The International Liver Transplant Society Guideline on Living Liver Donation.

    Science.gov (United States)

    Miller, Charles M; Durand, Francois; Heimbach, Julie K; Kim-Schluger, Leona; Lee, Sung-Gyu; Lerut, Jan; Lo, Chung-Mau; Quintini, Cristiano; Pomfret, Elizabeth Anne

    2016-06-01

    The following guideline represents the position of the International Liver Transplantation Society (ILTS) on key preoperative, operative, and postoperative aspects surrounding living liver donation. These recommendations were developed from experts in the field from around the world. The authors conducted an analysis of the National Library of Medicine indexed literature on "living donor liver transplantation" [Medline search] using Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). ILTS members, and many more nonmembers, were invited to comment. Recommendations have been based on information available at the time of final submission (March 2016). The lack of randomized controlled trials in this field to date is acknowledged and is reflected in the grading of evidence. Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care.

  8. Diabetes and Hypertension: A Comparative Review of Current Guidelines.

    Science.gov (United States)

    Cryer, Michael J; Horani, Tariq; DiPette, Donald J

    2016-02-01

    Cardiovascular disease plays a major role in the morbidity and mortality of patients with diabetes mellitus. In turn, hypertension is a major risk factor for cardiovascular disease, and its prevalence is increased in diabetes mellitus. Therefore, the detection and management of elevated blood pressure (BP) is a critical component of the comprehensive clinical management of diabetics. Despite significant advances in our understanding of the pathogenesis and treatment of hypertension, there continues to be debate regarding the pharmacologic treatment of hypertension, especially in high-risk groups such as in patients with diabetes mellitus with and without chronic kidney disease (CKD). This debate largely involves at what BP (ie, treatment threshold BP) to initiate pharmacologic antihypertensive therapy and subsequently what treatment target BP should be achieved (ie, goal BP). Presently, there are several guidelines that address hypertension in diabetes mellitus, including the recently released guideline from the Eighth Report of the Joint National Committee (JNC 8). Therefore, this review will compare and contrast these current guidelines, as they relate to the management and treatment of hypertension in diabetes mellitus. Since diabetes mellitus and CKD are significantly inter-related, the presence of CKD as it relates to patients with diabetes mellitus will also be addressed. ©2015 Wiley Periodicals, Inc.

  9. Internal and external validation of an ESTRO delineation guideline

    DEFF Research Database (Denmark)

    Eldesoky, Ahmed R.; Yates, Esben Svitzer; Nyeng, Tine B

    2016-01-01

    Background and purpose To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer. Materials and methods Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized mu......-regional radiation therapy in a multi-institutional setting. However, manual correction of some structures is important before clinical use. The ABAS is now available for routine clinical use in Danish patients. © 2016 Elsevier Ireland Ltd......Background and purpose To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer. Materials and methods Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized...... and axillary nodal levels and poor agreement for interpectoral, internal mammary nodal regions and LADCA. Correcting ABAS significantly improved all the results. External validation of ABAS showed comparable results. Conclusions ABAS is a clinically useful tool for segmenting structures in breast cancer loco...

  10. The Council for International Organizations and Medical Sciences (CIOMS) guidelines on ethics of clinical trials.

    Science.gov (United States)

    Macrae, Duncan J

    2007-05-01

    Numerous bodies from many countries, including governments, government regulatory departments, research organizations, medical professional bodies, and health care providers, have issued guidance or legislation on the ethical conduct of clinical trials. It is possible to trace the development of current guidelines back to the post-World War II Nuremburg war crimes trials, more specifically the "Doctors' Trial." From that trial emerged the Nuremburg Code, which set out basic principles to be observed when conducting research involving human subjects and which subsequently formed the basis for comprehensive international guidelines on medical research, such as the Declaration of Helsinki. Most recently, the Council for International Organizations and Medical Sciences (CIOMS) produced detailed guidelines (originally published in 1993 and updated in 2002) on the implementation of the principles outlined in the Declaration of Helsinki. The CIOMS guidelines set in an appropriate context the challenges of present-day clinical research, by addressing complex issues including HIV/AIDS research, availability of study treatments after a study ends, women as research subjects, safeguarding confidentiality, compensation for adverse events, as well guidelines on consent.

  11. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair: International Cartilage Repair Society Recommendations Based on Current Scientific Evidence and Standards of Clinical Care.

    Science.gov (United States)

    Mithoefer, Kai; Saris, Daniel B F; Farr, Jack; Kon, Elizaveta; Zaslav, Kenneth; Cole, Brian J; Ranstam, Jonas; Yao, Jian; Shive, Matthew; Levine, David; Dalemans, Wilfried; Brittberg, Mats

    2011-04-01

    To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products. A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field. Current literature reflects the methodological limitations of the scientific evidence available for articular cartilage repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment, control group considerations, study endpoint definition, documentation of results, use of validated patient-reported outcome instruments, and inclusion and exclusion criteria for the design and conduct of scientifically sound cartilage repair study protocols. A consensus statement among the International Cartilage Repair Society (ICRS) and contributing authors experienced in clinical trial design and implementation was achieved. High-quality clinical research methodology is critical for the optimal evaluation of current and new cartilage repair technologies. In addition to generally applicable principles for orthopedic study design, specific criteria and considerations apply to cartilage repair studies. Systematic application of these criteria and considerations can facilitate study designs that are scientifically rigorous, ethical, practical, and appropriate for the question(s) being addressed in any given cartilage repair research project.

  12. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2011-06-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

  13. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2012-02-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

  14. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

    National Research Council Canada - National Science Library

    Naser Z Alsharif; Adnan Dakkuri; Jeanine P Abrons; Dennis Williams; David N Ombengi; HaiAn Zheng; Sara Al-Dahir; Toyin Tofade; Suzanna Gim; Mary Beth O'Connell; Anna Ratka; Emily Dornblaser

    2016-01-01

      International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs...

  15. Screening for prostate cancer: the current evidence and guidelines controversy.

    Science.gov (United States)

    Gomella, Leonard G; Liu, Xiaolong S; Trabulsi, Edouard J; Kelly, Wm Kevin; Myers, Ronald; Showalter, Timothy; Dicker, Adam; Wender, Richard

    2011-10-01

    Prostate cancer presents a global public health dilemma. While screening with prostate specific antigen (PSA) has led to more men diagnosed with prostate cancer than in previous years, the potential for negative effects from over-diagnosis and treatment cannot be ignored. We reviewed Medline for recent articles that discuss clinical trials, evidence based recommendations and guidelines from major medical organizations in the United States and worldwide concerning prostate cancer screening. Results from the European Randomized Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, and Göteborg Swedish trials regarding prostate screening are controversial with the ERSPC and Göteborg showing a reduction in prostate cancer mortality and the PLCO trial showing no benefit. Recommendations from the American Urological Association (AUA), Japanese Urological Association (JUA), and National Comprehensive Cancer Network (NCCN) have recommended that all men obtain a baseline PSA beginning at age 40. The American Cancer Society (ACS) stratifies screening recommendations based on age and risk, but states that screening should take place only after an informed discussion between provider and patient. The United States Preventative Health Service Task Force (USPSTF) states that evidence is insufficient to assess the risks and benefits of prostate cancer screening in men younger than 75 years. Other major international health organizations offer a similar reserved approach or recommend against screening for prostate cancer. Most groups indicate that screening to determine who should undergo prostate biopsy typically includes both a serum PSA and digital rectal examination, with the latest ACS publications noting that the rectal exam is optional. A common theme from all groups is that an informed discussion with the patients is strongly recommended and that screening does increase the number of men diagnosed with non

  16. Clinical compliance of viewing conditions in radiology reporting environments against current guidelines and standards

    Science.gov (United States)

    Daly, S.; Rainford, L.; Butler, M. L.

    2014-03-01

    Several studies have demonstrated the importance of environmental conditions in the radiology reporting environment, with many indicating that incorrect parameters could lead to error and misinterpretation. Literature is available with recommendations as to the levels that should be achieved in clinical practice, but evidence of adherence to these guidelines in radiology reporting environments is absent. This study audited the reporting environments of four teleradiologist and eight hospital based radiology reporting areas. This audit aimed to quantify adherence to guidelines and identify differences in the locations with respect to layout and design, monitor distance and angle as well as the ambient factors of the reporting environments. In line with international recommendations, an audit tool was designed to enquire in relation to the layout and design of reporting environments, monitor angle and distances used by radiologists when reporting, as well as the ambient factors such as noise, light and temperature. The review of conditions were carried out by the same independent auditor for consistency. The results obtained were compared against international standards and current research. Each radiology environment was given an overall compliance score to establish whether or not their environments were in line with recommended guidelines. Poor compliance to international recommendations and standards among radiology reporting environments was identified. Teleradiology reporting environments demonstrated greater compliance than hospital environments. The findings of this study identified a need for greater awareness of environmental and perceptual issues in the clinical setting. Further work involving a larger number of clinical centres is recommended.

  17. International guidelines for the management and treatment of Morquio A syndrome.

    Science.gov (United States)

    Hendriksz, Christian J; Berger, Kenneth I; Giugliani, Roberto; Harmatz, Paul; Kampmann, Christoph; Mackenzie, William G; Raiman, Julian; Villarreal, Martha Solano; Savarirayan, Ravi

    2015-01-01

    Morquio A syndrome (mucopolysaccharidosis IVA) is a lysosomal storage disorder associated with skeletal and joint abnormalities and significant non-skeletal manifestations including respiratory disease, spinal cord compression, cardiac disease, impaired vision, hearing loss, and dental problems. The clinical presentation, onset, severity and progression rate of clinical manifestations of Morquio A syndrome vary widely between patients. Because of the heterogeneous and progressive nature of the disease, the management of patients with Morquio A syndrome is challenging and requires a multidisciplinary approach, involving an array of specialists. The current paper presents international guidelines for the evaluation, treatment and symptom-based management of Morquio A syndrome. These guidelines were developed during two expert meetings by an international panel of specialists in pediatrics, genetics, orthopedics, pulmonology, cardiology, and anesthesia with extensive experience in managing Morquio A syndrome.

  18. Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

    Directory of Open Access Journals (Sweden)

    Burgers Jako S

    2007-11-01

    Full Text Available Abstract Background Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Method Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Results Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. Conclusion As a result of international developments and consensus, the described processes

  19. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Haas, Rick L.M. [Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montreal, Montreal, Quebec (Canada); Salerno, Kilian [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); O' Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Le Pechoux, Cecile [Department of Radiotherapy, Institut Gustave-Roussy, Villejuif (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  20. Systematic review of evidence and consensus on perianal fistula: an analysis of national and international guidelines.

    Science.gov (United States)

    de Groof, E J; Cabral, V N; Buskens, C J; Morton, D G; Hahnloser, D; Bemelman, W A

    2016-04-01

    Treatment of perianal fistula has evolved with the introduction of new techniques and biologicals in Crohn's disease (CD). Several guidelines are available worldwide, but many recommendations are controversial or lack high-quality evidence. The aim of this work was to provide an overview of the current available national and international guidelines for perianal fistula and to analyse areas of consensus and areas of conflicting recommendations, thereby identifying topics and questions for future research. MEDLINE, EMBASE and PubMed were systematically searched for guidelines on perianal fistula. Inclusion was limited to papers in English less than 10 years old. The included topics were classified as having consensus (unanimous recommendations in at least two-thirds of the guidelines) or controversy (fewer than three guidelines commenting on the topic or no consensus) between guidelines. The highest level of evidence was scored as sufficient (level 3a or higher of the Oxford Centre for Evidence-based Medicine Levels of Evidence 2009, http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/) or insufficient. Twelve guidelines were included and topics with recommendations were compared. Overall, consensus was present in 15 topics, whereas six topics were rated as controversial. Evidence levels varied from strong to lack of evidence. Evidence on the diagnosis and treatment of perianal fistulae (cryptoglandular or related to CD) ranged from nonexistent to strong, regardless of consensus. The most relevant research questions were identified and proposed as topics for future research. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  1. International Guidelines on Human Rights and Drug Control

    Science.gov (United States)

    Pol, Luciana

    2017-01-01

    Abstract Discrimination and inequality shape women’s experiences of drug use and in the drug trade and the impact of drug control efforts on them, with disproportionate burdens faced by poor and otherwise marginalized women. In recent years, UN member states and UN drug control and human rights entities have recognized this issue and made commitments to integrate a ‘gender perspective’ into drug control policies, with ‘gender’ limited to those conventionally deemed women. But the concept of gender in international law is broader, rooted in socially constructed and culturally determined norms and expectations around gender roles, sex, and sexuality. Also, drug control policies often fail to meaningfully address the specific needs and circumstances of women (inclusively defined), leaving them at risk of recurrent violations of their rights in the context of drugs. This article explores what it means to ‘mainstream’ this narrower version of gender into drug control efforts, using as examples various women’s experiences as people who use drugs, in the drug trade, and in the criminal justice system. It points to international guidelines on human rights and drug control as an important tool to ensure attention to women’s rights in drug control policy design and implementation. PMID:28630557

  2. The diagnosis, treatment and prevention of gout: The 2014 international clinical guidelines

    Directory of Open Access Journals (Sweden)

    N. T. Vatutin

    2015-01-01

    Full Text Available The given description of the 2014 new international guidelines prepared by the International Panel of Rheumatologists in the 3e Initiative reflects the diagnosis, treatment and prevention of gout, which are adapted for clinical practice.

  3. Current codex guidelines for assessment of potential protein allergenicity.

    Science.gov (United States)

    Ladics, G S

    2008-10-01

    A rigorous safety assessment process exists for GM crops. It includes evaluation of the introduced protein as well as the crop containing such protein with the goal of demonstrating the GM crop is "as-safe-as" non-transgenic crops in the food supply. One of the major issues for GM crops is the assessment of the expressed protein for allergenic potential. Currently, no single factor is recognized as an identifier for protein allergenicity. Therefore, a weight-of-evidence approach, which takes into account a variety of factors and approaches for an overall assessment of allergenic potential, is conducted [Codex Alimentarious Commission, 2003. Alinorm 03/34: Joint FAO/WHO Food Standard Programme, Codex Alimentarious Commission, Twenty-Fifth Session, Rome, Italy, 30 June-5 July, 2003. Appendix III, Guideline for the conduct of food safety assessment of foods derived from recombinant-DNA plants, and Appendix IV, Annex on the assessment of possible allergenicity, pp. 47-60]. This assessment is based on what is known about allergens, including the history of exposure and safety of the gene(s) source; protein structure (e.g., amino acid sequence identity to human allergens); stability to pepsin digestion in vitro [Thomas, K. et al., 2004. A multi-laboratory evaluation of a common in vitro pepsin digestion assay protocol used in assessing the safety of novel proteins. Regul. Toxicol. Pharmacol. 39, 87-98]; an estimate of exposure of the novel protein(s) to the gastrointestinal tract where absorption occurs (e.g., protein abundance in the crop, processing effects); and when appropriate, specific IgE binding studies or skin prick testing. Additional approaches may be considered (e.g., animal models; targeted sera screening) as the science evolves; however, such approaches have not been thoroughly evaluated or validated for predicting protein allergenicity.

  4. International clinical guideline for the management of classical galactosemia: diagnosis, treatment, and follow-up.

    Science.gov (United States)

    Welling, Lindsey; Bernstein, Laurie E; Berry, Gerard T; Burlina, Alberto B; Eyskens, François; Gautschi, Matthias; Grünewald, Stephanie; Gubbels, Cynthia S; Knerr, Ina; Labrune, Philippe; van der Lee, Johanna H; MacDonald, Anita; Murphy, Elaine; Portnoi, Pat A; Õunap, Katrin; Potter, Nancy L; Rubio-Gozalbo, M Estela; Spencer, Jessica B; Timmers, Inge; Treacy, Eileen P; Van Calcar, Sandra C; Waisbren, Susan E; Bosch, Annet M

    2017-03-01

    Classical galactosemia (CG) is an inborn error of galactose metabolism. Evidence-based guidelines for the treatment and follow-up of CG are currently lacking, and treatment and follow-up have been demonstrated to vary worldwide. To provide patients around the world the same state-of-the-art in care, members of The Galactosemia Network (GalNet) developed an evidence-based and internationally applicable guideline for the diagnosis, treatment, and follow-up of CG. The guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A systematic review of the literature was performed, after key questions were formulated during an initial GalNet meeting. The first author and one of the working group experts conducted data-extraction. All experts were involved in data-extraction. Quality of the body of evidence was evaluated and recommendations were formulated. Whenever possible recommendations were evidence-based, if not they were based on expert opinion. Consensus was reached by multiple conference calls, consensus rounds via e-mail and a final consensus meeting. Recommendations addressing diagnosis, dietary treatment, biochemical monitoring, and follow-up of clinical complications were formulated. For all recommendations but one, full consensus was reached. A 93 % consensus was reached on the recommendation addressing age at start of bone density screening. During the development of this guideline, gaps of knowledge were identified in most fields of interest, foremost in the fields of treatment and follow-up.

  5. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O; Day, Peter

    2012-01-01

    and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations......Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature...

  6. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Diangelis, Anthony J; Andreasen, Jens O; Ebeleseder, Kurt A

    2012-01-01

    should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers...... and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary...

  7. Tailoring International Pressure Ulcer Prevention Guidelines for Nigeria: A Knowledge Translation Study Protocol

    Directory of Open Access Journals (Sweden)

    Rose Ekama Ilesanmi

    2015-07-01

    Full Text Available Background: The 2014 International Pressure Ulcer Prevention (PUP Clinical Practice Guidelines (CPG provides the most current evidence based strategies to prevent Pressure Ulcer (PU. The evidence upon which these guidelines have been developed has predominantly been generated from research conducted in developed countries. Some of these guidelines may not be feasible in developing countries due to structural and resource issues; therefore there is a need to adapt these guidelines to the context thus making it culturally acceptable. Aim: To present a protocol detailing the tailoring of international PUPCPG into a care bundle for the Nigerian context. Methods: Guided by the Knowledge to Action (KTA framework, a two phased study will be undertaken. In Phase 1, the Delphi technique with stakeholder leaders will be used to review the current PUPCPG, identifying core strategies that are feasible to be adopted in Nigeria. These core strategies will become components of a PUP care bundle. In Phase 2, key stakeholder interviews will be used to identify the barriers, facilitators and potential implementation strategies to promote uptake of the PUP care bundle. Results: A PUP care bundle, with three to eight components is expected to be developed from Phase 1. Implementation strategies to promote adoption of the PUP care bundle into clinical practice in selected Nigerian hospitals, is expected to result from Phase 2. Engagement of key stakeholders and consumers in the project should promote successful implementation and translate into better patient care. Conclusion: Using KTA, a knowledge translation framework, to guide the implementation of PUPCPG will enhance the likelihood of successful adoption in clinical practice. In implementing a PUP care bundle, developing countries face a number of challenges such as the feasibility of its components and the required resources.

  8. An international ISHLT/ATS/ERS clinical practice guideline:

    DEFF Research Database (Denmark)

    Meyer, Keith C; Raghu, Ganesh; Verleden, Geert M

    2014-01-01

    Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts...... to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific......, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly...

  9. International guidelines for infectious diseases: a practical guide

    NARCIS (Netherlands)

    I.C. Gyssens (Inge)

    2005-01-01

    textabstractA growing number of organisations have become involved in the development of guidelines for infectious diseases (ID). The degree of acceptation of guidelines varies from one country to another. Some of these national differences are determining the practices of

  10. [Update on current care guidelines: urinary tract infections].

    Science.gov (United States)

    Wuorela, Maarit; Kouri, Timo; Laato, Matti; Lipponen, Pertti; Sammalkorpi, Kari; Uhari, Matti; Uusitalo, Leena; Vuento, Risto

    2011-01-01

    This guideline is focused on the diagnostics and treatment of acute, recurrent and relapsing urinary tract infections in adults and children. Sexually transmitted diseases are not addressed, but must be considered in differential diagnostics. The resistance prevalence of the causative microbes and the ecological adverse effects of antimicrobial agents were considered important factors in selecting optimal therapeutic choices for the guideline. Diagnosis and management of cystitis in otherwise healthy women aged 18-65 years can be based on structured telephone interviews. Primary antimicrobiotic drugs are nitrofurantoin, pivmesillinam and trimetoprim for three days.

  11. Developing International Guidelines on Volcanic Hazard Assessments for Nuclear Facilities

    Science.gov (United States)

    Connor, Charles

    2014-05-01

    Worldwide, tremendous progress has been made in recent decades in forecasting volcanic events, such as episodes of volcanic unrest, eruptions, and the potential impacts of eruptions. Generally these forecasts are divided into two categories. Short-term forecasts are prepared in response to unrest at volcanoes, rely on geophysical monitoring and related observations, and have the goal of forecasting events on timescales of hours to weeks to provide time for evacuation of people, shutdown of facilities, and implementation of related safety measures. Long-term forecasts are prepared to better understand the potential impacts of volcanism in the future and to plan for potential volcanic activity. Long-term forecasts are particularly useful to better understand and communicate the potential consequences of volcanic events for populated areas around volcanoes and for siting critical infrastructure, such as nuclear facilities. Recent work by an international team, through the auspices of the International Atomic Energy Agency, has focused on developing guidelines for long-term volcanic hazard assessments. These guidelines have now been implemented for hazard assessment for nuclear facilities in nations including Indonesia, the Philippines, Armenia, Chile, and the United States. One any time scale, all volcanic hazard assessments rely on a geologically reasonable conceptual model of volcanism. Such conceptual models are usually built upon years or decades of geological studies of specific volcanic systems, analogous systems, and development of a process-level understanding of volcanic activity. Conceptual models are used to bound potential rates of volcanic activity, potential magnitudes of eruptions, and to understand temporal and spatial trends in volcanic activity. It is these conceptual models that provide essential justification for assumptions made in statistical model development and the application of numerical models to generate quantitative forecasts. It is a

  12. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

  13. Core Stability in Athletes: A Critical Analysis of Current Guidelines.

    Science.gov (United States)

    Wirth, Klaus; Hartmann, Hagen; Mickel, Christoph; Szilvas, Elena; Keiner, Michael; Sander, Andre

    2017-03-01

    Over the last two decades, exercise of the core muscles has gained major interest in professional sports. Research has focused on injury prevention and increasing athletic performance. We analyzed the guidelines for so-called functional strength training for back pain prevention and found that programs were similar to those for back pain rehabilitation; even the arguments were identical. Surprisingly, most exercise specifications have neither been tested for their effectiveness nor compared with the load specifications normally used for strength training. Analysis of the scientific literature on core stability exercises shows that adaptations in the central nervous system (voluntary activation of trunk muscles) have been used to justify exercise guidelines. Adaptations of morphological structures, important for the stability of the trunk and therefore the athlete's health, have not been adequately addressed in experimental studies or in reviews. In this article, we explain why the guidelines created for back pain rehabilitation are insufficient for strength training in professional athletes. We critically analyze common concepts such as 'selective activation' and training on unstable surfaces.

  14. Research ethics for a globalised world: the revised CIOMS international guidelines.

    Science.gov (United States)

    Ehni, Hans-Jöerg; Wiesing, Urban

    2017-03-07

    On December 6, 2016, the Council of International Organisations of Medical Sciences published a new version of its guidelines with the title "International Ethical Guidelines for Health-related Research Involving Humans." In this article we briefly describe the revision process and the structure and content of these guidelines. We outline some of its main guidelines such as the ones on social value, post-trial access, and risk-benefit ratio. In our overall evaluation we come to the conclusion that the CIOMS guidelines manage to strike a balance between the protection of human participants in health-related research and the promotion of such research activities in an exemplary way. The guidelines combine key principles with a guide to their application based on the state of the art in research ethics. Thus they represent a timely and indispensable orientation for researchers, ethics committees, and other stakeholders in health-related research.

  15. The current issues of internal control and internal audit harmonization

    OpenAIRE

    Синюгіна, Наталія Вікторівна

    2013-01-01

    The relevance of topics related to a harmonization of internal control and internal audit system of internal financial control is being proved. It is high lightened the essence of harmonization period by reviewing existing thoughts on this object, a concept of 'harmonization of internal control and internal audit", and provided reasonably practical recommendations to ensure such harmonization in the modern world. The scientific impact of this research is to clarify the concept of "harmonizati...

  16. Mobile application to induce lifestyle modifications in type 2 diabetic patients: prototype based on international guidelines

    Science.gov (United States)

    García-Jaramillo, M.; Delgado, J. S.; León-Vargas, F.

    2015-12-01

    This paper describes a prototype app to induce lifestyle modifications in newly diagnosed type 2 diabetic patients. The app design is based on International Diabetes Federation guidelines and recommendations from clinical studies related to diabetes health-care. Two main approaches, lifestyle modification and self-management education are used owing to significant benefits reported. The method used is based on setting goals under medical support related to physical activity, nutritional habits and weight loss, in addition to educational messages. This is specially implemented to address the main challenges that have limited the success of similar mobile applications already validated on diabetic patients. A traffic light is used to show the overall state of the goals compliance. This state could be understood as excellent (green), there are aspects to improve (yellow), or some individual goals are not carrying out (red). An example of how works this method is presented in results. Furthermore, the app provides recommendations to the user in case the overall state was in yellow or red. The recommendations pretend to induce the user to make changes in their eating habits and physical activity. According to international guidelines and clinical studies, a prototype of mobile application to induce a lifestyle modification in order to prevent adverse risk factors related to diabetes was presented. The resulting application is apparently consistent with clinical judgments, but a formal clinical validation is required. The effectiveness of this app is currently under consideration for the Colombian population with type 2 diabetes.

  17. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Buller, H. R.

    2013-01-01

    . Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this settin

  18. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Buller, H. R.

    2013-01-01

    . Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this settin

  19. Current International Cooperation and Developments in Information Security

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Global information security and the threats to its integrity are becoming increasingly important. In this paper,the authors talk about areas requiring international cooperation, the major problems with current international cooperation, and finally give their reflections on international cooperation.

  20. Guidelines for assessment of work disability: An international survey

    NARCIS (Netherlands)

    Boer, W.E.L. de; Rijkenberg, A.M.; Donceel, P.

    2011-01-01

    Background: Assessments of long-term work disability are carried out by social insurance physicians (SIPs) and are little supported with evidence or instruments. Guidelines are hardly ever used in social insurance medicine. Developments in social insurance medicine might be slow as insurance is diff

  1. conformity to the surviving sepsis campaign international guidelines ...

    African Journals Online (AJOL)

    2010-08-08

    Aug 8, 2010 ... Sepsis is a systemic inflammatory response to presumed or ... humanity, no comprehensive clinical guidelines existed until 2002. ... Objectives:To determine the conformity rate for resuscitation and management bundles for septic ... volume ventilation that may reduce mortality. ... Stress ulcer prophylaxis.

  2. Current clinical practice guidelines in atrial fibrillation: a review

    Directory of Open Access Journals (Sweden)

    osé Kelvin Galvez-Olortegui

    2016-03-01

    Full Text Available El objetivo del presente estudio es la evaluación metodológica de las guías de práctica clínica en fibrilación auricular. Este es el segundo de una serie de artículos de revisión, análisis, valoración metodológica y contenido de las guías de práctica clínica en cardiología. De todas las guías de práctica clínica se seleccionaron la Guía Americana, Canadiense y la del National Institute for Health and Care Excellence, (NICE, por su sigla en inglés, y se utilizó el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II para evaluar cada una de ellas En general, las guías obtuvieron el menor puntaje en el dominio de aplicabilidad (media 36,1%; mientras que el mayor puntaje fue para el dominio de claridad en la presentación (media 93,5%. El menor puntaje hallado fue en el dominio de independencia editorial (Guía Canadiense y el mayor de todos los puntajes fue en el dominio “Claridad de la presentación” (guía The National Institute for Health and Care Excellence, NICE. Al evaluar la calidad global de las guías de práctica clínica analizadas, NICE es la que mejor puntuaciones obtiene al aplicar el instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE, seguido de la americana, siendo ambas recomendadas sin modificaciones.

  3. Galeazzi fractures: Is DRUJ instability predicted by current guidelines?

    Science.gov (United States)

    Tsismenakis, Tony; Tornetta, Paul

    2016-07-01

    Clinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury. A retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation. Average age was 34 years old (range: 18-90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (-2.6-22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02). Using a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. The Argument of Current International Order

    Institute of Scientific and Technical Information of China (English)

    Wang Jiangli

    2016-01-01

    As the trend of globalization strengthened,Global Village increasingly strengthens association between nations,which breaks old international order that is not consistent with contemporary international order,so the construction of new international order has become the demand of the times. However,under the complex background of international,and appearing emerging economic structure,all nations know how to achieve fairness and justice and how to safeguard the legitimate interests of the small and weak countries,which have become the problem that need to be solved in the study of a new international order.

  5. Astrobiology: guidelines and future missions plan for the international community

    Science.gov (United States)

    French, L.; Miller, D.

    The search for extra-terrestrial life has been going on ever since humans realized there was more to the Universe than just the Earth. These quests have taken many forms including, but not limited to: the quest for understanding the biological origins of life on Earth; the deployment of robotic probes to other planets to look for microbial life; the analysis of meteorites for chemical and fossil remnants of extra - terrestrial life; and the search of the radio spectrum for signs of extra-solar intelligence. These searches so far have yielded hints, but no unambiguous proof of life with origins from off Earth. The emerging field of astrobiology studies the origin, distribution, and future of life in the Universe. Technical advances and new, though not conclusive, evidence of extinct microbial life on Mars have created a new enthusiasm for astrobiology in many nations. However, the next steps to take are not clear, and should a positive result be returned, the follow-on missions are yet to be defined. This paper reports on the results of an eight-week study by the students of the International Space University during the summer of 2002. The study created a source book that can be used by mission designers and policy makers to chart the next steps in astrobiology. In particular, the study addresses the following questions:1.What is the full set of dimensions along which we can search forextra-terrestrial life?2.What activities are currently underway by the internationalcommunity along each of these dimensions?3.What are the most effective next steps that can be taken by theinternational space community in order to further this search (from a policy,sociological and mission point of view)?4.What are the proper steps for eliminating possible contaminationof the Earth's biosphere?5.What are the issues with planetary quarantine with regards tounwanted contamination of other biospheres with terrestrial organisms? Integrating all the considerations affecting the search for

  6. Are the current IHS guidelines for migraine drug trials being followed?

    DEFF Research Database (Denmark)

    Hougaard, Anders; Tfelt-Hansen, Peer

    2010-01-01

    In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst...... or not double-blinded. Adherence to international guidelines like these of IHS is important to ensure that only high-quality trials are performed, and to provide the consensus that is required for meta analyses. The primary efficacy measure for trials of acute treatment should be "pain free" and not "headache...... investigators of the methodological issues specific to this particular illness. Until now the adherence to these guidelines has not been systematically assessed. We reviewed all published controlled trials of drugs in migraine from 2002 to 2008. Eligible trials were scored for compliance with the IHS guidelines...

  7. International double (non-)taxation : comparative guidelines from European legal principles

    OpenAIRE

    Vijver, van de, L.P.L.

    2015-01-01

    Abstract: The principle of fairness advocates against international double taxation and international double non-taxation. Countries and international organizations (OECD, G20 and EU) have taken several initiatives against such taxation. However, these initiatives are not always effective. Also, certain legal authors question the legitimacy of the OECD and its action plan on BEPS. The essential goal of this research is to find guidelines to address international double (non-) taxation. We fir...

  8. International Harmonization of Guidelines-Role of ICLAS

    Institute of Scientific and Technical Information of China (English)

    Gilles; Demers; M.Sc.

    2005-01-01

    The international harmonization of guidelinesforthe use of animalsinresearch,teachingandtestingis an emergingissueinthe context of the globalization of research.The International Council for Laboratory Animal Science(ICLAS),as aninternational umbrella organization,is well situatedtoact as afacilitatorinthis area.Accordingly,ICLAS was pleasedtoinvite a number of representativesfrombothinternational andscientific organizations,which produce or use guidelinesforthe use of animals inresearch,to attendthe First ...

  9. Perioperative anesthetic documentation: Adherence to current Australian guidelines

    Directory of Open Access Journals (Sweden)

    Islam Elhalawani

    2013-01-01

    Full Text Available Purpose: The lack of adequate perioperative documentation has legal implications and can potentially affect the quality and safety of patient care. Despite the presence of guidelines, the adequacy of perioperative documentation in Australasia has not been adequately assessed. The aim of this study is to assess the adequacy of anesthetic documentation on the pre and intraoperative encounters and to test the hypotheses that documentation is incomplete in the settings of emergency vs. elective procedures, regional vs. general anesthesia, and manual vs. electronic documentation. Materials and Methods: The study was an observational retrospective study in the setting of a 250-bed teaching hospital in metropolitan Adelaide, Australia. The perioperative records of 850 patients were analyzed. A scoring system was designed, based on a policy statement from the Australian and New Zealand College of Anesthetists and a survey of the hospital anesthetists. Scored and categorical data was analyzed using Chi-square test. Numerical data was analyzed using student t-test. The null hypothesis was accepted or rejected at 0.05 significance. Results: There were significant deficiencies in the adequacy of preanesthetic and intraoperative records. This has been shown to be true in all cases. Documentation was found to be poorer in the emergency setting when compared to elective cases (median scores 15 vs. 21 P = 0.03 as well as documentation of airway assessment for cases done solely under regional anesthesia (42 vs. 85%, P = 0.05. There were no significant differences in the adequacy of electronic vs. manual records ( P = 0.92. Conclusion: There are significant deficiencies in the adequacy of perioperative records. This has been shown to be true in all cases, but is especially so in emergency cases and for patients having only regional anesthesia.

  10. Guidelines from the International Conference on Harmonisation (ICH).

    Science.gov (United States)

    Branch, Sarah K

    2005-08-10

    This article describes the development of international guidance on registration of technical dossiers supporting applications to market medicinal products. Aspects of guidance of particular relevance to the use of NMR spectroscopy in drug development and control are discussed.

  11. CIOMS stellt "International Guidelines for Ethical Review of Epidemiological Studies" zur Diskussion

    OpenAIRE

    Müller,W.

    2005-01-01

    Das Council for International Organisations of Medical Sciences (CIOMS) bei der WHO - in dem Deutschland durch die AWMF vertreten ist - erstellt derzeit eine Überarbeitung der erstmals 1991 verabschiedeten International Guidelines for Ethical Review of Epidemiological Studies. Alle interessierten Wissenschaftler aus dem Gesamtbereich der Medizin sind gebeten, ihre Anregungen bis Ende Oktober 2005 einzubringen.

  12. INTERNATIONAL TERRORISM. CURRENT RESEARCH AND FUTURE DIRECTIONS.

    Directory of Open Access Journals (Sweden)

    A.D. Naudé

    2012-02-01

    Full Text Available This publication was first published by the Journal of International Affairs, Volume 32/Number 1, of Columbia University, City of New York. The editors are both connected with this university.

  13. Protectionism in the Current International Context

    Directory of Open Access Journals (Sweden)

    Botescu Ion

    2017-01-01

    The attempt to impose a set of international trade rules to be respected by world statesrepresents progress in this area. Further issues are related to how the agreed rules apply so thatthe benefits of international trade are placed in an equitable area. The global financial crisis, theBrexit, Trump's attitude as candidate and especially as US President are disturbing factors in thetrade relationships between states.

  14. PHARMACOTHERAPY FOR RHEUMATOID ARTHRITIS: RUSSIAN AND INTERNATIONAL GUIDELINES

    Directory of Open Access Journals (Sweden)

    E. L. Nasonov

    2016-01-01

    Full Text Available The lecture considers the present trends in the strategy of pharmacotherapy for rheumatoid  arthritis (RA in the light of the guidelines by the European  League Against Rheumatism, the American College of Rheumatology and the All-Russian Public Organization  "The Association of Rheumatologists  of Russia". It emphasizes the most important  role of the treat-to-target RA treatment strategy, the key place of which is occupied by early controlled  active therapy with methotrexate (MT.  The therapeutic  place of glucocorticoids  and especially biologic agents, the rational use of which in combination  with MT allows a remission to be achieved in most patients,  is discussed.

  15. A critique of current practice: ten foundational guidelines for autoethnographers.

    Science.gov (United States)

    Tolich, Martin

    2010-12-01

    Any research is potentially compromised when researchers address ethical issues retrospectively rather than by anticipating these issues. In this regard, creative analytical practices (CAP) autoethnography has endemic problems. In Part 1 of this article, I detail a case study of an autoethnography in which journal reviewers insisted that an author gain retrospective informed consent from the 23 persons documented in an autoethnography. Yet the journal reviewers' insistence failed to go one step further-acknowledging that a conflict of interest develops when gaining consent retrospectively. In Part 2, I contrast three leading autoethnographers' justifications for not gaining informed consent with the Position Statement on Qualitative Research developed by successive Congresses of Qualitative Inquiry. In Part 3, I identify resources available for autoethnographers, including ethical issues present when researchers use autoethnography to heal themselves, violating the internal confidentiality of relational others. In Part 4, I question if autoethnography is research and, like journalism, exempt from formal ethics review. Throughout the article, 10 foundational ethical considerations for autoethnographers are developed, taking autoethnographers beyond procedural ethics and providing tools for their ethics in practice.

  16. DISCONTINUOUS FLOW OF TURBID DENSITY CURRENTS Ⅱ. INTERNAL HYDRAULIC JUMP

    Institute of Scientific and Technical Information of China (English)

    Jiahua FAN

    2005-01-01

    Traveling and stationary internal hydraulic jumps in density currents with positive or negative entrainment coefficients were analyzed based on simple assumptions. An expression of internal hydraulic jumps with entrainment coefficients was derived. Experimental data, published in literature, of stationary internal hydraulic jumps in turbid, thermal and saline density currents including measured values of water entrainment were used to compare with theory. Comparison was also made of traveling internal hydraulic jumps between measured data and theory.

  17. [Comments on current guidelines of type 2 diabetes mellitus treatment].

    Science.gov (United States)

    Martinka, Emil

    In an effort to facilitate the widest possible application of recent findings in diabetology and the related medical fields, with regard to characteristics of medicines and current possibilities of using modern procedures, but also to their limitations due to the financial capacities of health insurance companies, SDS innovates its therapeutic recommendations for the treatment of diabetes mellitus on a regular basis. The most recent recommendations were issued by SDS in August 2016. The review discusses and describes several factors which the authors considered during their preparation: (1) Compliance with the findings of evidence-based medicine, compliance with reference recommendations (therapeutic recommendations ADA/EASD), compliance with summary characteristics of active substances in the treatment of diabetes mellitus and approved possibilities of their use, and compliance with indica-tive restrictions (IO) which define medical and economic conditions for health insurance covered treatment. (2) Certain departure from the "glucocentric" approach to therapy, in favour of the approach preferring the selection of drugs based on clinical characteristics of the patient and proven benefits/risks of individual drugs (3) Preference of groups as well as individual active substances within groups based on evidence medicine regarding the individual active substances for specific patient groups. (4) Emphasis on individualization of goals for glycemic control (5) Emphasis on the right classification of diabetes mellitus as the basic condition for the selection of an optimum thera-peutic procedure, and (6) Emphasis on education and overcoming of clinical inertia, and patient medication adherence and medication "literacy" as the basic condition for successful therapy. The discussion also considers the outcomes of the most recent studies including of the studies focusing on empagliflozin and liraglutide, as well as recent modifications of the therapeutic recommendations of

  18. International current of the genotoxicity testing

    Institute of Scientific and Technical Information of China (English)

    HayaM

    2002-01-01

    One of the goals of the genetic toxicology is to assess the risk to humans that derives from genotoxic agents.The risk involves both somatic and germ cells,with damage to the former resulting in cancer and damage to the latter in adverse effects that could be transmitted through generations.It is necessary to consider not only direct effects,but also effects that are the result of analtered environment.To perform an accurate risk assessment.it is necessary to evaluate genotoxic hazards in ways that are appropriate both methodologically and strategically.In establishing a genotoxicity assay system,international cooperation is important because it enables us to incorporate the thoughts of specialists everywhere and to learn of specific regional concerns.Here I will introduce the “Guidance on a Strategy for Testing of Chemicals for Mutagenicity” recently reported by the UK Committee on Mutagenicity (COM) and also I will briefly summarize the activities of the International Workshop on Genotoxicity Test Procedures(IWGTP).The first and the second workshops focused on methodology.we started to include the strategic issues as well as procedures in the third workshop.Starting with the 3rd IWGT,the workshop will become an activity of the International Association of EMSs.

  19. Radiation safety awareness among medical interns: are EU guidelines being implemented?

    Science.gov (United States)

    Lee, A M; Lee, M J

    2016-11-14

    European recommendations suggest that medical students should be taught radiation safety before entering clinical practice. The aim of this study was to produce a summative assessment of radiation protection training in medical school in Ireland. A web-based questionnaire was distributed to the 2014 intern population (n = 683) via network intern-coordinators. The survey encompassed knowledge of radiation dose in X-ray investigations, laws governing the prescribing of radiation and complications of radiation exposure to staff and patients. Response rate was 14.2% (97/683) with all Irish medical schools represented. 64% of interns reported no formal training in radiation safety. 80% correctly identified MRI and 94% US as not posing a radiation risk. 54% identified CT PET as emitting the highest radiation dose to patients. Only 32% correctly identified one CT abdomen/pelvis as equivalent to the dose from 300 to 500 chest X-rays and 22% correctly identified the theoretical lifetime risk of cancer induction from CT abdomen/pelvis as 1 in 2000. While 71% thought it was very important that prescribers should be aware of patient radiation dose and 28% thought it was moderately important, 74% were not aware of any laws governing the prescribing of radiology investigations. Currently, there is little formal radiation safety training in Irish medical schools. Knowledge of radiation dose and the laws governing prescribing is limited among qualifying interns. Implementation of a formal radiation safety curriculum in Irish Medical Schools would adhere to EU guidelines and improve prescriber knowledge, patient, and personal radiation safety.

  20. Are the current IHS guidelines for migraine drug trials being followed?

    DEFF Research Database (Denmark)

    Hougaard, Anders; Tfelt-Hansen, Peer

    2010-01-01

    In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst investigat......In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst...... investigators of the methodological issues specific to this particular illness. Until now the adherence to these guidelines has not been systematically assessed. We reviewed all published controlled trials of drugs in migraine from 2002 to 2008. Eligible trials were scored for compliance with the IHS guidelines...... by using grading scales based on the most essential recommendations of the guidelines. The primary efficacy measure of each trial was also recorded. A total of 145 trials of acute treatment and 52 trials of prophylactic treatment were eligible for review. Of the randomized, double-blind trials, acute...

  1. Current Status on Onshore Petroleum Internal Audit

    Institute of Scientific and Technical Information of China (English)

    Sun Shourong

    1995-01-01

    @@ The onshore petroleum internal audit has been carried out for 10years since it had started from 1985.Up to now, there are 430 independent audit organizations and 1500professional employees. With the development of petroleum audit, the auditing has played an important role in the further reform, managing reinforcement and economic efficiency improvement of petroleum enterprises. Through 10 years efforts, a total direct economic value of 2.2 billion yuan has been achieved by correcting violation and misfeasance and decreasing the capitalized cost.

  2. Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

    Science.gov (United States)

    Naik, Ronak J; Patel, Neil R; Wang, Ming; Shah, Nishant C

    2016-08-01

    In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

  3. The International Curriculum: Current Trends and Emerging Needs

    Science.gov (United States)

    Richter, Jesse Jones

    2015-01-01

    This paper examines the current state of tertiary level international curricula and provides groundwork for future research aimed at ongoing needs. Recognized is the premise that existing international curricular programs require maintenance. Burn (1995) called for curriculum reform in international departments two decades ago with the rationale…

  4. Counselling International Students in Turkish Universities: Current Status and Recommendations

    Science.gov (United States)

    Bektas, Dilek Yelda

    2008-01-01

    In the present study, the current status of international students and counselling services provided at Turkish universities is addressed. Firstly, a brief history of counselling and counselling services in Turkish universities is examined, leading to a consideration of the current status of international students and counselling services.…

  5. Extraction of Internal Tidal Currents from A Portion of Sea Current Profile

    Institute of Scientific and Technical Information of China (English)

    韩春明; 潘增弟; 范典

    2002-01-01

    Internal tide is one of the major oceanic phenomena. Determination of internal tide is important for theoretical studyand for ocean engineering research. As an inverse problem, extraction of internal tidal currents from sea currents is diffi-cult. In this paper, a method is developed to extract internal tidal currents from a portion of the sea current profile basedon the fact that the directions of internal tidal currents above and below the thermocline are inverse. Sea current data col-lected from the South China Sea is processed with this method. The internal tidal currents and the depth of the thermo-cline are successfully extracted. The depth of the thermocline determined is in good agreement with that measured in 1959.

  6. [International clinical practice guidelines and management of rheumatology in Madagascar].

    Science.gov (United States)

    Ralandison, S; Rafalimanana, E; Rakotonirainy, H; Rabenja, R

    2012-02-01

    Developed countries issue recommendations regarding healthcare that aren't constantly appropriate for emergent countries. We suggest some remarks concerning rheumatology in Madagascar, taking account of scientific data, medical ethics, equality and equity. We have studied the minimal cost of care of medical conditions found in our hospital department if we were to follow international recommendations for their management. Then, we have estimated treatment expenses as a percentage of the SMIC (Malagasy minimum monthly salary). Out of 517 patients examined yearly, we have found 62.8% osteoarthritis cases, 6.3% rheumatoid arthritis (RA), and 4,2% septic arthritis. Therefore, the first month of treatment for an arthritis of the knee would absorb 147.3% of the SMIC; diagnosis and treatment of a case of septic arthritis would take up 1762.8% of the minimum wage, and a case of RA without biotherapy would require 175%. According to the American College of Rheumatology criteria which are used as a reference, the treatment of an arthritis of the knee would take only 23% of the SMIC. Caring for septic arthritis would demand 57.5% of the SMIC and while it would yield more arguments for diagnosis such as clinical examination, CRP, and Gram coloration on joint liquid aspiration. We can proceed to RA diagnosis with an acceptable security through precise clinical examination, blood cell count, ESR, CRP, rheumatoid factor and radiography. This means 56% of the SMIC. From this 517 patients, our suggestions would reduce the expense by 35,850% of the SMIC per year. The allocation of such funds onto the treatment of complicated forms of rheumatism would be fair. By refining and evaluating these suggestions, we would come up with appropriate recommendations for emergent countries.

  7. A review of current guidelines for the management of Helicobacter pylori infection in children and adolescents

    OpenAIRE

    Jones, Nicola L.

    2004-01-01

    Helicobacter pylori infection is acquired in childhood and plays a causative role in chronic gastritis, peptic ulcer disease and the development of gastric cancer. The present review focuses on recent advances in the management of H pylori infection in children and provides an update of current Canadian guidelines regarding clinical sequelae, diagnosis and treatment.

  8. Critical analysis of the current treatment guidelines for complex ptsd in adults

    NARCIS (Netherlands)

    de Jongh, A.; Resick, P.A.; Zoelner, L.A.; van Minnen, A.; Lee, C.W.; Monson, C.M.; Foa, E.B.; Wheeler, K.; ten Broeke, E.; Feeny, N.; Rauch, S.A.M.; Chard, K.M.; Mueser, K.T.; Sloan, D.M.; van der Gaag, M.; Rothbaum, B.O.; Neuner, F.; de Roos, C.; Hehenkamp, L.M.J.; Rosner, R.; Bicanic, I.A.E.

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a “stabilization phase.” This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  9. CRITICAL ANALYSIS of the CURRENT TREATMENT GUIDELINES for COMPLEX PTSD in ADULTS

    NARCIS (Netherlands)

    De Jongh, Ad; Resick, Patricia A.; Zoellner, Lori A.; Van Minnen, Agnes; Lee, Christopher W.; Monson, Candice M.; Foa, Edna B.; Wheeler, Kathleen; Broeke, Erik Ten; Feeny, Norah; Rauch, Sheila A M; Chard, Kathleen M.; Mueser, Kim T.; Sloan, Denise M.; Van Der Gaag, Mark; Rothbaum, Barbara Olasov; Neuner, Frank; De Roos, Carlijn; Hehenkamp, Lieve M J; Rosner, Rita; Bicanic, Iva A E

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  10. The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients : are current ophthalmologic screening guidelines adequate?

    NARCIS (Netherlands)

    Reininga, J K; Los, L I; Wulffraat, N M; Armbrust, W

    2008-01-01

    OBJECTIVE: The aims of this study are to examine in our juvenile idiopathic arthritis (JIA) population: 1) the prevalence and characteristics of uveitis, 2) the complications and outcome of uveitis, 3) prognostic factors, and 4) the adequacy of the current ophthalmologic screening guidelines. METHOD

  11. The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients : are current ophthalmologic screening guidelines adequate?

    NARCIS (Netherlands)

    Reininga, J K; Los, L I; Wulffraat, N M; Armbrust, W

    2008-01-01

    OBJECTIVE: The aims of this study are to examine in our juvenile idiopathic arthritis (JIA) population: 1) the prevalence and characteristics of uveitis, 2) the complications and outcome of uveitis, 3) prognostic factors, and 4) the adequacy of the current ophthalmologic screening guidelines. METHOD

  12. Building an information security strategy for EHR: guidelines for assessing the current situation.

    Science.gov (United States)

    Mohammad, Yara; Stergioulas, Lampros

    2010-01-01

    This paper is looking at electronic health record (EHR) systems and their information security strategy. It focuses on the first step of building an information security strategy which is analysing the current situation of an EHR system. This research is based on different research methods applied to different EHR systems. In this paper we define eight elements that can be used as guidelines for how best to assess the current situation of any EHR system.

  13. [Treatment of manic phases of bipolar disorder: critical synthesis of international guidelines].

    Science.gov (United States)

    Geoffroy, P A; Bellivier, F; Henry, C

    2014-09-01

    Bipolar disorder (BD) is the seventh leading cause of disability per year of life among all diseases in the population aged 15 to 44. It is a group of heterogeneous diseases, with frequent comorbid psychiatric or somatic disorders, variable treatment response and frequent residual symptoms between episodes. The major impairment associated with this disorder is related to the high relapse and recurrence rates, the functional impact of comorbidities and cognitive impairment between episodes. The prognosis of the disease relies on the efficacy of relapse and recurrence prevention interventions. Given the heterogeneity of the disorder, relapse and recurrence prevention needs to develop a personalized care plan from the start of the acute phase. In such a complex situation, guideline-driven algorithms of decision are known to improve overall care of patients with bipolar disorder, compared to standard treatment decisions. Although guidelines do not account for all the situations encountered with patients, this systematic approach contributes to the development of personalized medicine. We present a critical review of recent international recommendations for the management of manic phases. We summarize treatment options that reach consensus (monotherapy and combination therapy) and comment on options that differ across guidelines. The synthesis of recent international guidelines shows a consensus for the initial treatment for manic phases. For acute and long-term management, the anti-manic drugs proposed are traditional mood stabilizers (lithium or valproate) and atypical antipsychotics (APA - olanzapine, risperidone, aripiprazole and quetiapine). All guidelines indicate stopping antidepressant drugs during manic phases. International guidelines also present with some differences. First, as monotherapy is often non sufficient in clinical practice, combination therapy with a traditional mood stabilizer and an APA are disputed either in first line treatment for severe

  14. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?

    Science.gov (United States)

    Price, Kym Joanne; Gordon, Brett Ashley; Bird, Stephen Richard; Benson, Amanda Clare

    2016-11-01

    Cardiac rehabilitation is an important component in the continuum of care for individuals with cardiovascular disease, providing a multidisciplinary education and exercise programme to improve morbidity and mortality risk. Internationally, cardiac rehabilitation programmes are implemented through various models. This review compared cardiac rehabilitation guidelines in order to identify any differences and/or consensus in exercise testing, prescription and monitoring. Guidelines, position statements and policy documents for cardiac rehabilitation, available internationally in the English language, were identified through a search of electronic databases and government and cardiology society websites. Information about programme delivery, exercise testing, prescription and monitoring were extracted and compared. Leading cardiac rehabilitation societies in North America and Europe recommend that patients progress from moderate- to vigorous-intensity aerobic endurance exercise over the course of the programme, with resistance training included as an important adjunct, for maintaining independence and quality of life. North American and European guidelines also recommend electrocardiograph-monitored exercise stress tests. Guidelines for South America and individual European nations typically include similar recommendations; however, those in the United Kingdom, Australia and New Zealand specify lower-intensity exercise and less technical assessment of functional capacity. Higher-intensity aerobic training programmes, supplemented by resistance training, have been recommended and deemed safe for cardiac rehabilitation patients by many authorities. Based on research evidence, this may also provide superior outcomes for patients and should therefore be considered when developing an international consensus for exercise prescription in cardiac rehabilitation. © The European Society of Cardiology 2016.

  15. The effects of a randomised multi-centre trial and international accreditation on availability and quality of clinical guidelines

    DEFF Research Database (Denmark)

    Juul, AB; Gluud, C; Wetterslev, J;

    2005-01-01

    To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation.......To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation....

  16. [Methodology for the development and update of practice guidelines: current state].

    Science.gov (United States)

    Barrera-Cruz, Antonio; Viniegra-Osorio, Arturo; Valenzuela-Flores, Adriana Abigail; Torres-Arreola, Laura Pilar; Dávila-Torres, Javier

    2016-01-01

    The current scenario of health services in Mexico reveals as a priority the implementation of strategies that allow us to better respond to the needs and expectations of individuals and society as a whole, through the provision of efficient and effective alternatives for the prevention, diagnosis and treatment of diseases. In this context, clinical practice guidelines constitute an element of management in the health care system, whose objective is to establish a national bechmark for encouraging clinical and management decision making, based on recommendations from the best available evidence, in order to contribute to the quality and effectiveness of health care. The purpose of this document is to show the methodology used for the development and updating of clinical practice guidelines that the Instituto Mexicano del Seguro Social has developed in line with the sectorial model in order to serve the user of these guidelines.

  17. Needs and Availability of Snake Antivenoms: Relevance and Application of International Guidelines

    Directory of Open Access Journals (Sweden)

    Laura Scheske

    2015-07-01

    Full Text Available Background Snakebite has recently been declared a global public health emergency. Empirical data showing the true burden of snakebite is lacking. Treatment with specific antivenoms is considered the only cure. However, several factors have led to an ongoing antivenom crisis. This study offers recommendations concerning the improvement of antivenom access and control, by providing an overview of the factors limiting the successful implementation of international guidelines within the international industry and state institutions. It further investigates the reasons for the epidemiological knowledge gap regarding snakebites. Methods Data for this study was collected using surveys with closed- and open-ended questions, which allowed for descriptive and thematic analysis, respectively. Participants for this study were selected as follows: 46 manufacturers were contacted from the open-access World Health Organization (WHO Database for antivenom producers; 23 National Health Authorities (NHAs of high-burden countries were contacted; and 11 poison centers or experts were randomly contacted. Results In total, responses from 6/46 (13% manufacturers, 10/23 (43% NHAs, and 3/11 (27% poison centers were received. The low response rates had a limiting effect on the coverage of this study, allowing only exploratory conclusions to be drawn. Based on the gathered information, a probable reason for the epidemiological knowledge gap is the low priority given to snakebites on public health agendas, driving interest and funding away from research in this field. As a consequence, the ensuing lack in funding is preventing state institutions and manufacturers from implementing international guidelines to the highest standards. Furthermore, manufacturers indicated that international guidelines were often not applicable in the field, lacking technical information and protocols. Conclusion Snakebite ranks low on international public health agendas, and partially due to

  18. Are the current Australian sun exposure guidelines effective in maintaining adequate levels of 25-hydroxyvitamin D?

    Science.gov (United States)

    Kimlin, Michael; Sun, Jiandong; Sinclair, Craig; Heward, Sue; Hill, Jane; Dunstone, Kimberley; Brodie, Alison

    2016-01-01

    An adequate vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D) concentration, is important in humans for maintenance of healthy bones and muscle function. Serum 25(OH)D concentration was assessed in participants from Melbourne, Australia (37.81S, 144.96E), who were provided with the current Australian guidelines on sun exposure for 25(OH)D adequacy (25(OH)D ≥50 nmol/L). Participants were interviewed in February (summer, n=104) and August (winter, n=99) of 2013. Serum 25(OH)D concentration was examined as a function of measures of sun exposure and sun protection habits with control of key characteristics such as dietary intake of vitamin D, body mass index (BMI) and skin colour, that may modify this relationship. The mean 25(OH)D concentration in participants who complied with the current sun exposure guidelines was 67.3 nmol/L in summer and 41.9 nmol/L in winter. At the end of the study, 69.3% of participants who complied with the summer sun exposure guidelines were 25(OH)D adequate, while only 27.6% of participants who complied with the winter sun exposure guidelines were 25(OH)D adequate at the end of the study. The results suggest that the current Australian guidelines for sun exposure for 25(OH)D adequacy are effective for most in summer and ineffective for most in winter. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.

  19. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries. 2

    DEFF Research Database (Denmark)

    Diangelis, A J; Andreasen, J O; Ebeleseder, K A;

    2014-01-01

    and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations...

  20. Review of Select Practice Parameters, Evidence-Based Treatment Algorithms, and International Guidelines for Hereditary Angioedema.

    Science.gov (United States)

    Jose, Jaison; Zacharias, Jamie; Craig, Timothy

    2016-10-01

    Hereditary angioedema (HAE) is a rare bradykinin-mediated disease that is characterized by recurrent attacks of subcutaneous or submucosal edema, which can be life threatening. HAE affects all ethnic groups equally and does not differentiate between age, sex, or race. However, the availability of therapies varies amongst countries resulting in a lack of uniformity of care. Not only is there a disparity of medication availability, but since HAE is a rare disease, it is frequently overlooked and the diagnosis is missed. Even with diagnosis, treatment and management is often less than optimal. For these reasons, it is essential to have practice parameters and guidelines. In this chapter, we focus on recent guidelines. These guidelines deal with recognition, diagnosis, medical care, patient management, and assessment, all which are essential to provide optimal care to people with a rare and orphan disease. The intent of the guidelines, and thus this chapter, is to reduce morbidity and mortality, and restore a normal quality of life for the patient with HAE. We will review the guidelines from various regions of the world as well as international group recommendations. In addition, specific patient populations such as the pregnant, elderly, and juvenile require modified treatment regimens, and for this reason, we have included these data as well. The intent of this chapter is to aid the practitioner in holistic care of the patient with HAE in order to ultimately provide the best standard of care possible.

  1. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries. 1

    DEFF Research Database (Denmark)

    Diangelis, A J; Andreasen, J O; Ebeleseder, K A;

    2014-01-01

    Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines...... should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers...

  2. Current practices and guidelines for clinical next-generation sequencing oncology testing

    Institute of Scientific and Technical Information of China (English)

    Samuel P. Strom

    2016-01-01

    Next-generation sequencing (NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.

  3. Perspective: Improving nutritional guidelines for sustainable health policies: Current status and perspectives

    DEFF Research Database (Denmark)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio

    2017-01-01

    application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline...... a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic...

  4. Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012.

    Science.gov (United States)

    Gissler, Mika; Karalis, Elina; Ulander, Veli-Matti

    2015-02-01

    Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 - 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 - 2012 in Finland. We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 - 1996 (period with no guidelines), 1997 - 2001 (with unofficial guidelines) and 2002 - 2012 (with Current Care Guidelines). The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 - 1996 to 24.3/100,000 in 1997 - 2001 and then 24.8/100,000 in 2002 - 2012. The age-adjusted suicide rate among women aged 15 - 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 - 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 - 49. The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further. © 2014 the Nordic Societies of Public Health.

  5. Refractory Immune Thrombocytopenic Purpura and Cytomegalovirus Infection: A Call for a Change in the Current Guidelines

    Directory of Open Access Journals (Sweden)

    Alex Shimanovsky

    2016-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP is characterized by a decreased platelet count caused by excess destruction of platelets and inadequate platelet production. In many cases the etiology is not known, but viral illness is thought to play a role in the development of some cases of ITP. The current (2011 American Society of Hematology ITP guidelines recommend initial diagnostic studies to include testing for HIV and Hepatitis C. The guidelines suggest that initial treatment consist of observation, therapy with corticosteroids, IVIG or anti D. While most cases respond to the standard therapy such that the steroids may be tapered and the platelet counts remain at a hemostatically safe level. Some patients with ITP are dependent on long term steroid maintenance and the thrombocytopenia persists with the tapering of the steroids. Recent case reports demonstrate that ITP related to cytomegalovirus (CMV can persist in spite of standard therapy and that antiviral therapy maybe indicated. Herein we report a case of a 26-year-old female with persistent ITP that resolved after the delivery of a CMV infected infant and placenta. Furthermore we review the current literature on CMV-associated ITP and propose that the current ITP guidelines be amended to include assessment for CMV as part of the work-up for severe and refractory ITP prior to splenectomy.

  6. Overview and comparative study of GPR international standards and guidelines - COST Action TU1208

    Science.gov (United States)

    Pajewski, Lara; Marciniak, Marian; Benedetto, Andrea; Tosti, Fabio

    2016-04-01

    Ground Penetrating Radar (GPR) can be effectively used for non-destructive testing of composite structures and diagnostics affecting the whole life-cycle of civil engineering works. Nevertheless, few recognised international standards exist in this field and inhomogeneous recommendations are present in different countries. Moreover, the levels of knowledge, awareness and experience regarding the use of GPR in civil engineering vary strongly across different European areas. The COST Action TU1208 is working hard on leveraging these differences, by sharing and disseminating knowledge and experience, as well as by developing guidelines and protocols for a safe and effective use of GPR in civil engineering. GPR users need to know which is the best way to conduct GPR measurements and what the quality level for the results should be. The TU1208 guidelines will ensure a higher efficiency and quality of GPR services and they will constitute a scientific basis for the introduction of European Standards on the application of GPR in civil engineering. The aim of this contribution is to present an in-depth overview and critical analysis of the existing GPR international and national standards and guidelines. The main documents considered in our work are listed and briefly described in the following. Three standards are provided by the American Society for Testing and Materials (ASTM), to guide the GPR use for subsurface investigation, evaluation of asphalt-covered concrete bridge decks, and determination of pavement-layer thickness: 1. ASTM D6432-11, Standard Guide for Using the Surface Ground Penetrating Radar Method for Subsurface Investigation, ASTM International, West Conshohocken, PA, 2011, www.astm.org, DOI: 10.1520/D6432-11. 2. ASTM D6087-08, Standard Test Method for Evaluating Asphalt-Covered Concrete Bridge Decks Using Ground Penetrating Radar, ASTM International, West Conshohocken, PA, 2008, www.astm.org, DOI: 10.1520/D6087-08. 3. ASTM D4748-10, Standard Test Method

  7. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

    OpenAIRE

    Alsharif, Naser Z.; Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-01-01

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of unde...

  8. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

    OpenAIRE

    Alsharif, Naser Z.; Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-01-01

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of unde...

  9. “More bang for the buck”: exploring optimal approaches for guideline implementation through interviews with international developers

    Directory of Open Access Journals (Sweden)

    Gagliardi Anna R

    2012-11-01

    Full Text Available Abstract Background Population based studies show that guidelines are underused. Surveys of international guideline developers found that many do not implement their guidelines. The purpose of this research was to interview guideline developers about implementation approaches and resources. Methods Semi-structured telephone interviews were conducted with representatives of guideline development agencies identified in the National Guideline Clearinghouse and sampled by country, type of developer, and guideline clinical indication. Participants were asked to comment on the benefits and resource implications of three approaches for guideline implementation that varied by responsibility: developers, intermediaries, or users. Results Thirty individuals from seven countries were interviewed, representing government (n = 12 and professional (n = 18 organizations that produced guidelines for a variety of clinical indications. Organizations with an implementation mandate featured widely inconsistent funding and staffing models, variable approaches for choosing promotional strategies, and an array of dissemination activities. When asked to choose a preferred approach, most participants selected the option of including information within guidelines that would help users to implement them. Given variable mandate and resources for implementation, it was considered the most feasible approach, and therefore most likely to have impact due to potentially broad use. Conclusions While implementation approaches and strategies need not be standardized across organizations, the findings may be used by health care policy makers and managers, and guideline developers to generate strategic and operational plans that optimize implementation capacity. Further research is needed to examine how to optimize implementation capacity by guideline developers, intermediaries and users.

  10. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel.

    Science.gov (United States)

    Serafetinides, Efraim; Kitrey, Noam D; Djakovic, Nenad; Kuehhas, Franklin E; Lumen, Nicolaas; Sharma, Davendra M; Summerton, Duncan J

    2015-05-01

    The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Andrews, Kimberly; Brooks, Durado; DeSantis, Carol E; Fedewa, Stacey A; Lortet-Tieulent, Joannie; Manassaram-Baptiste, Deana; Brawley, Otis W; Wender, Richard C

    2016-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines, including the update of the breast cancer screening guideline, discuss quality issues in colorectal cancer screening and new developments in lung cancer screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey.

  12. Management of Breast Cancer during Pregnancy: Are We Compliant with Current Guidelines?

    Science.gov (United States)

    Shlensky, Victoria; Hallmeyer, Sigrun; Juarez, Lourdes; Parilla, Barbara V.

    2017-01-01

    Introduction The purpose of this study was to evaluate the management of patients with breast cancer in pregnancy treated at the Advocate Health Care, to determine whether these patients were treated according to guidelines for pregnant patients, which aim to maximize both fetal and maternal outcomes. Methods A retrospective chart review was performed at the Advocate Lutheran General Hospital, Christ Medical Center, and Illinois Masonic Medical Center from 2002 to 2012 on patients diagnosed with breast cancer during pregnancy using ICD-9 (International Classification of Diseases - 9th version) codes. Results Eleven patients between 12 and 37 weeks' gestation matched the search criteria. One patient terminated the pregnancy. Patients in our study were treated appropriately according to guidelines with the following exceptions. Trastuzumab was used in one patient during pregnancy which likely caused the oligohydramnios resulting in an induction of labor at 33 weeks. Three patients were delivered preterm between 34 and 36 weeks without an obstetric indication. Two patients underwent sentinel node biopsy. Conclusion The diagnosis of breast cancer in pregnancy is an infrequent but devastating diagnosis that is likely to increase. Although sentinel lymph node biopsy is not generally recommended in pregnancy, this may be an outdated guideline as using a low-dose lymphoscintigraphic technique appears to be safe in pregnancy. PMID:28255521

  13. A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2012-02-01

    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn\\'s disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate\\/severe Crohn\\'s disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn\\'s disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate\\/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate\\/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn\\'s disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.

  14. Current progress on internal medicine in China-2006 Part Ⅰ

    Institute of Scientific and Technical Information of China (English)

    YAO Dingkang; ZHU Liang; ZHAO Xue; MEI Changlin

    2007-01-01

    The growing interest has been placed in the current state of China's internal medicine from all over the world.Many data of internal medicine in China were collected by searching through some of the most prominent medical magazines published in China in 2006.Because there are many researches on the field of internal medicine,just some representative reports focusing on this topic were selected in this paper.In part Ⅰ of this study,a summary of the advances made in cardiology,respiration diseases,and gastroenterology was presented.

  15. CHALLENGES OF INTERNAL AUDIT IN THE CURRENT CRISIS

    Directory of Open Access Journals (Sweden)

    Popa Adriana Florina

    2013-07-01

    Full Text Available Modern economic theories reject the generalization of theories concerning the economic and financial crises. Each financial crisis is unique, a historic accident, generated by specific factors in a certain socio-economic and political set-up. According to these theories, crises cannot be anticipated so as to minimize their negative effects. In spite of the fact that economic and financial crises are not identical and do not produce identical effects, history teaches us that they are strongly correlated with the cyclic nature of economic processes. The current economic recession, which shows in all fields of activity, is determining auditors to make evaluations which are a lot more precise, based on extensive procedures, as long as the presumption of activity continuity into the future is accurate. In this context, internal audit is individualized as an managerial assistance function, which allows a correct perception of the reality of the business as a whole and/or as predefined processes. The purpose of this paper is to create an overall picture of internal audit by collecting data and information from literature and showing the dimensions and the internal audit practices internationally. Therefore, we conducted a research based on the analysis of national and international publications, various articles and studies in the financial press, on the emergence and development of the internal audit function both internationally and nationally. Later we analyzed the position of internal audit in terms of global financial crisis, all these leading to the usage of a comparative study of twelve international companies in order to highlight the specific features of the internal audit function in each organization. Our intention is to emphasize aspects of internal audit departments, relations between them and the management, their role in companies based on studies provided by Protiviti, a global consulting and internal audit services company, having

  16. Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children.

    Science.gov (United States)

    Colan, Steven D

    2015-08-01

    In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional

  17. [Results of a National Questionnaire on "Treatment of the subperitoneal rectal cancer". Comparision among the international guidelines and metaanalysis].

    Science.gov (United States)

    Pappalardo, Giuseppe; Nunziale, Aldo; Coiro, Saverio; Spoletini, Domenico; De Lucia, Francesca; Frattaroli, Fabrizio Maria

    2010-01-01

    A questionnaire including 20 questions about different aspects of subperitoneal rectal cancer was sent to 2200 fellows of Italian Society of Surgery. The answers were compared with International guidelines and with more recent metaanalyses from the literature. On the whole less than half of Italian surgeons fulfil the terms of the guidelines and the prevalent trend of the International literature. This behaviour concerns the choice of surgical procedure and prevention and diagnosis of anastomotic fistulas.

  18. Energetics of internal solitary waves in a background sheared current

    Directory of Open Access Journals (Sweden)

    K. G. Lamb

    2010-10-01

    Full Text Available The energetics of internal waves in the presence of a background sheared current is explored via numerical simulations for four different situations based on oceanographic conditions: the nonlinear interaction of two internal solitary waves; an internal solitary wave shoaling through a turning point; internal solitary wave reflection from a sloping boundary and a deep-water internal seiche trapped in a deep basin. In the simulations with variable water depth using the Boussinesq approximation the combination of a background sheared current, bathymetry and a rigid lid results in a change in the total energy of the system due to the work done by a pressure change that is established across the domain. A final simulation of the deep-water internal seiche in which the Boussinesq approximation is not invoked and a diffuse air-water interface is added to the system results in the energy remaining constant because the generation of surface waves prevents the establishment of a net pressure increase across the domain. The difference in the perturbation energy in the Boussinesq and non-Boussinesq simulations is accounted for by the surface waves.

  19. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases)

    DEFF Research Database (Denmark)

    Hillier, Andrew; Lloyd, David H.; Weese, J. Scott

    2014-01-01

    BACKGROUND: Superficial bacterial folliculitis (SBF) is usually caused by Staphylococcus pseudintermedius and routinely treated with systemic antimicrobial agents. Infection is a consequence of reduced immunity associated with alterations of the skin barrier and underlying diseases that may be di...... will improve antimicrobial use and reduce selection of MRSP and other multidrug-resistant bacteria affecting animal and human health....... of an internationally available resource guiding practitioners in the diagnosis, treatment and prevention of SBF. DEVELOPMENT OF THE GUIDELINES: The guidelines were developed by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases, with consultation and advice...... on infection control. Guidance is given for topical and systemic modalities, including approaches suitable for MRSP. Systemic drugs are classified in three tiers. Tier one drugs are used when diagnosis is clear cut and risk factors for antimicrobial drug resistance are not present. Otherwise, tier two drugs...

  20. Beyond ethical and curricular guidelines in global health: attitudinal development on international service-learning trips.

    Science.gov (United States)

    Ventres, William B; Wilson, Calvin L

    2015-04-03

    Health professionals from high-income countries are increasingly becoming involved in international service-learning trips in low and low/middle-income countries. While much has been written about the ethics and curricular guidelines related to such endeavors, scant attention has been paid to the attitudes with which trainees and clinicians enter into or return from them. In this essay the authors explore how attitudes contribute to the success or failure of international service-learning trips. The authors submit that the attitudes with which visiting health professionals approach international service-learning trips are much more critical to the success of these experiences than their demonstrated knowledge base or specialized skill sets. They list five attitudes that can aid those participating in international service-learning trips. They list five troubling attitudes that, while common, those participating in international service-learning trips can learn to recognize and avoid. They suggest five strategies key to learning respectful attitudes that can foster success in such cross-cultural activities. Lastly, the authors review several concepts related to attitude development in short or long-term global health work. The attitudes with which visiting health professionals approach international service-learning activities can be important components of the success or failure of the experiences. Through thoughtful consideration of attitudes and approaches, participants on such trips can build a framework for rich and rewarding experiences in global medicine and global health.

  1. Health Risk Assessment of Dietary Cadmium Intake: Do Current Guidelines Indicate How Much is Safe?

    Science.gov (United States)

    Satarug, Soisungwan; Vesey, David A.; Gobe, Glenda C.

    2017-01-01

    Background: Cadmium (Cd), a food-chain contaminant, is a significant health hazard. The kidney is one of the primary sites of injury after chronic Cd exposure. Kidney-based risk assessment establishes the urinary Cd threshold at 5.24 μg/g creatinine, and tolerable dietary intake of Cd at 62 μg/day per 70-kg person. However, cohort studies show that dietary Cd intake below a threshold limit and that tolerable levels may increase the risk of death from cancer, cardiovascular disease, and Alzheimer’s disease. Objective: We evaluated if the current tolerable dietary Cd intake guideline and urinary Cd threshold limit provide sufficient health protection. Discussion: Staple foods constitute 40–60% of total dietary Cd intake by average consumers. Diets high in shellfish, crustaceans, mollusks, spinach, and offal add to dietary Cd sources. Modeling studies predict the current tolerable dietary intake corresponding to urinary Cd of 0.70–1.85 μg/g creatinine in men and 0.95–3.07 μg/g creatinine in women. Urinary Cd levels of protection from this pervasive toxic metal. Citation: Satarug S, Vesey DA, Gobe GC. 2017. Health risk assessment of dietary cadmium intake: do current guidelines indicate how much is safe? Environ Health Perspect 125:284–288; http://dx.doi.org/10.1289/EHP108 PMID:28248635

  2. Screening for Maternal Thyroid Dysfunction in Pregnancy: A Review of the Clinical Evidence and Current Guidelines

    Directory of Open Access Journals (Sweden)

    Donny L. F. Chang

    2013-01-01

    Full Text Available Observational studies have demonstrated that maternal thyroid dysfunction and thyroid autoimmunity in pregnancy may be associated with adverse obstetric and fetal outcomes. Treatment of overt maternal hyperthyroidism and overt hypothyroidism clearly improves outcomes. To date there is limited evidence that levothyroxine treatment of pregnant women with subclinical hypothyroidism, isolated hypothyroxinemia, or thyroid autoimmunity is beneficial. Therefore, there is ongoing debate regarding the need for universal screening for thyroid dysfunction during pregnancy. Current guidelines differ; some recommend an aggressive case-finding approach, whereas others advocate testing only symptomatic women or those with a personal history of thyroid disease or other associated medical conditions.

  3. Review of the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel.

    Science.gov (United States)

    Lumen, Nicolaas; Kuehhas, Franklin E; Djakovic, Nenad; Kitrey, Noam D; Serafetinidis, Efraim; Sharma, Davendra M; Summerton, Duncan J

    2015-05-01

    The most recent European Association of Urology (EAU) guidelines on urologic trauma were published in 2014. To present a summary of the 2014 version of the EAU guidelines on urologic trauma of the lower urinary tract with an emphasis on diagnosis and treatment. The EAU Trauma Panel reviewed the English-language literature via a Medline search for lower urinary tract injury (LUTI) up to November 2013. The focus was on newer publications and reviews, although older key references could be included. A full version of the guidelines is available in print (EAU Guidelines 2014 edition, ISBN/EAN 978-90-79754-65-6) and online (www.uroweb.org). Blunt trauma is the main cause of LUTI. The preferred diagnostic modality for bladder and urethral injury is cystography and urethrography, respectively. In the treatment of bladder injuries, it is important to distinguish between extra- and intraperitoneal ruptures. Treatment of male anterior urethral injuries depends on the cause (blunt vs penetrating vs penile-fracture-related injury). Blunt posterior urethral injuries can be corrected by immediate/early endoscopic realignment. If this is not possible, such injuries are managed by suprapubic urinary diversion and deferred (>3 mo) urethroplasty. Treatment of female urethral injuries depends on the location of the injury and is usually surgical. Correct treatment of LUTIs is important to minimise long-term urinary symptoms and sexual dysfunction. This review performed by the EAU trauma panel summarises the current management of LUTIs. Patients with trauma to the lower urinary tract benefit from accurate diagnosis and appropriate treatment according to the nature and severity of their injury. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  4. INTERNATIONAL CONFERENCE ON HARMONISATION GUIDELINES ON THE LIMITS OF GENOTOXIC IMPURITIES IN DRUG PRODUCT

    OpenAIRE

    Malik Ajay; Thukral Kapil; Kumar Tarun; Sunil

    2012-01-01

    An impurity in a drug substance as defined by the International Conference on Harmonisation (ICH) guidelines is any component of the drug substance that is not the chemical entity defined as the drug substance. Similarly, an impurity in a drug product is any component of the drug product that is not the chemical entity defined as the drug substance or an excipient in the drug product. Genotoxic compounds have the potential to damage DNA at any level of exposure and that such damage may lead/c...

  5. Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines

    Directory of Open Access Journals (Sweden)

    Holder Roger L

    2009-07-01

    Full Text Available Abstract Background Multiple imputation (MI provides an effective approach to handle missing covariate data within prognostic modelling studies, as it can properly account for the missing data uncertainty. The multiply imputed datasets are each analysed using standard prognostic modelling techniques to obtain the estimates of interest. The estimates from each imputed dataset are then combined into one overall estimate and variance, incorporating both the within and between imputation variability. Rubin's rules for combining these multiply imputed estimates are based on asymptotic theory. The resulting combined estimates may be more accurate if the posterior distribution of the population parameter of interest is better approximated by the normal distribution. However, the normality assumption may not be appropriate for all the parameters of interest when analysing prognostic modelling studies, such as predicted survival probabilities and model performance measures. Methods Guidelines for combining the estimates of interest when analysing prognostic modelling studies are provided. A literature review is performed to identify current practice for combining such estimates in prognostic modelling studies. Results Methods for combining all reported estimates after MI were not well reported in the current literature. Rubin's rules without applying any transformations were the standard approach used, when any method was stated. Conclusion The proposed simple guidelines for combining estimates after MI may lead to a wider and more appropriate use of MI in future prognostic modelling studies.

  6. CT pulmonary angiography utilization in the emergency department: diagnostic yield and adherence to current guidelines.

    Science.gov (United States)

    Perelas, Apostolos; Dimou, Anastasios; Saenz, Augustina; Rhee, Ji Hyun; Teerapuncharoen, Krittika; Rowden, Adam; Eiger, Glenn

    2015-01-01

    The aim is to investigate the patterns of computed tomography pulmonary angiography (CTPA) use and adherence to current guidelines. Medical records of patients investigated with CTPA for pulmonary embolism (PE) in a single academic hospital from January 2011 until December 2012 were reviewed. Wells scores were calculated retrospectively by researchers blinded to the results of the CTPA. "Avoidable imaging" was defined as imaging performed against current recommendations of the European Society of Cardiology or the PIOPED investigation group. A total of 646 patients underwent testing; 61 cases of PE were diagnosed (9.4%). Potentially avoidable imaging was performed in 49.5% and 71.5% of patients, depending on the criteria used; 11.5% of imaging studies were performed in low-risk patients with negative D-dimer assays. There is evidence of CTPA overuse and D-dimer underuse. Adherence to guidelines and appropriate use of D-dimer assay might reduce avoidable imaging and ionizing radiation exposure. © The Author(s) 2014.

  7. Cost of treating chronic hepatitis B: Comparison of current treatment guidelines

    Institute of Scientific and Technical Information of China (English)

    Monica Robotin; Yumi Patton; Melanie Kansil; Andrew Penman; Jacob George

    2012-01-01

    AIM:To compare program costs of chronic hepatitis B (CHB) screening and treatment using Australian and other published CHB treatment guidelines.METHODS:Economic modeling demonstrated that in Australia a strategy of hepatocellular cancer (HCC)prevention in patients with CHB is more cost-effective than current standard care,or HCC screening.Based upon this model,we developed the B positive program to optimize CHB management of Australians born in countries of high CHB prevalence.We estimated CHB program costs using the B positive program algorithm and compared them to estimated costs of using the CHB treatment guidelines published by the AsianPacific,American and European Associations for the Study of Liver Disease (APASL,AASLD,EASL) and those suggested by an independent United States hepatology panel.We used a Markov model that factored in the costs of CHB screening and treatment,individualized by viral load and alanine aminotransferase levels,and calculated the relative costs of program components.Costs were discounted by 5% and calculated in Australian dollars (AUD).RESULTS:Using the B positive algorithm,total program costs amount to 13 979 224 AUD,or 9634 AUD per patient.The least costly strategy is based upon using the AASLD guidelines,which would cost 34% less than our B positive algorithm.Using the EASL and the United States Expert Group guidelines would increase program costs by 46%.The largest expenditure relates to the cost of drug treatment (66.9% of total program costs).The contribution of CHB surveillance (20.2%)and HCC screening and surveillance (6.6%) is small -and together they represent only approximately a quarter of the total program costs.CONCLUSION:The significant cost variations in CHB screening and treatment using different guidelines are relevant for clinicians and policy makers involved in designing population-based disease control programs.(C) 2012 Baishideng.All rights reserved.

  8. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

    Science.gov (United States)

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

    2017-03-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

  9. Poor compliance with antifungal drug use guidelines by transplant physicians: a framework for educational guidelines and an international consensus on patient safety.

    Science.gov (United States)

    Muñoz, Patricia; Rojas, Loreto; Cervera, Carlos; Garrido, Gregorio; Fariñas, Maria Carmen; Valerio, Maricela; Giannella, Maddalena; Bouza, Emilio

    2012-01-01

    The rate of compliance with antifungal drug use guidelines by transplant physicians is mostly unknown. We performed a nationwide electronic survey to assess antifungal use by different types of transplant physicians. Sixty-one percent (53/87) of the transplant programs responded (accounting for 85% of heart transplant procedures, 65% of kidney transplantations, and 71.5% of liver transplantations). Antifungal prophylaxis was used in 41.5% programs (liver 93.3%, heart 30.8%, and kidney 16%). Prophylaxis was universal in 32% of the programs and targeted only to selected patients in 68%, mainly indicated after re-transplantation (73.3%), re-intervention (66.7%) and hemodialysis (60%). Main drugs for universal prophylaxis were fluconazole and itraconazole (42.9% each), while fluconazole (60%), L-amphotericin B (AMB), and caspofungin (13.4% each) were preferred for targeted prophylaxis. Overall, 84.9% of the programs used galactomannan for the diagnosis of invasive aspergillosis (only 34% in BAL) and 66.6% used voriconazole as first-line monotherapy. Combination first-line therapy for invasive aspergillosis was used by 31.3%, mainly with voriconazole with caspofungin (40%) or anidulafungin (26.7%) or L-AMB-caspofungin (26.7%). Adherence of transplant physicians to current recommendations on antifungal treatment and prophylaxis is poor. An international consensus that responds to differences in patients and centers and emphasizes patient safety is clearly needed.

  10. Current guidelines in melanoma treatment. Melanoma Working Group of Gent and Bordet.

    Science.gov (United States)

    Brochez, L; Verhaeghe, E; Sales, F; Del Marmol, V; Deraemaecker, R; Vossaert, K; Naeyaert, J M

    2000-01-01

    This article focuses on the actual management of cutaneous melanoma, dealing both with established, internationally well-accepted standard procedures and interventions which are still being investigated. It wants to offer a global picture to the dermatologist of what is currently available in the therapeutic arsenal against melanoma.

  11. Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population

    Directory of Open Access Journals (Sweden)

    Hetlevik Irene

    2009-10-01

    Full Text Available Abstract Background Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007 hypertension guidelines in a general Norwegian population. Methods Implementation of the current European Guidelines for the Management of Arterial Hypertension was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97, comprising 65,028 adults, aged 20-89, of whom 51,066 (79% were eligible for modelling. Results Among individuals with blood pressure ≥120/80 mmHg, 93% (74% of the total, adult population would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults. Conclusion The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered.

  12. Current Situation of International Nuclear Arms Control and Nuclear Disarmament

    Institute of Scientific and Technical Information of China (English)

    Gong; Xianfu

    2014-01-01

    <正>Currently,international nuclear arms control and nuclear disarmament process is showing both encouraging and frustrating signs,with a stress on the latter.The following is a general picture:First,the new U.S.-Russian nuclear disarmament process faces challenges and prospect of a new round of nuclear disarmament negotiation is grim.As a result of implementing the New START signed in February 2011,as of March 1,2014,the United States has 1585

  13. International Guidelines for Bioequivalence of Locally Acting Orally Inhaled Drug Products: Similarities and Differences

    OpenAIRE

    Lu, Dongmei; Lee, Sau L.; Lionberger, Robert A.; Choi, Stephanie; Adams, Wallace; Caramenico, Hoainhon N.; Chowdhury, Badrul A.; Conner, Dale P.; Katial, Rohit; Limb, Susan; Peters, John R.; Yu, Lawrence; Seymour, Sally; Li, Bing V.

    2015-01-01

    International regulatory agencies have developed recommendations and guidances for bioequivalence approaches of orally inhaled drug products (OIDPs) for local action. The objective of this article is to discuss the similarities and differences among these approaches used by international regulatory authorities when applications of generic and/or subsequent entry locally acting OIDPs are evaluated. We focused on four jurisdictions that currently have published related guidances for generic and...

  14. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement.

    Science.gov (United States)

    Ferri, Clodoveo; Ramos-Casals, Manuel; Zignego, Anna Linda; Arcaini, Luca; Roccatello, Dario; Antonelli, Alessandro; Saadoun, David; Desbois, Anne Claire; Sebastiani, Marco; Casato, Milvia; Lamprecht, Peter; Mangia, Alessandra; Tzioufas, Athanasios G; Younossi, Zobair M; Cacoub, Patrice

    2016-12-01

    Hepatitis C virus (HCV) infection is responsible for both hepatic and extra-hepatic disorders (HCV-EHDs); these latter are correlated on one hand clearly with HCV lymphotropism causing immune-system dysregulation as well as with viral oncogenic potential, and on the other hand probably with chronic inflammatory status causing cardio-metabolic complications as well as neurocognitive disturbances. The spectrum of HCV-EHDs ranges from mild or moderate manifestations, such as arthralgia, sicca syndrome, peripheral neuropathy, to severe, life-threatening complications, mainly vasculitis and neoplastic conditions. Given the clinical heterogeneity of HCV-EHDs, HCV-infected individuals are inevitably referred to different specialists according to the presenting/prevalent symptom(s); therefore, the availability of comprehensive diagnostic guidelines is necessary for a patient's whole assessment that is decisive for early diagnosis and correct therapeutic approach of various hepatic and HCV-EHDs, regardless of the specific competencies of different physicians or referral centers. In this respect, a multidisciplinary network of experts, the International Study Group of Extrahepatic Manifestations Related to Hepatitis C Virus Infection (ISG-EHCV), was organized with the intention to formulate diagnostic guidelines for the work-up of possible HCV-EHDs. There was a broad consensus among ISG-EHCV members on the proposed guidelines, which essentially are based on two main levels of patient's assessment. At the referral stage, it is proposed that all patients with HCV infection should be invariably examined by means of first-line diagnostic procedures including virological and hepatic parameter evaluation, as well as the detection of clinical findings that may suggest one or more HCV-EHDs. This preliminary assessment should reveal specific HCV-EHDs, which will be deeper analyzed by means of second-line, targeted investigations. The proposed multidisciplinary expert statement

  15. Current Trends in Nursing Informatics: Results of an International Survey.

    Science.gov (United States)

    Peltonen, Laura-Maria; Alhuwail, Dari; Ali, Samira; Badger, Martha K; Eler, Gabrielle Jacklin; Georgsson, Mattias; Islam, Tasneem; Jeon, Eunjoo; Jung, Hyunggu; Kuo, Chiu-Hsiang; Lewis, Adrienne; Pruinelli, Lisiane; Ronquillo, Charlene; Sarmiento, Raymond Francis; Sommer, Janine; Tayaben, Jude L; Topaz, Maxim

    2016-01-01

    Nursing informatics (NI) can help provide effective and safe healthcare. This study aimed to describe current research trends in NI. In the summer 2015, the IMIA-NI Students Working Group created and distributed an online international survey of the current NI trends. A total of 402 responses were submitted from 44 countries. We identified a top five NI research areas: standardized terminologies, mobile health, clinical decision support, patient safety and big data research. NI research funding was considered to be difficult to acquire by the respondents. Overall, current NI research on education, clinical practice, administration and theory is still scarce, with theory being the least common. Further research is needed to explain the impact of these trends and the needs from clinical practice.

  16. Compliance of disease awareness campaigns in printed Dutch media with national and international regulatory guidelines.

    Directory of Open Access Journals (Sweden)

    Teresa Leonardo Alves

    Full Text Available BACKGROUND: The European legislation prohibits prescription-only medicines' advertising but allows pharmaceutical companies to provide information to the public on health and diseases, provided there is no direct or indirect reference to a pharmaceutical product. Various forms of promotion have become increasingly common in Europe including "disease-oriented" campaigns. OBJECTIVES: To explore examples of disease awareness campaigns by pharmaceutical companies in the Netherlands, by assessing their compliance with the World Health Organization (WHO Ethical Criteria for medicinal drug promotion and the Dutch guidelines for provision of information by pharmaceutical companies. METHODS: Materials referring to health/disease and treatments published in the most widely circulated newspapers and magazines were collected from March to May 2012. An evaluation tool was developed based on relevant underlying principles from the WHO ethical criteria and Dutch self-regulation guidelines. Collected disease awareness advertisements were used to pilot the evaluation tool and to explore the consistency of information provided with the WHO and Dutch criteria. FINDINGS: Eighty materials met our inclusion criteria; 71 were published in newspapers and 9 in magazines. The large majority were news items but 21 were disease awareness advertisements, of which 5 were duplicates. Fifteen out of the 16 disease awareness campaigns were non-compliant with current guidelines mainly due to lack of balance (n = 12, absence of listed author and/or sponsor (n = 8, use of misleading or incomplete information (n = 5 and use of promotional information (n = 5. None mentioned a pharmaceutical product directly. CONCLUSION: Disease Awareness Campaigns are present in Dutch printed media. Although no brand names were mentioned, the lack of compliance of disease awareness campaigns with the current regulations is alarming. There were information deficiencies and evidence of information

  17. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

    Science.gov (United States)

    Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul

    2016-01-01

    In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%–40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%–100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. PMID:27314832

  18. Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines

    Science.gov (United States)

    Dhayat, Sameer A.; Mirgorod, Philip; Lenschow, Christina; Senninger, Norbert

    2017-01-01

    Background Pancreatic ductal adenocarcinoma (PDAC) remains one of the most deadly cancers in Europe and the USA. There is consensus that radical tumor surgery is the only viable option for any long-term survival in patients with PDAC. So far, limited data are available regarding the routine surgical management of patients with advanced PDAC in the light of surgical guidelines. Methods A national survey on perioperative management of patients with PDAC and currently applied criteria on their tumor resectability in German university and community hospitals was carried out. Results With a response rate of 81.6% (231/283) a total of 95 (41.1%) participating departments practicing pancreatic surgery in Germany are certified as competence and reference centers for surgical diseases of the pancreas in 2016. More than 95% of them indicate to carry out structured and interdisciplinary therapies along with an interdisciplinary pre- and postoperative tumor board. The majority of survey respondents prefer the pylorus-preserving partial pancreatoduodenectomy (93.1%) with standard lymphadenectomy for cancer of the pancreatic head. Intraoperative histological evaluation of the resection margins is used regularly by 99% of the survey respondents. 98.7% of survey respondents carry out partial or complete vein resection, 126 respondents (54.5%) would resect tumor adjacent arteries, and 102 respondents (44.2%) would perform metastasectomy if complete PDAC resection (R0) is possible. Conclusion Evidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany. However, a significant number of survey respondents support an extended radical tumor resection in patients with advanced PDAC even when not indicated by current clinical guidelines. PMID:28267771

  19. Guidelines of the Office International des Epizooties for laboratory quality evaluation, for international reference standards for antibody assays and for laboratory proficiency testing.

    Science.gov (United States)

    1998-08-01

    Three guidelines, adopted by the International Committee of the Office International des Epizooties (OIE), have been combined for publication in a single document. The Guidelines for evaluating laboratory quality (adopted in 1995) form part of the OIE Guidelines for evaluating Veterinary Services. General requirements for equipment, staffing and management of laboratories are outlined. The guidelines for international reference standards for antibody assays (adopted in 1998) provide general rules governing the preparation of immune sera by OIE Reference Laboratories. A data sheet should accompany each preparation dispatched from the laboratory, and details are given of the information to be contained in the data sheet. The guidelines are to be used in conjunction with the OIE Manual of standards for diagnostic tests and vaccines. Guidelines on the proficiency of laboratory testing (adopted in 1996) describe how the operation of a laboratory can be assessed by inter-laboratory testing, and by voluntary participation in an accreditation (quality assurance) audit, operated by an independent authority. Criteria for assessing serological testing are provided.

  20. International Society Of Neuropathology--Haarlem consensus guidelines for nervous system tumor classification and grading.

    Science.gov (United States)

    Louis, David N; Perry, Arie; Burger, Peter; Ellison, David W; Reifenberger, Guido; von Deimling, Andreas; Aldape, Kenneth; Brat, Daniel; Collins, V Peter; Eberhart, Charles; Figarella-Branger, Dominique; Fuller, Gregory N; Giangaspero, Felice; Giannini, Caterina; Hawkins, Cynthia; Kleihues, Paul; Korshunov, Andrey; Kros, Johan M; Beatriz Lopes, M; Ng, Ho-Keung; Ohgaki, Hiroko; Paulus, Werner; Pietsch, Torsten; Rosenblum, Marc; Rushing, Elisabeth; Soylemezoglu, Figen; Wiestler, Otmar; Wesseling, Pieter

    2014-09-01

    Major discoveries in the biology of nervous system tumors have raised the question of how non-histological data such as molecular information can be incorporated into the next World Health Organization (WHO) classification of central nervous system tumors. To address this question, a meeting of neuropathologists with expertise in molecular diagnosis was held in Haarlem, the Netherlands, under the sponsorship of the International Society of Neuropathology (ISN). Prior to the meeting, participants solicited input from clinical colleagues in diverse neuro-oncological specialties. The present "white paper" catalogs the recommendations of the meeting, at which a consensus was reached that incorporation of molecular information into the next WHO classification should follow a set of provided "ISN-Haarlem" guidelines. Salient recommendations include that (i) diagnostic entities should be defined as narrowly as possible to optimize interobserver reproducibility, clinicopathological predictions and therapeutic planning; (ii) diagnoses should be "layered" with histologic classification, WHO grade and molecular information listed below an "integrated diagnosis"; (iii) determinations should be made for each tumor entity as to whether molecular information is required, suggested or not needed for its definition; (iv) some pediatric entities should be separated from their adult counterparts; (v) input for guiding decisions regarding tumor classification should be solicited from experts in complementary disciplines of neuro-oncology; and (iv) entity-specific molecular testing and reporting formats should be followed in diagnostic reports. It is hoped that these guidelines will facilitate the forthcoming update of the fourth edition of the WHO classification of central nervous system tumors.

  1. An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability.

    Science.gov (United States)

    Akl, Elie A; Mustafa, Reem; Slomka, Thomas; Alawneh, Alia; Vedavalli, Abhishek; Schünemann, Holger J

    2008-11-18

    Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability. We developed the Guide-O-Game(c) in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game(c) consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process. The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable. We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.

  2. [Update on current care guidelines: physical activity and exercise training for adults in sickness and in health].

    Science.gov (United States)

    2011-01-01

    The purpose of the aforementioned guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity, either alone or combined with other lifestyle modifications, plays a key role in the management of several chronic diseases. In this guideline, the following diseases will be discussed: musculoskeletal, endocrinological, cardiovascular and respiratory diseases, as well as cancer, depression and urinary incontinence. In addition, physical activity during pregnancy and in senior citizens is discussed. Physical activity and exercise training have also been mentioned in 27 other Current Care clinical guidelines.

  3. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Fonseca Andrade

    2016-01-01

    Full Text Available Objective to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. Method systematic review on literature based on data from CINAHL(r, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r, Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. Results studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. Conclusion the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice.

  4. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines1

    Science.gov (United States)

    Andrade, Vera Lúcia Fonseca; Fernandes, Filipa Alexandra Veludo

    2016-01-01

    Objective to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. Method systematic review on literature based on data from CINAHL(r), Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. Results studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. Conclusion the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice. PMID:27027676

  5. The impact of the 2005 International Society of Urological Pathology consensus guidelines on Gleason grading

    DEFF Research Database (Denmark)

    Berg, Kasper D; Thomsen, Frederik B; Nerstrøm, Camilla

    2016-01-01

    OBJECTIVES: To investigate whether the International Society of Urological Pathology (ISUP) 2005 revision of the Gleason grading system has influenced the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), as the new guideline implies that some prostate cancers previously graded...... as Gleason score 6 (3 + 3) are now considered as 7 (3 + 4). PATIENTS AND METHODS: A matched-pair analysis was conducted. In all, 215 patients with Gleason score 6 or 7 (3 + 4) prostate cancer on biopsy who underwent RP before 31 December 2005 (pre-ISUP group), were matched 1:1 by biopsy Gleason score......, clinical tumour category, PSA level, and margin status to patients undergoing RP between 1 January 2008 and 31 December 2011 (post-ISUP group). Patients were followed until BCR defined as a PSA level of ≥0.2 ng/mL. Risk of BCR was analysed in a competing-risk model. RESULTS: The median follow-up was 9...

  6. International Child Welfare: Guidelines for Educators and a Case Study from Cyprus

    Science.gov (United States)

    Howe, Tasha R.

    2010-01-01

    This article outlines challenges and opportunities educators and students face while attempting to develop a global perspective in social work. It discusses the need for more international focus in the classroom and increased field placements in non-Western countries. Exercises using an in-depth case study of the historic and current dynamics of…

  7. Between universalism and relativism: a conceptual exploration of problems in formulating and applying international biomedical ethical guidelines.

    Science.gov (United States)

    Tangwa, G B

    2004-02-01

    In this paper, the author attempts to explore some of the problems connected with the formulation and application of international biomedical ethical guidelines, with particular reference to Africa. Recent attempts at revising and updating some international medical ethical guidelines have been bedevilled by intractable controversies and wrangling regarding both the content and formulation. From the vantage position of relative familiarity with both African and Western contexts, and the privilege of having been involved in the revision and updating of one of the international ethical guidelines, the author reflects broadly on these issues and attempts prescribing an approach from both the theoretical and practical angles liable to mitigate, if not completely eliminate, some of the problems and difficulties.

  8. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Tessa E R Gillon

    Full Text Available Clinical practice guidelines (CPGs are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy to inform clinical practice.MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface, Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13 in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii antihypertensive treatment of severe hypertension; (iv MgSO4 for eclampsia and severe pre-eclampsia; (v antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i definitions of pre-eclampsia and severe pre-eclampsia; (ii target BP for non-severe hypertension; (iii timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv MgSO4 for non-severe pre-eclampsia, and (v postpartum maternal monitoring.Existing international HDP CPGs have areas of consistency with which clinicians and

  9. Presentation of Local and International Culture in Current International English-Language Teaching Textbooks

    Science.gov (United States)

    Shin, Jeeyoung; Eslami, Zohreh R.; Chen, Wen-Chun

    2011-01-01

    The place of culture in teaching English as an international language (EIL) is a complex issue, given the diversity of contexts in which English is currently being used globally. Building on a sociocultural perspective that language use is open to negotiation and is context-dependent, this paper argues that the design and content of…

  10. The International Permafrost Association: current initiatives for cryospheric research

    Science.gov (United States)

    Schollaen, Karina; Lewkowicz, Antoni G.; Christiansen, Hanne H.; Romanovsky, Vladimir E.; Lantuit, Hugues; Schrott, Lothar; Sergeev, Dimitry; Wei, Ma

    2015-04-01

    The International Permafrost Association (IPA), founded in 1983, has as its objectives to foster the dissemination of knowledge concerning permafrost and to promote cooperation among persons and national or international organizations engaged in scientific investigation and engineering work on permafrost. The IPA's primary responsibilities are convening International Permafrost Conferences, undertaking special projects such as preparing databases, maps, bibliographies, and glossaries, and coordinating international field programs and networks. Membership is through adhering national or multinational organizations or as individuals in countries where no Adhering Body exists. The IPA is governed by its Executive Committee and a Council consisting of representatives from 26 Adhering Bodies having interests in some aspect of theoretical, basic and applied frozen ground research, including permafrost, seasonal frost, artificial freezing and periglacial phenomena. This presentation details the IPA core products, achievements and activities as well as current projects in cryospheric research. One of the most important core products is the circumpolar permafrost map. The IPA also fosters and supports the activities of the Global Terrestrial Network on Permafrost (GTN-P) sponsored by the Global Terrestrial Observing System, GTOS, and the Global Climate Observing System, GCOS, whose long-term goal is to obtain a comprehensive view of the spatial structure, trends, and variability of changes in the active layer thickness and permafrost temperature. A further important initiative of the IPA are the biannually competitively-funded Action Groups which work towards the production of well-defined products over a period of two years. Current IPA Action Groups are working on highly topical and interdisciplinary issues, such as the development of a regional Palaeo-map of Permafrost in Eurasia, the integration of multidisciplinary knowledge about the use of thermokarst and permafrost

  11. The Dynamics of Flat Surface Internal Geophysical Waves with Currents

    Science.gov (United States)

    Compelli, Alan; Ivanov, Rossen I.

    2016-08-01

    A two-dimensional water wave system is examined consisting of two discrete incompressible fluid domains separated by a free common interface. In a geophysical context this is a model of an internal wave, formed at a pycnocline or thermocline in the ocean. The system is considered as being bounded at the bottom and top by a flatbed and wave-free surface respectively. A current profile with depth-dependent currents in each domain is considered. The Hamiltonian of the system is determined and expressed in terms of canonical wave-related variables. Limiting behaviour is examined and compared to that of other known models. The linearised equations as well as long-wave approximations are presented.

  12. The Dynamics of Flat Surface Internal Geophysical Waves with Currents

    CERN Document Server

    Compelli, Alan

    2016-01-01

    A two-dimensional water wave system is examined consisting of two discrete incompressible fluid domains separated by a free common interface. In a geophysical context this is a model of an internal wave, formed at a pycnocline or thermocline in the ocean. The system is considered as being bounded at the bottom and top by a flatbed and wave-free surface respectively. A current profile with depth-dependent currents in each domain is considered. The Hamiltonian of the system is determined and expressed in terms of canonical wave-related variables. Limiting behaviour is examined and compared to that of other known models. The linearised equations as well as long-wave approximations are presented.

  13. Current status of preventive cardiology training among United States cardiology fellowships and comparison to training guidelines.

    Science.gov (United States)

    Pack, Quinn R; Keteyian, Steven J; McBride, Patrick E; Weaver, W Douglas; Kim, Henry E

    2012-07-01

    We evaluated preventive cardiology education in United States cardiology fellowship programs and their adherence to Core Cardiovascular Training Symposium training guidelines, which recommend 1 month of training, faculty with expertise, and clinical experience in cardiac rehabilitation, lipid disorder management, and diabetes management as a part of the prevention curricula. We sent an anonymous survey to United States cardiology program directors and their chief fellow. The survey assessed the program curricula, rotation structure, faculty expertise, obstacles, and recommended improvements. The results revealed that 24% of surveyed programs met the Core Cardiovascular Training Symposium guidelines with a dedicated 1-month rotation in preventive cardiology, 24% had no formalized training in preventive cardiology, and 30% had no faculty with expertise in preventive cardiology, which correlated with fewer rotations in prevention than those with specialized faculty (p = 0.009). Fellows rotated though the following experiences (% of programs): cardiac rehabilitation, 71%; lipid management, 37%; hypertension, 15%; diabetes, 7%; weight management/obesity, 6%; cardiac nutrition, 6%; and smoking cessation, 5%. The program directors cited "lack of time" as the greatest obstacle to providing preventive cardiology training and the chief fellows reported "lack of a developed curriculum" (p = 0.01). The most recommended improvement was for the American College of Cardiology to develop a web-based curriculum/module. In conclusion, most surveyed United States cardiology training programs currently do not adhere to basic preventive cardiovascular medicine Core Cardiovascular Training Symposium recommendations. Additional attention to developing curricular content and structure, including the creation of an American College of Cardiology on-line knowledge module might improve fellowship training in preventive cardiology.

  14. Current Practice of Heart Donor Evaluation in Germany: Multivariable Risk Factor Analysis Confirms Practicability of Guidelines

    Directory of Open Access Journals (Sweden)

    Sylke Ruth Zeissig

    2013-01-01

    Full Text Available Background. Organ shortage has liberalised the acceptance criteria of grafts for heart transplantation, but which donor characteristics ultimately influence the decision to perform transplantation? For the first time this was evaluated using real-time donor data from the German organ procurement organization (DSO. Observed associations are discussed with regard to international recommendations and guidelines. Methods. 5291 German donors (2006–2010 were formally eligible for heart donation. In logistic regression models 160 donor parameters were evaluated to assess their influence on using grafts for transplantation (random split of cases: 2/3 study sample, 1/3 validation sample. Results. Successful procurement was determined by low donor age (OR 0.87 per year; 95% CI [0.85–0.89], P<0.0001, large donor height (OR 1.04 per cm; 95% CI [1.02–1.06], P<0.0001, exclusion of impaired left ventricular function or wall motion (OR 0.01; 95% CI [0.002–0.036], P<0.0001, arrhythmia (OR 0.05; 95% CI [0.009–0.260], P=0.0004, and of severe coronary artery disease (OR 0.003; 95% CI [<0.001–0.01], P<0.0001. Donor characteristics differed between cases where the procedure was aborted without and with allocation initiated via Eurotransplant.

  15. Guidelines for internal optics optimization of the ITER EC H and CD upper launcher

    Energy Technology Data Exchange (ETDEWEB)

    Moro, A.; Bruschi, A.; Figini, L.; Farina, D.; Platania, P.; Sozzi, C. [Istituto di Fisica del Plasma CNR, Euratom-ENEA Association, 20125 Milano (Italy); Chavan, R.; Goodman, T. P.; Krause, A.; Landis, J. D.; Sanchez Galan, F.; Toussaint, M. [Centre de Recherches en Physique des Plasmas, CRPP-EPFL, CH-1015 Lausanne (Switzerland); Henderson, M. A. [ITER Organization, 13108 Saint-Paul-lez-Durance (France); Saibene, G. [Fusion for Energy, Barcelona (Spain)

    2014-02-12

    The importance of localized injection of Electron Cyclotron waves to control Magneto-HydroDynamic instability is well assessed in tokamak physics and the set of four Electron Cyclotron (EC) Upper Launchers (UL) in ITER is mainly designed for this purpose. Each of the 4 ULs uses quasi-optical mirrors (shaping and planes, fixed and steerable) to redirect and focus 8 beams (in two rows, with power close to 1 MW per beam coming from the EC transmission lines) in the plasma region where the instability appears. Small beam dimensions and maximum beam superposition guarantee the necessary localization of the driven current. To achieve the goal of MHD stabilization with minimum EC power to preserve the energy confinement in the outer half of the plasma cross section, optimization of the quasi-optical design is required and a guideline of a strategy is presented. As a result of this process and following the guidelines indicated, modifications of the design (new mirrors positions, rotation axes and/or focal properties) will be proposed for the next step of an iterative process, including the mandatory compatibility check with the mechanical constraints.

  16. [Comparison of treatment principles of elderly hypertensive patients with different cardiovascular risks based on Hungarian and international guidelines (2001-2015)].

    Science.gov (United States)

    Bödör, Anikó; Kiss, István

    2016-02-14

    The aim of this review is to present recommendations of the currently valid Hungarian practice guidelines regarding antihypertensive therapy of the elderly and very elderly with different cardiovascular risk profiles, compare and contrast these with international guidelines, describe changes brought about by the past 15 years, and review the evidence behind. Hypertension treatment guidelines and relevant statements of the Hungarian and European Societies of Hypertension, of the Joint National Committee and American Heart Association were processed. The use of age-independent treatment threshold, goal blood pressure values, and the tendency towards more intensive control in co-morbidities conferring high cardiovascular risk were overcome by the upsurge of new evidence and the re-evaluation of previous clinical trial data. These lead to the introduction of age-specific and generally less stringent blood pressure targets in all regions compared. However, the guidelines currently in force still differ in terms of the attainable values in concomitant diabetes, chronic kidney disease or albuminuria, use of beta-blockers and the definition of elderly. Nevertheless, there is unanimous agreement that benefit from lowering of blood pressure under systolic 140 mmHg is not supported by evidence and further investigation is warranted to determine optimal treatment targets in the elderly, in the aged over 80 and specific elderly risk groups.

  17. [Bibliometric analysis of the current international ophthalmic publications].

    Science.gov (United States)

    Ohba, Norio

    2005-03-01

    To assess the current status of international ophthalmic publications. A collection of 55,591 original articles were found by an on-line National Library of Medicine database Medline search for 32 international ophthalmic journals during a 15-year period from 1988 to 2002 (internet access, November 11-13, 2003). The contributions to international ophthalmic publications were by 49.5% from North America, 31.3% from Western Europe, 15.1% from Asia and Oceania, 2.2% from Middle East, 0.85% from Central and South America, 0.53% from Eastern Europe, and 0.47% from Africa. Countries of Asia and Oceania showed an increasing trend in contributions while North America had a decreasing productivity in a relative sense. The top 10 productive countries were USA, United Kingdom, Japan, Germany, Canada, Australia, Italy, Netherlands, Sweden, and France. Among the Asian countries India ranked 13th, China 18th, and Korea 21st. When related to population, small countries such as Israel, France, Finland, Sweden, and Denmark were more productive. When related to economic productivity as defined by GDP, Israel, the United Kingdom, Australia, Finland, and Sweden were among the most productive countries, whereas rich countries such as Japan and Germany had a lower number of publications relative to their GDP. As regards clinical research in terms of randomized controlled trials, The USA was by far the most productive. The number of authors per article has shown an increasing trend worldwide, so that Japan and France had a significantly larger proportion of multiauthored articles. There is an increasing trend in the productivity of international ophthalmic publications from non-English-speaking countries including Japan, China, and Korea.

  18. Current management of bipolar affective disorder: is it reflective of the BAP guidelines?

    Science.gov (United States)

    Farrelly, N; Dibben, C; Hunt, N

    2006-01-01

    In October 2003 the British Association of Psychopharmacology (BAP) published evidence-based guidelines on the management of bipolar disorder. The aim of this study was to assess whether the guidelines could provide the basis for examining clinical decisions and the extent to which practice accords with these guidelines. Case notes of out patients with bipolar disorder were reviewed. Demographic details, and treatment recommendations were determined. The management of affective episodes was evaluated and compared with BAP guidelines. In 84 subjects, 224 affective episodes were identified. Treatment was consistent with BAP guidelines in 72% of episodes. Mania was more likely to be managed in accordance with guidelines than depression or mixed episodes. The use of antidepressant medication was the most likely intervention to deviate from recommendations. Reasons for treatments at odds with the guidelines were identified. Our study demonstrates that clinical practice among a range of psychiatrists broadly reflects the guidelines that have been issued by the British Association of Psychopharmacology (BAP). The BAP guidelines offer a practical and auditable basis for the short- and long-term treatment of bipolar affective disorder.

  19. Ethical issues in the translation of social neuroscience: a policy analysis of current guidelines for public dialogue in human research.

    Science.gov (United States)

    Zimmerman, Emma; Racine, Eric

    2012-01-01

    Social neuroscience and its potential implications create an interesting case study for examining human research ethics policies on the topic of public communication of research. We reviewed mainstream national and international human research ethics guidelines and policies on issues of public communication of research. Our analysis relied on five thematic nets to capture the interactions between research and the public: public understanding, knowledge translation, public participation, social outcomes, and dual use. Coverage of these topics is sparse and inconsistent in mainstream policies and guidelines. We identify three options to address these gaps and analyze their strengths and weaknesses.

  20. The wide variation of definitions of genetic testing in international recommendations, guidelines and reports.

    Science.gov (United States)

    Sequeiros, Jorge; Paneque, Milena; Guimarães, Bárbara; Rantanen, Elina; Javaher, Poupak; Nippert, Irma; Schmidtke, Jörg; Kääriäainen, Helena; Kristoffersson, Ulf; Cassiman, Jean-Jacques

    2012-04-01

    In spite of being very commonly used, the term genetic testing is debatable and used with several meanings. The diversity of existing definitions is confusing for scientists, clinicians and other professionals, health authorities, legislators and regulating agencies and the civil society in general, particularly when genetic testing is the object of guidelines or legal documents. This work compares definitions of genetic testing found in recommendations, guidelines and reports from international institutions, policy makers and professional organizations, but also in documents from other stakeholders in the field, as the pharmaceutical industry, insurers, ethics bodies, patient organizations or human-rights associations. A systematic review of these documents confirmed the extreme variability existing in the concepts and the ambiguous or equivocal use of the term. Some definitions (narrower) focus on methodologies or the material analysed, while others (broader) are information- or context-based. Its scope may range from being synonymous of just DNA analysis, to any test that yields genetic data. Genetic testing and genetic information, which may be derived from a range of medical exams or even family history, are often used interchangeably. Genetic testing and genetic screening are sometimes confused. Human molecular genetics (a discipline) is not always distinguished from molecular biology (a tool). Professional background, geographical context and purpose of the organizations may influence scope and usage. A common consensus definition does not exist. Nevertheless, a clear set of precise definitions may help creating a common language among geneticists and other health professionals. Moreover, a clear context-dependent, operative definition should always be given.

  1. GENERAL GUIDELINES CONCERNING THE RELATION INTERNATIONAL INTELLECTUAL PROPERTY BUSINESS VERSUS HUMAN RIGHTS AND CIVIL LIBERTIES

    Directory of Open Access Journals (Sweden)

    Speriusi-Vlad Alin

    2014-07-01

    Full Text Available Today, the intellectual property protection is no longer an absolute social and legal that justifies adoption of any measures necessary to protect it. Initially seen as the prerequisite for sustainable development, implementation of new technologies, and encouragement of international trade, the intellectual property, especially prior to ACTA (Anti-Counterfeiting Trade Agreement international trial implementation, and also thereafter, was increasingly identified as a source of violation of fundamental rights and civil liberties, i.e. the right to protection of personal data, the right to privacy, freedom to send and receive information freedom of information, freedom to contract, and freedom to carry out economic activities (freedom of commerce. As far as international trade transactions have often a component of intellectual property that requires to be protected, it is necessary to identify the landmarks, the rules establishing de facto limits in order to protect the intellectual property without risk of infringement of fundamental rights and civil liberties of other persons, in particular users or potential users of goods and services incorporating intellectual property. The best guidelines in this regard may be provided by the CJEU (Court of Justice of the European Union case-law both due to its reasoning underlying the decision of the Parliament to reject ACTA ratification and the fact that the case-law of this Court, especially the most recent one, is highly complex and nuanced, not denying in any way the importance of intellectual property, and identifying certain cases where their primacy persist and whose analysis leads to laying down some general rules in the field.

  2. Modern Radiation Therapy for Primary Cutaneous Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena, E-mail: lena.specht@regionh.dk [Departments of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Wilson, Lynn D. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States)

    2015-05-01

    Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era.

  3. Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ashish Atreja

    2012-01-01

    Full Text Available Background. Patients with inflammatory bowel disease (IBD are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis. Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA findings. Results. 59% of patients (1004/1703 in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%, and of these, 196 patients had DXA completed (“at-risk” group. Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group. 139 (70.9% patients in “at-risk” group had low BMD, while 51 (53.7% of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3% missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42; P=0.003. Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

  4. Development of Guidelines for Mentoring Internal Supervision for the Schools under Roi-Et Office of Primary Education Service Area 2

    Directory of Open Access Journals (Sweden)

    Natchana Sahunil

    2017-06-01

    Full Text Available The research aimed to 1 study the factors and indicators of mentoring internal supervision for schools, 2 study the current state and the desirable state of mentoring internal supervision for schools, and 3 study the guidelines on the operation of mentoring internal supervision for the schools under Roi-Et Office of Primary Education Service Area 2. The research was divided into 3 phases. In phase 1 the informants comprised 5 certified experts. In phase 2 the sample comprised 488 government teachers under Roi-Et Office of Primary Education Service Area 2, btained through multi-stage random sampling. In phase 3 the informants comprised school directors, school deputy directors and supervisor teachers under Roi-Et Office of Primary Education Service Area 2, totally 9 persons. The research instruments onsisted of 1 a questionnaire having the discrimination from 0.34 to 0.79 and the total reliability of 0.87, 2 a structured interview form, and 3 a suitability and feasibility assessment form for the guidelines on the operation of mentoring internal supervision. The analysis of data employed percentage, the mean and standard deviation. The results are as follows: 1. There are 4 factors of the guidelines on mentoring internal supervision for schools. They are: preparation of mentoring supervision, with 12 indicators ; management of mentoring supervision, with 12 indicators ; operation of mentoring supervision, with 14 indicators ; and evaluation of mentoring supervision, with 10 indicators, all of which had been evaluated by the experts as, on the whole, very suitable. 2. The current state of the mentoring internal supervision for schools, on the whole and factor by factor, was in the moderate level in every factor. Meanwhile, the desirable state of mentoring internal supervision for schools, on the whole, was in the high level. When considered factor by factor, the factor with the highest mean is management of mentoring supervision. The factor with

  5. 12 CFR Appendix C to Part 3 - Capital Adequacy Guidelines for Banks: Internal-Ratings-Based and Advanced Measurement Approaches

    Science.gov (United States)

    2010-01-01

    ... loss must reflect the net present value of cash flows as of the default date using a discount rate...-Ratings-Based and Advanced Measurement Approaches C Appendix C to Part 3 Banks and Banking COMPTROLLER OF... Appendix C to Part 3—Capital Adequacy Guidelines for Banks: Internal-Ratings-Based and Advanced...

  6. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

    DEFF Research Database (Denmark)

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D

    2014-01-01

    INTRODUCTION: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and pa...

  7. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

    NARCIS (Netherlands)

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D; Serefoglu, Ege Can; Shindel, Alan W; Adaikan, P Ganesan; Becher, Edgardo; Dean, John; Giuliano, Francois; Hellstrom, Wayne J G; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

    2014-01-01

    INTRODUCTION: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partn

  8. Retinal damage by optical radiation. An alternative approach to current, ACGIH-inspired guidelines

    NARCIS (Netherlands)

    Vos, J.J.; Norren, D. van

    2005-01-01

    Background: The ACGIH guidelines for protection against retinal damage by optical radiation are often difficult to apply due to their lack of transparency. The less known guidelines by the Netherlands Health Council (HCN), dating from 1978 and updated in 1993, might offer a way out in many cases. Me

  9. Internal solitary waves propagating through variable background hydrology and currents

    Science.gov (United States)

    Liu, Z.; Grimshaw, R.; Johnson, E.

    2017-08-01

    Large-amplitude, horizontally-propagating internal wave trains are commonly observed in the coastal ocean, fjords and straits. They are long nonlinear waves and hence can be modelled by equations of the Korteweg-de Vries type. However, typically they propagate through regions of variable background hydrology and currents, and over variable bottom topography. Hence a variable-coefficient Korteweg-de Vries equation is needed to model these waves. Although this equation is now well-known and heavily used, a term representing non-conservative effects, arising from dissipative or forcing terms in the underlying basic state, has usually been omitted. In particular this term arises when the hydrology varies in the horizontal direction. Our purpose in this paper is to examine the possible significance of this term. This is achieved through analysis and numerical simulations, using both a two-layer fluid model and a re-examination of previous studies of some specific ocean cases.

  10. Adequacy of Physicians Knowledge Level of Cardiopulmonary Resuscitation to Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ümmu Kocalar

    2016-01-01

    Full Text Available Aim: The purpose of this study is to test the level of information on CPR and suitability to current application of the phsicians practicing in hospital ANEAH. Material and Method: The form of a test of 20 questions fort his purpose has been prepared in accordance with the 2010 AHA-ERC CPR guidelines. This form distributed to volunteer physicians to fill in. A total of 173 physicians agreed to participate in he study. The results were analyzed statistically and tried to determine the factors affecting the level of information. Results:According to the results of the study physicians gender, age and the total duration of physicians and medical asistance doesn%u2019t affect the level of information. The number of CPR within 1 month positively affect the level of knowledge. The number of theoretical and practical training in medical school, have taken the positive impact the level of knowledge of physicians. The training period after graduation, significantly increased the level of physicians information. The order of these training sessions with the asistant courses, congress, seminars and lessions on the sempozims are effective. Discussion: CPR trainig programs for physicians should be standardized, updated and expanded. Recurent in-service trainig should be provided to increase phsicians knowledge on skills.

  11. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

    Institute of Scientific and Technical Information of China (English)

    Stefania Angeloni; Cinzia Leboffe; Antonella Parente; Mario Venditti; Alessandra Giordano; Manuela Merli; Oliviero Riggio

    2008-01-01

    AIM:To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.METHODS:All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study.SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was>250 cells/mm3,and empirically treated with cefotaxime.RESULTS:Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women;mean age:58.6±11.2 years).Prevalence of SBP,in our population,was 17%.Ascitic fluid culture was positive in nine (24%)cases only.Eleven episodes were nosocomial and 71%community-acquired.Treatment with cefotaxime was successful in 59% of cases,while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h.Change of antibiotic therapy led to the resolution of infection in 87% of episodes.Among the cases with positive culture,the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series.In these cases,the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.CONCLUSIOM:In clinical practice,ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy.The initial treatment with cefotaxime failed more frequently than expected.An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding.A different first-line antibiotic treatment should be investigated.

  12. The Guideline Implementability Decision Excellence Model (GUIDE-M): a mixed methods approach to create an international resource to advance the practice guideline field.

    Science.gov (United States)

    Brouwers, Melissa C; Makarski, Julie; Kastner, Monika; Hayden, Leigh; Bhattacharyya, Onil

    2015-03-15

    Practice guideline (PG) implementability refers to PG features that promote their use. While there are tools and resources to promote PG implementability, none are based on an evidence-informed and multidisciplinary perspective. Our objectives were to (i) create a comprehensive and evidence-informed model of PG implementability, (ii) seek support for the model from the international PG community, (iii) map existing implementability tools on to the model, (iv) prioritize areas for further investigation, and (v) describe how the model can be used by PG developers, users, and researchers. A mixed methods approach was used. Using our completed realist review of the literature of seven different disciplines as the foundation, an iterative consensus process was used to create the beta version of the model. This was followed by (i) a survey of international stakeholders (guideline developers and users) to gather feedback and to refine the model, (ii) a content analysis comparing the model to existing PG tools, and (iii) a strategy to prioritize areas of the model for further research by members of the research team. The Guideline Implementability for Decision Excellence Model (GUIDE-M) is comprised of 3 core tactics, 7 domains, 9 subdomains, 44 attributes, and 40 subattributes and elements. Feedback on the beta version was received from 248 stakeholders from 34 countries. The model was rated as logical, relevant, and appropriate. Seven PG tools were selected and compared to the GUIDE-M: very few tools targeted the Contextualization and Deliberations domain. Also, fewer of the tools addressed PG appraisal than PG development and reporting functions. These findings informed the research priorities identified by the team. The GUIDE-M provides an evidence-informed international and multidisciplinary conceptualization of PG implementability. The model can be used by PG developers to help them create more implementable recommendations, by clinicians and other users to help them

  13. Safety of transcranial magnetic stimulation: review of international guidelines and new findings

    Directory of Open Access Journals (Sweden)

    N. A. Suponeva

    2017-01-01

    Full Text Available Transcranial magnetic stimulation (TMS is a rapidly developing method of neuromodulation. The use of TMS has increased significantly in both research and clinical practice. This allows not only to better understand this method, but also assess possible risks and consequences for both healthy individuals and patients. In 1998 and 2009 safety, ethical considerations, and application guidelines for the use of TMS in clinical practice and research were published. These recommendations are now the basis for safe application of the method in clinical practice and research. Safety of brain stimulation includes several aspects: the prevention and treatment of adverse effects, the strategy of patient and stimulation protocols selection, as well as safety and monitoring procedures. The most common adverse effects of TMS include headache and neck pain, syncope, transient hearing impairment. The risk of epileptic seizureis extremely low and can be minimized by careful selection of patients and the use of safe stimulation protocols. Careful selection of patients is important, taking into account a large number of factors that influence the risk of adverse effects. These factors are considered in the questionnaires to identify limitations and absolute or relative contraindications to TMS. Another important part of TMS safety is the choice of the stimulation protocol and parameters such as intensity, frequency, duration of one train of stimuli, and the interstimulus interval. Currently, the recommended limits of stimulation parameters are covered in the safety guidelines. It is also necessary to follow the procedure, including the monitoring the patient's condition during TMS and the providing qualified assistance in case of adverse effects.

  14. The prevalence and correlates of meeting the current physical activity for health guidelines in older people: a cross-sectional study in Brazilian women.

    Science.gov (United States)

    Vagetti, Gislaine Cristina; Barbosa Filho, Valter Cordeiro; Moreira, Natália Boneti; de Oliveira, Valdomiro; Mazzardo, Oldemar; de Campos, Wagner

    2013-01-01

    This study aimed to identify the prevalence and correlates of meeting the current physical activity for health (PAfH) guidelines, proposed by the World Health Organization in 2010, in community-dwelling older women from Brazil. A cross-sectional study was performed with 1806 women (aged 60.0-92.7 years) who were randomly selected from eighteen care centers. The short version of the International Physical Activity Questionnaire was used to determine the weekly time spent in physical activities, and this variable was categorized into three categories (0high blood pressure (OR=1.33, 95% CI: 1.09-1.62) were more likely to meet the current PAfH guidelines than their peers with primary incomplete education, negative self-rated health, and normal blood pressure. Increasing age was inversely associated with meeting the PAfH guidelines (odds ranging: 0.77-0.48). These results highlighted the elderly population subgroups, in a developing country, that needspecific guidelinesfor inclusion inhealth programs andmotivation toparticipate in physical activities. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Could a revision of the current guidelines for cancer drug use improve the quality of cancer treatment?

    Directory of Open Access Journals (Sweden)

    Lippert TH

    2014-01-01

    Full Text Available Theodor H Lippert,1 Hans-Jörg Ruoff,1 Manfred Volm2 1Medical Faculty, University of Tübingen, Tübingen, Germany; 2Medical Faculty, University of Heidelberg, Heidelberg, Germany Abstract: Clinical practice guidelines are indispensable for such a variable disease as malignant solid tumors, with the complex possibilities of drug treatment. The current guidelines may be criticized on several points, however. First, there is a lack of information on the outcome of treatment, such as the expected success and failure rates. Treating not only drug responders but also nonresponders, that is, patients with drug resistance, must result in failures. There is no mention of the possibility of excluding the drug nonresponders, identifiable by special laboratory tests and no consideration is given to the different side effects of the recommended drug regimens. Nor are there any instructions concerning tumor cases for which anticancer drug treatment is futile. In such cases, early palliative care may lead to significant improvements in both life quality and life expectancy. Not least, there is no transparency concerning the preparation of the guidelines: persons cannot be identified who could give a statement of conflicts of interest, and responsibility is assumed only by anonymous medical associations. A revision of the current guidelines could considerably improve cancer treatment. Keywords: anticancer drugs, quality of guidelines, critical remarks

  16. Modern Guidelines for Forming the International Image of Universities: Foreign Experience

    Directory of Open Access Journals (Sweden)

    Padalka Oleh

    2015-12-01

    Full Text Available The article presents the analysis of scientific and technological activities of higher education pedagogical institutions of Ukraine at the end of 2014 according to the staffing situation, the functioning of postgraduate and doctoral studies and the availability of the valid specialized academic councils on thesis defense, according to students’ research works aiming at young scientists’ training. The criteria of evaluation of scientific work results of the university faculty and the ways to encourage young teachers to do the research work through postgraduate and doctoral studies and the defense of the thesis as the final result. We raised a problem of training young scientists int higher education pedagogical institutions of Ukraine as a powerful intellectual force, which determines the scientific future of the country. The main directions of scientific and technical activities of the universities aimed at foreign cooperation within the country and the world were defined as well. Modern guidelines for forming the international image of universities in foreign experience (the USA and European countries have been outlined.

  17. INTERNATIONAL CONFERENCE ON HARMONISATION GUIDELINES ON THE LIMITS OF GENOTOXIC IMPURITIES IN DRUG PRODUCT

    Directory of Open Access Journals (Sweden)

    Malik Ajay

    2012-04-01

    Full Text Available An impurity in a drug substance as defined by the International Conference on Harmonisation (ICH guidelines is any component of the drug substance that is not the chemical entity defined as the drug substance. Similarly, an impurity in a drug product is any component of the drug product that is not the chemical entity defined as the drug substance or an excipient in the drug product. Genotoxic compounds have the potential to damage DNA at any level of exposure and that such damage may lead/contribute to tumour development. Thus for genotoxic carcinogens it is prudent to assume that there is no discernible threshold and that any level of exposure carries a risk. A threshold of toxicological concern (TTC value of 1.5μg/day intake of a genotoxic impurity is considered to be associated with an acceptable risk (excess cancer risk of <1 in 100,000 over a lifetime for most pharmaceuticals. From this threshold value, a permitted level in the active substance can be calculated based on the expected daily dose. Higher limits may be justified under certain conditions such as short-term exposure periods.

  18. Cancer screening in the United States, 2015: a review of current American cancer society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Manassaram-Baptiste, Deana; Brooks, Durado; Doroshenk, Mary; Fedewa, Stacey; Saslow, Debbie; Brawley, Otis W; Wender, Richard

    2015-01-01

    Each year, the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines. The latest data on utilization of cancer screening from the National Health Interview Survey (NHIS) also is described, as are several issues related to screening coverage under the Affordable Care Act, including the expansion of the Medicaid program.

  19. Revision of OECD Guidelines for Genotoxicity Testing: Current Status and Next Steps

    Science.gov (United States)

    Over the past 30 years, assays have been developed to evaluate chemical genotoxicity. OECD Genotoxicity Test Guidelines (TG) describe assay procedures for regulatory safety testing. Since the last OECD TG revision (1997), there has been tremendous scientific and technological pro...

  20. Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Andrews, Kimberly S; Brooks, Durado; Fedewa, Stacey A; Manassaram-Baptiste, Deana; Saslow, Debbie; Brawley, Otis W; Wender, Richard C

    2017-03-01

    Answer questions and earn CME/CNE Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, the authors summarize current American Cancer Society cancer screening guidelines, describe an update of their guideline for using human papillomavirus vaccination for cancer prevention, describe updates in US Preventive Services Task Force recommendations for breast and colorectal cancer screening, discuss interim findings from the UK Collaborative Trial on Ovarian Cancer Screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey. CA Cancer J Clin 2017;67:100-121. © 2017 American Cancer Society. © 2017 American Cancer Society.

  1. Implementation of contemporary radiation therapy planning concepts for pediatric Hodgkin lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group.

    Science.gov (United States)

    Hodgson, David C; Dieckmann, Karin; Terezakis, Stephanie; Constine, Louis

    2015-01-01

    The optimal management of children with Hodgkin lymphoma (HL) should limit the risk of treatment-related toxicity without compromising disease control. Consequently, increasing effort is being directed to retaining the demonstrated efficacy of radiation therapy (RT) in maximizing the cure of HL while reducing the radiation exposure of normal tissues. Historically, guidelines for RT volume definition used in pediatric HL trials have referenced 2-dimensional imaging and bony landmarks to define classical involved field RT. With recognition of the efficacy of chemotherapy, the data on the adverse late effects of radiation, and the evolution of advanced imaging techniques that reveal the location of both tumor and normal tissues, it is necessary that radiation techniques for children and adolescents be refined. The concepts described by the International Commission on Radiation Units provide a common approach for field definition using 3-dimensional computed tomographic--based RT planning and volumetric image guidance. Here we describe the application of these concepts in the planning of RT for pediatric HL. This will be increasingly important as current and upcoming pediatric HL trials will employ these concepts to deliver RT.

  2. Evolution of Asthma Concept and Effect of Current Asthma Management Guidelines

    OpenAIRE

    2010-01-01

    Concept of asthma has changed from symptom-complex or airway hypersensitivity to airway inflammation and airway remodeling. Based on this concept asthma management guidelines (JGL) has been developed in Japan. Death from asthma has decreased drastically since the publication of the guidelines, although it is still high in elderly population. Further works are expected for "zero-death" from asthma and for tighter control of airway inflammation and resultant airway remodeling.

  3. Current guidelines for high-density lipoprotein cholesterol in therapy and future directions

    Directory of Open Access Journals (Sweden)

    Subedi BH

    2014-04-01

    Full Text Available Bishnu H Subedi,1,2 Parag H Joshi,1 Steven R Jones,1 Seth S Martin,1 Michael J Blaha,1 Erin D Michos1 1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 2Greater Baltimore Medical Center, Baltimore, MD, USA Abstract: Many studies have suggested that a significant risk factor for atherosclerotic cardiovascular disease (ASCVD is low high-density lipoprotein cholesterol (HDL-C. Therefore, increasing HDL-C with therapeutic agents has been considered an attractive strategy. In the prestatin era, fibrates and niacin monotherapy, which cause modest increases in HDL-C, reduced ASCVD events. Since their introduction, statins have become the cornerstone of lipoprotein therapy, the benefits of which are primarily attributed to decrease in low-density lipoprotein cholesterol. Findings from several randomized trials involving niacin or cholesteryl ester transfer protein inhibitors have challenged the concept that a quantitative elevation of plasma HDL-C will uniformly translate into ASCVD benefits. Consequently, the HDL, or more correctly, HDL-C hypothesis has become more controversial. There are no clear guidelines thus far for targeting HDL-C or HDL due to lack of solid outcomes data for HDL specific therapies. HDL-C levels are only one marker of HDL out of its several structural or functional properties. Novel approaches are ongoing in developing and assessing agents that closely mimic the structure of natural HDL or replicate its various functions, for example, reverse cholesterol transport, vasodilation, anti-inflammation, or inhibition of platelet aggregation. Potential new approaches like HDL infusions, delipidated HDL, liver X receptor agonists, Apo A-I upregulators, Apo A mimetics, and gene therapy are in early phase trials. This review will outline current therapies and describe future directions for HDL therapeutics. Keywords: high-density lipoprotein, lipids, cholesterol, atherosclerosis, cardiovascular disease, therapy

  4. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J;

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implement......OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

  5. Support for international agricultural research: current status and future challenges.

    Science.gov (United States)

    Zeigler, Robert S; Mohanty, Samarendu

    2010-11-30

    The success of the first Green Revolution in the form of abundant food supplies and low prices over the past two decades has diverted the world's attention from agriculture to other pressing issues. This has resulted in lower support for the agricultural research work primarily undertaken by the 15 research centers of the Consultative Group on International Agricultural Research (CGIAR). The total support in real dollars for most of the last three decades has been more or less flat although the number of centers increased from 4 to 15. However, since 2000, the funding situation has improved for the CGIAR centers, with almost all the increase coming from grants earmarked for specific research projects. Even for some centers such as the International Rice Research Institute (IRRI), the downward trend continued as late as 2006 with the budget in real dollars reaching the 1978 level of support. The recent food crisis has renewed the call for a second Green Revolution by revitalizing yield growth to feed the world in the face of growing population and a shrinking land base for agricultural use. The slowdown in yield growth because of decades of neglect in agricultural research and infrastructure development has been identified as the underlying reason for the recent food crisis. For the second Green Revolution to be successful, the CGIAR centers will have to play a complex role by expanding productivity in a sustainable manner with fewer resources. Thus, it is crucial to examine the current structure of support for the CGIAR centers and identify the challenges ahead in terms of source and end use of funds for the success of the second Green Revolution. The objective of this paper is to provide a historical perspective on the support to the CGIAR centers and to examine the current status of funding, in particular, the role of project-specific grants in rebuilding capacity of these centers. The paper will also discuss the nature of the support (unrestricted vs. project

  6. Uniform guidelines improve client care.

    Science.gov (United States)

    Barnett, B

    1994-12-01

    Uniform national guidelines on the delivery of family planning methods and services improve client care, assuming these guidelines are based on current scientific information. Compliance with these guidelines yields safe and efficient delivery of family planning services. Service providers need information, training, supplies, and guidelines to deliver quality services. Guidelines contribute to consistency among family planning programs in different settings. Even though clinics may not provide the same services, the guidelines allow them to provide the same standards of care. Specifically, eligibility criteria, contraindications, and follow-up schedules are the same regardless of the service delivery point. Various international health organizations (such as World Health Organization, USAID, Program for International Training in Health, International Planned Parenthood Federation, and Association for Voluntary Surgical Contraception) have developed guidelines for family planning service delivery. Governments can use these documents to develop national family planning guidelines and policies. They should adapt the guidelines to local needs and consider program resources. After development of the national guidelines, training, workshops, and dissemination of written materials should be provided for policymakers, physicians, nurses, and other health providers. Countries that have either developed or are working to draft their own national guidelines are Cameroon, Ghana, Mexico, and Nepal.

  7. International Workshop on Current Problems in Condensed Matter

    CERN Document Server

    Current Problems in Condensed Matter

    1998-01-01

    This volume contains the papers presented at the International Workshop on the Cur­ rent Problems in Condensed Matter: Theory and Experiment, held at Cocoyoc, More­ los, Mexico, during January 5-9, 1997. The participants had come from Argentina, Austria, Chile, England, France, Germany, Italy, Japan, Mexico, Switzerland, and the USA. The presentations at the Workshop provided state-of-art reviews of many of the most important problems, currently under study, in condensed matter. Equally important to all the participants in the workshop was the fact that we had come to honor a friend, Karl Heinz Bennemann, on his sixty-fifth birthday. This Festschrift is just a small measure of recognition of the intellectualleadership of Professor Bennemann in the field and equally important, as a sincere tribute to his qualities as an exceptional friend, college and mentor. Those who have had the privilege to work closely with Karl have been deeply touched by Karl's inquisitive scientific mind as well as by bis k...

  8. The Baltic policy of Germany and current international relations

    Directory of Open Access Journals (Sweden)

    Salikov Aleksey

    2016-03-01

    Full Text Available This article analyses the Baltic policy of united Germany from the 1990s until today. The authors set out to identify the significance of German-Baltic relations and the role of the Eastern policy in Russian-German relations. The method of dynamic comparison between the political and economic narrative in intergovernmental relations makes it possible to identify distinctive features of Germany’s Baltic policy in the context of current international relations. In particular, it is noted that Germany was most active in the Baltic region in the 1990s, when the country was establishing political, economic, and cultural ties with the new independent states. In the second half of the 1990s, Germany’s foreign policy became less intense. After the accession of Lithuania, Latvia, and Estonia to the EU and NATO in 2004, certain disagreements started to arise between Germany and the Baltics. It explains the lukewarm relations between them. The Ukraine events brought about a change in Germany’s regional policy. Despite Russia remaining one of the key economic and political counteractors, Germany, being a partner of the Baltics in the EU and NATO, cannot adopt a neutral position in the conflict of interests between the Baltics and Russia.

  9. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE

    Directory of Open Access Journals (Sweden)

    Stanley E. Althof, PhD

    2014-06-01

    Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE. Sex Med 2014;2:60–90.

  10. Toward best practice in Human Machine Interface design for older drivers: A review of current design guidelines.

    Science.gov (United States)

    Young, K L; Koppel, S; Charlton, J L

    2017-09-01

    Older adults are the fastest growing segment of the driving population. While there is a strong emphasis for older people to maintain their mobility, the safety of older drivers is a serious community concern. Frailty and declines in a range of age-related sensory, cognitive, and physical impairments can place older drivers at an increased risk of crash-related injuries and death. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In-Vehicle Information Systems (IVIS) may provide assistance to older drivers. However, these technologies will only benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) guidelines. However, it is unclear to what extent the declining sensory, cognitive and physical capabilities of older drivers are addressed in the current guidelines. This paper provides a review of key current design guidelines for IVIS and ADAS with respect to the extent they address age-related changes in functional capacities. The review revealed that most of the HMI guidelines do not address design issues related to older driver impairments. In fact, in many guidelines driver age and sensory cognitive and physical impairments are not mentioned at all and where reference is made, it is typically very broad. Prescriptive advice on how to actually design a system so that it addresses the needs and limitations of older drivers is not provided. In order for older drivers to reap the full benefits that in-vehicle technology can afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into HMI design guidelines. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. A critical analysis of the scientific evidence behind international guidelines related to cardiac arrhythmias

    NARCIS (Netherlands)

    Roos, M.; Brodbeck, J.; Sarkozy, A.; Chierchia, G.B.; Asmundis, C. de; Brugada, P.

    2011-01-01

    BACKGROUND: Guidelines have become very important in assisting with decision making in clinical practice. However, few studies have analyzed the level of evidence (LOE) underlying guidelines critically. This study aims to assess the accuracy of the referenced literature that has led to recommendatio

  12. Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit.

    Science.gov (United States)

    Mo, Yoonsun; Zimmermann, Anthony E; Thomas, Michael C

    2017-04-01

    The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey. Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60). Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

  13. ITER (International Thermonuclear Experimental Reactor) current drive and heating physics

    Energy Technology Data Exchange (ETDEWEB)

    Nevins, W.M.; Lindquist, W. (Lawrence Livermore National Lab., CA (USA)); Fujisawa, N.; Kimura, H. (Japan Atomic Energy Research Inst., Naka, Ibaraki (Japan)); Hopman, H.; Rebuffi, L.; Wegrowe, J.G. (Max-Planck-Institut fuer Plasmaphysik, Garching (Germany, F.R.). NET Design Team); Parail, V.; Vdovin, V. (Gosudarstvennyj Komitet po Ispol' zovaniyu Atomnoj Ehnergii SSSR, Moscow (USSR). Inst. Atomnoj Ehn

    1990-01-01

    The ITER Current Drive and Heating (CD H) systems are required for: Ionization and current initiation; Non-inductive current ramp-up assist; Heating of the plasma; Steady-state operation with full non-inductive current drive; Current profile control; and Burn control by modulation of the auxiliary power. Steady-state current drive is the most demanding requirement, so this has driven the choice of the ITER current drive and heating systems.

  14. Report from AmSECT’s International Consortium for Evidence-Based Perfusion: American Society of ExtraCorporeal Technology Standards and Guidelines for Perfusion Practice: 2013

    Science.gov (United States)

    Baker, Robert A.; Bronson, Shahna L.; Dickinson, Timothy A.; Fitzgerald, David C.; Likosky, Donald S.; Mellas, Nicholas B.; Shann, Kenneth G.

    2013-01-01

    Abstract: One of the roles of a professional society is to develop standards and guidelines of practice as an instrument to guide safe and effective patient care. The American Society of Extracorporeal Technology (AmSECT) first published its Essentials for Perfusion Practice, Clinical Function: Conduct of Extracorporeal Circulation in 1993. The International Consortium for Evidence-Based Perfusion (ICEBP), a committee within AmSECT, was tasked with updating this document in 2010. The aim of this report is to describe the method of development and content of AmSECT’s new professional standards and guidelines. The ICEBP committee independently evaluated and provided input regarding the current “Essentials and Guidelines.” Structural changes were made to the entire document, and a draft document was developed, presented, and circulated to the AmSECT Board of Directors and broader membership for comment. Informed by these reviews, a revised document was then presented to the Society for a membership vote. The final document consists of 15 areas of practice covered by 50 Standards and 38 Guidelines (see Appendix 1) with the first standard focusing on the development of institutional protocols to support their implementation and use. A majority of the membership voted to accept the document (81.2% of the voting membership accepting, 18.8% rejecting). After an audit of the balloting process by AmSECT’s Ethics Committee, the results were reported to the membership and the document was officially adopted on July 24, 2013. The Standards and Guidelines will serve as a useful guide for cardiac surgical teams that wish to develop institution-specific standards and guidelines to improve the reliability, safety, and effectiveness of adult cardiopulmonary bypass. The ICEBP recognizes that the development of a Standards and Guidelines statement alone will not change care. Safe, reliable, and effective care will be best served through the development and implementation of

  15. Current Practice vs. Guideline Based Imaging in Abdominal Radiology in the German Speaking Area: Results of an Online Survey.

    Science.gov (United States)

    Schreyer, A G; Wessling, J; Grenacher, L

    2016-03-01

    The working group for abdominal imaging within the German Roentgen Society (DRG) performed an online survey amongst radiologist concerning the current status of techniques for abdominal imaging. The results of this survey were compared with the most recent guidelines. We performed an online survey open for all members of the DRG during a 76-day period with 65 questions and an overall estimated time for finishing the questionnaire of 15 minutes concerning technical specifications for abdominal radiological imaging. The results were evaluated using descriptive statistics. 90 of all participants, who filled out the survey covering more than 80% of the questions, were included in the statistical evaluation. 27% of all participants were registered radiologists while 73% represented radiologists working in a hospital. Most participants worked in a managerial position. The participants gave detailed information regarding the radiological techniques used in dedicated organ systems (esophagus, stomach, pancreas, liver, small intestines, colon) regarding acquired contrast phases and oral and intravenous administration of contrast medium. The results confirm that most radiologists participating in this survey perform their examinations and choose their modalities in conformity with the current existing clinical guidelines. Because most clinical guidelines do not specify radiological examinations in detail, there is a noteworthy heterogeneity of the acquired contrast phases and major divergence in terms of technical parameters. Therefore a joint radiological effort should be initiated for developing and publishing updated radiological parameters for abdominal imaging. • In German speaking countries indications for abdominal radiological examinations are performed with a high compliance to published guidelines. • There is a significant heterogeneity regarding the acquisition of different contrast phases for parenchymal abdominal organs. • There is an urgent need to

  16. Current progress on internal medicine in China-2006 Part Ⅱ

    Institute of Scientific and Technical Information of China (English)

    YAO Dingkang; ZHU Liang; YU Renqian; MEI Changlin

    2007-01-01

    A lot of progress has been made on internal medicine in the past year.Here a great deal of data were collected about internal medicine in China by searching for some most important medicine magazines published in China in 2006.Because there are so many articles on internal medicine,some representative reports were selected and further reviewed.In the part II,a summary of advances made in four branches includes nephrology,hematology,endocrinology and metabolism,rheumatology.

  17. Mapping and Mitigating the International Rip Current Health Hazard

    Science.gov (United States)

    Trimble, S. M.; Houser, C.

    2016-12-01

    Rip currents are concentrated seaward flows of water originating in the surf zones of beaches. Rips cause hundreds of international drownings each year. Calculating exact numbers is barred by logistical difficulties in obtaining accurate incident reports, but annual rip current fatalities are estimated at 100, 53 and 21 in the United States (US), Costa Rica, and Australia respectively. Notably, Australia's lifeguards rescue 17,600 swimmers from rips each year. This project addresses the geophysical, social, and systematic causes of fatalities in hopes of decreasing the global number of rip-related deaths. We demonstrate a novel method for mapping bathymetry in the surf zone (20m deep or less), specifically within rip channels (topographic low spots in the nearshore that result from feedback amongst waves, substrate, and antecedent bathymetry). We calculate bathymetry using 8-band multispectral imagery from the Digital Globe WorldView2 (WV2) satellite and field measurements of depth, generating maps of the changing nearshore at two embayed, rip-prone beaches: Playa Cocles, Costa Rica, and Bondi Beach, Australia. WV2 has a 1.1 day pass-over rate with 1.84m ground pixel resolution of 8 bands, including `yellow' (585-625 nm) and `coastal blue' (400-450 nm). Methods are tested for consistency amongst dates and locations. Previous research shows drownings result from a combination of the physical environment with personal and group behaviors; for this reason we build on rip-detection by evaluating tourists' and locals' knowledge and understanding of their beach's rip behavior. By combining the geomorphologic maps developed from WV2 with interview data, we evaluate how the physical environment dictates the exposure of certain swimmers. Controls include rip channel location, beach access points, and environmental factors favored by swimmers. The project serves as an evaluation of the landscape's creation of a physical feature that becomes a hazard when vulnerable humans

  18. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

    Science.gov (United States)

    Lefaucheur, Jean-Pascal; Antal, Andrea; Ayache, Samar S; Benninger, David H; Brunelin, Jérôme; Cogiamanian, Filippo; Cotelli, Maria; De Ridder, Dirk; Ferrucci, Roberta; Langguth, Berthold; Marangolo, Paola; Mylius, Veit; Nitsche, Michael A; Padberg, Frank; Palm, Ulrich; Poulet, Emmanuel; Priori, Alberto; Rossi, Simone; Schecklmann, Martin; Vanneste, Sven; Ziemann, Ulf; Garcia-Larrea, Luis; Paulus, Walter

    2017-01-01

    A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform t

  19. Dyslipidemia management in primary prevention of cardiovascular disease: Current guidelines and strategies.

    Science.gov (United States)

    Hendrani, Aditya D; Adesiyun, Tolulope; Quispe, Renato; Jones, Steven R; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

    2016-02-26

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making cost-effective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.

  20. Dyslipidemia management in primary prevention of cardiovascular disease:Current guidelines and strategies

    Institute of Scientific and Technical Information of China (English)

    Aditya D Hendrani; Tolulope Adesiyun; Renato Quispe; Steven R Jones; Neil J Stone; Roger S Blumenthal; Seth S Martin

    2016-01-01

    Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making costeffective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.

  1. Diabetic Dyslipidemia Review: An Update on Current Concepts and Management Guidelines of Diabetic Dyslipidemia.

    Science.gov (United States)

    Dake, Andrew W; Sora, Nicoleta D

    2016-04-01

    Cardiovascular disease is the most common cause of morbidity and mortality in patients with diabetes and the major source of cost in the care of diabetes. Treatment of dyslipidemia with cholesterol-lowering medications has been shown to decrease cardiovascular events. However, available guidelines for the treatment of dyslipidemia often contain significant differences in their recommendations. Lipid guidelines from National Cholesterol Education Program Adult Treatment Panel III, American Association of Clinical Endocrinologists, American Diabetes Association and American Heart Association/American College of Cardiology were reviewed. In addition a literature review was performed using PubMed to research diabetic peculiarities to the topic of lipids. Summarized within this article are the aforementioned, commonly-used guidelines as they relate to diabetes, as well as information regarding the diabetic phenotype of dislipidemia and the association between statins and new-onset diabetes. While the multitude of guidelines and the differences between them may contribute to confusion for practitioners, they are best viewed as tools to help tailor appropriate treatment plans for individual patients. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  2. Current guidelines and recommendations for the management of skin and soft tissue infections.

    Science.gov (United States)

    Montravers, Philippe; Snauwaert, Aurelie; Welsch, Camille

    2016-04-01

    The incidence of severe skin and soft tissue infections (SSTIs) has significantly increased over the last years. In addition, major ecological changes have been reported with the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), involved in a large proportion of these cases. A large number of expert opinions, guidelines, and recommendations for the management of SSTIs have been published over the last decade. The purpose of this review is to compare these guidelines. A total of six official publications have presented recommendations for the management of SSTIs. During the same period, other guidelines for the management of MRSA infections have also been published, including some recommendations for SSTIs. The applicability of the guidelines is questionable in many ways. The distinction between necrotizing/nonnecrotizing infections is valuable but difficult to apply prior to surgical management. The prescribers should choose a pragmatic approach to empirical antibiotic therapy, taking into account the patient's initial severity, the extent of infection and risk factors for resistant microorganisms essentially related to healthcare-associated circumstances.

  3. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...... with guidelines for treatment and care of patients with CAP....

  4. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

    DEFF Research Database (Denmark)

    Alfieri, S; Amid, P K; Campanelli, G

    2011-01-01

    To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain....

  5. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)

    DEFF Research Database (Denmark)

    Bittner, R; Arregui, M E; Bisgaard, T

    2011-01-01

    This study describes unsedated transnasal oesophagogastroduodenoscopy (UT-OGD) in the office setting. Evaluation of national guidelines regarding primary endoscopy for the investigation of upper gastrointestinal (GI) symptoms was also a focus of this study....

  6. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

    Directory of Open Access Journals (Sweden)

    Hyun-Woo Cho

    Full Text Available OBJECTIVES: The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs and evidence from current systematic reviews and meta-analyses (SR-MAs and to analyze the impact of this gap on present CPGs. METHODS: We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. RESULTS: Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54% mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure. However, the CPGs did not recommend acupuncture (or acupressure. Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (subacute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (subacute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. CONCLUSIONS: The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

  7. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

    DEFF Research Database (Denmark)

    Alfieri, S; Amid, P K; Campanelli, G

    2011-01-01

    To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain.......To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain....

  8. Is there consensus across international evidence-based guidelines for the management of bipolar disorder?

    Science.gov (United States)

    Parker, G B; Graham, R K; Tavella, G

    2017-06-01

    To examine the level of agreement across professionally auspiced evidence-based guidelines for managing the bipolar disorders. A literature search in PubMed, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews and PsycInfo was undertaken using the search terms 'bipolar disorder' and 'guidelines', generating 11 evidence-based guidelines published by professional organisations over the 2002-2015 period. Each guideline was reviewed by two independent reviewers and key themes extracted via qualitative analyses. There was agreement on issues such as the first-line treatment of mania where mood-stabilising and/or an antipsychotic medication together with tapering or ceasing antidepressant medications was most commonly recommended. Differences included the extent to which (i) the different bipolar disorders were defined or not, (ii) there were separate recommendations for bipolar I and bipolar II disorders vs. non-differentiating general bipolar management strategies, (iii) 'general' vs. severity-based recommendations were made, and (iv) narrow vs. broad sets of candidate medications were nominated, while there was variable consideration of treatments such as electroconvulsive therapy (ECT). While there was some consistency across guidelines on key recommendations, there was also substantial inconsistencies, limiting the generation of any 'meta-consensus' model for managing the bipolar disorders. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. A Prospective Real World Experience of Moxonidine Use in Indian Hypertensive Patients–Prescription beyond Current Guidelines

    Science.gov (United States)

    Sagarad, Suresh V; Biradar-Kerure, Sudha; MR, Ramakrishna; Kumar S, Chaitanya; Reddy, S S

    2013-01-01

    Objective: The primary objective of this study was to assess the use of moxonidine, a centrally acting anti–hypertensive agent in real world practice. Material and Methods: Patients who attended out-patients clinic with diagnosis of hypertension were enrolled in the study. Demographics with co-morbid illnesses of all patients were recorded. Patient’s prescriptions were recorded and anti-hypertensive medications were also analysed. Results: A total of 990 patients were eligible during the study period. Moxonidine was used in 4.54% of patients. Two groups could be identified in moxonidine users – one Group with resistant hypertension (30 patients, 3.03% of total, 66.66% of moxonidine users) on multiple drugs to control BP and another Group with intolerance to conventional, first line drugs (15 patients 1.51% of total, 33.33% of moxonidine users). Moxonidine was not used in newly diagnosed hypertension cases. Resistant hypertension and renal failure predicted the use of moxonidine. Majority of drug used was as per current guidelines. Conclusions: Our study results reflected real world practice of current anti-hypertensive therapy. Patients generally receive medications in accordance with current recommendations and guidelines. Small but significant proportion of patients may require use of drugs like moxonidine to control high BP. Guidelines need to incorporate these real world practices. PMID:24298479

  10. International Guidelines for Bioequivalence of Locally Acting Orally Inhaled Drug Products: Similarities and Differences.

    Science.gov (United States)

    Lu, Dongmei; Lee, Sau L; Lionberger, Robert A; Choi, Stephanie; Adams, Wallace; Caramenico, Hoainhon N; Chowdhury, Badrul A; Conner, Dale P; Katial, Rohit; Limb, Susan; Peters, John R; Yu, Lawrence; Seymour, Sally; Li, Bing V

    2015-05-01

    International regulatory agencies have developed recommendations and guidances for bioequivalence approaches of orally inhaled drug products (OIDPs) for local action. The objective of this article is to discuss the similarities and differences among these approaches used by international regulatory authorities when applications of generic and/or subsequent entry locally acting OIDPs are evaluated. We focused on four jurisdictions that currently have published related guidances for generic and/or subsequent entry OIDPs. They are Therapeutic Goods Administration (TGA) in Australia, Health Canada (HC) in Canada, European Medicines Association (EMA) of European Union (EU), and the Food and Drug Administration (FDA) in the United States of America (USA). The comparisons of these bioequivalence (BE) recommendations are based on selection of reference products, formulation and inhaler device comparisons, and in vitro tests and in vivo studies, including pharmacokinetic (PK), pharmacodynamics (PD), and clinical studies. For the in vivo studies, the study design, choices of dose, subject inclusion/ exclusion criteria, study period, study endpoint, and equivalence criteria are elaborated in details. The bioequivalence on multiple-strength products and waiver options are also discussed.

  11. Current and potential cyber attacks on medical journals; guidelines for improving security.

    Science.gov (United States)

    Dadkhah, Mehdi; Seno, Seyed Amin Hosseini; Borchardt, Glenn

    2017-03-01

    At the moment, scholarly publishing is faced with much academic misconduct and threats such as predatory journals, hijacked journals, phishing, and other scams. In response, we have been discussing this misconduct and trying to increase the awareness of researchers, but it seems that there is a lack of research that presents guidelines for editors to help them protect themselves against these threats. It seems that information security is missing in some parts of scholarly publishing that particularly involves medical journals. In this paper, we explain different types of cyber-attacks that especially threaten editors and academic journals. We then explain the details involved in each type of attack. Finally, we present general guidelines for detection and prevention of the attacks. In some cases, we use small experiments to show that our claim is true. Finally, we conclude the paper with a prioritization of these attacks.

  12. Speaker-Oriented Classroom Acoustics Design Guidelines in the Context of Current Regulations in European Countries

    DEFF Research Database (Denmark)

    Pelegrin Garcia, David; Brunskog, Jonas; Rasmussen, Birgit

    2014-01-01

    experienced at work. With the aim of improving working conditions for teachers, this article presents guidelines for classroom acoustics design that meet simultaneously criteria of vocal comfort and speech intelligibility, which may be of use in future discussions for updating regulatory requirements...... in classroom acoustics. Two room acoustic parameters are shown relevant for a speaker: the voice support, linked to vocal effort, and the decay time derived from an oral-binaural impulse response, linked to vocal comfort. Theoretical prediction models for room-averaged values of these parameters are combined...... with a model of speech intelligibility based on the useful-to-detrimental ratio and empirical models of signal-to-noise ratio in classrooms in order to derive classroom acoustic guidelines, taking into account physical volume restrictions linked to the number of students present in a classroom. The recommended...

  13. Issues in the management of acute agitation: how much current guidelines consider safety?

    Directory of Open Access Journals (Sweden)

    Bruno ePacciardi

    2013-05-01

    Full Text Available Agitated behavior constitutes up to 10% of emergency psychiatric interventions. Pharmacological tranquilization is often used as a valid treatment for agitation but a strong evidence base does not underpin it. Available literature shows different recommendations, supported by research data, theoretical considerations or clinical experience. Rapid tranquilization is mainly based on parenteral drug treatment and the few existing guidelines on this topic, when suggesting the use of first generation antipsychotics and benzodiazepines, include drugs with questionable tolerability profile such as chlorpromazine, haloperidol, midazolam and lorazepam. In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments. There is a growing evidence about safety profile of second generation antipsychotics for rapid tranquilization but further controlled studies providing definitive data in this area are urgently needed.

  14. [Update on current care guidelines: diagnosis and treatment of sexually transmitted infections].

    Science.gov (United States)

    Hiltunen-Back, Eija; Alanen, Anna; Heikkilä, Elina; Puolakkainen, Mirja; Reunala, Timo; Suni, Jukka; Suomalainen, Pekka; Valtonen, Kirsi; Varis, Tiina; Vuento, Risto

    2010-01-01

    Recognition of common sexually transmitted infection (STI) syndromes allows more efficient diagnosis and treatment. These evidence-based guidelines provide advice on the management of STIs, including the use of the appropriate diagnostic methods and therapeutic regimens. Early and appropriate therapy has the potential to significantly reduce the long-term complications of STIs. The prevention of further infection through the counselling and treatment of partners contributes to the sexual health of patients.

  15. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

    Science.gov (United States)

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D; Serefoglu, Ege Can; Shindel, Alan W; Adaikan, P Ganesan; Becher, Edgardo; Dean, John; Giuliano, Francois; Hellstrom, Wayne JG; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

    2014-01-01

    Introduction In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method A comprehensive literature review was performed. Results This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG

  16. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

    Science.gov (United States)

    Dellinger, R Phillip; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven A; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Some recommendations were ungraded (UG). Recommendations were classified into three groups: 1) those directly targeting severe sepsis; 2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and 3) pediatric considerations. Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 hr of recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de

  17. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.

    Science.gov (United States)

    Dellinger, R P; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B

  18. A Mismatch Between Athlete Practice and Current Sports Nutrition Guidelines Among Elite Female and Male Middle- and Long-Distance Athletes.

    Science.gov (United States)

    Heikura, Ida A; Stellingwerff, Trent; Mero, Antti A; Uusitalo, Arja Leena Tuulia; Burke, Louise M

    2017-08-01

    Contemporary nutrition guidelines promote a variety of periodized and time-sensitive recommendations, but current information regarding the knowledge and practice of these strategies among world-class athletes is limited. The aim of this study was to investigate this theme by implementing a questionnaire on dietary periodization practices in national/international level female (n = 27) and male (n = 21) middle- and long-distance runners/race-walkers. The questionnaire aimed to gain information on between and within-day dietary choices, as well as timing of pre- and posttraining meals and practices of training with low or high carbohydrate (CHO) availability. Data are shown as percentage (%) of all athletes, with differences in responses between subgroups (sex or event) shown as Chi-square x(2) when p key sessions. Twenty-six percent of athletes (11% of middle vs 42% of long-distance athletes [x(2) (1, n = 46) = 4.308, p = .038, phi = 0.3])) reported to undertake training in the fasted state, while 11% said they periodically restrict CHO intake, with 30% ingesting CHO during training sessions. Our findings show that elite endurance athletes appear to execute pre- and post-key session nutrition recovery recommendations. However, very few athletes deliberately undertake some contemporary dietary periodization approaches, such as training in the fasted state or periodically restricting CHO intake. This study suggests mismatches between athlete practice and current and developing sports nutrition guidelines.

  19. International Clinical Guidelines for the Adoption of Digital Pathology: A Review of Technical Aspects.

    Science.gov (United States)

    García-Rojo, Marcial

    2016-01-01

    Digital slides, also called whole-slide images, are being evaluated to replace conventional microscopy, and several guidelines have been published. This paper reviews technical specifications of digital pathology systems that have been included in the guidelines and position papers from the Canadian Association of Pathologists, the College of American Pathologists, the American Telemedicine Association, the Digital Pathology Association, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the Society of Toxicologic Pathology, the European Commission, the Spanish Society of Anatomic Pathology, The Royal College of Pathologists and The Royal College of Pathologists of Australasia. In conclusion, most technical aspects are well covered by these guidelines, although they offer limited information regarding image quality and compression, and file formats.

  20. Current indicators of nutritional care in children with type 1 diabetes in India: Do we need a national nutritional guideline?

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2017-01-01

    Full Text Available Background: Nutrition is an important pillar of management in children with type 1 diabetes. Indian food is heavily influenced by region, religion, traditions, seasons, and cultural choices. This survey was done to assess current practices and the need for India specific nutritional guidelines for children with type 1 diabetes. Materials and Methods: Two 12-item questionnaires were administered to forty health-care professionals across India. The first questionnaire evaluated current clinical practice indicators for nutrition in these children and second assessed practices for counseling a child on dietary habits. Results: There is great heterogeneity across the country with regard to dietary advice offered to children with type 1 diabetes. 97.5% of the respondents feel there is a need for an Indian dietary guideline for children with type 1 diabetes. Conclusion: There is need of India specific nutritional guidelines that should be made considering key variants such as age, region, cultural preference, economic burden and psychosocial beliefs, to offer guidance to diabetes care professionals.

  1. An Investigation of the Variety and Complexity of Statistical Methods Used in Current Internal Medicine Literature.

    Science.gov (United States)

    Narayanan, Roshni; Nugent, Rebecca; Nugent, Kenneth

    2015-10-01

    Accreditation Council for Graduate Medical Education guidelines require internal medicine residents to develop skills in the interpretation of medical literature and to understand the principles of research. A necessary component is the ability to understand the statistical methods used and their results, material that is not an in-depth focus of most medical school curricula and residency programs. Given the breadth and depth of the current medical literature and an increasing emphasis on complex, sophisticated statistical analyses, the statistical foundation and education necessary for residents are uncertain. We reviewed the statistical methods and terms used in 49 articles discussed at the journal club in the Department of Internal Medicine residency program at Texas Tech University between January 1, 2013 and June 30, 2013. We collected information on the study type and on the statistical methods used for summarizing and comparing samples, determining the relations between independent variables and dependent variables, and estimating models. We then identified the typical statistics education level at which each term or method is learned. A total of 14 articles came from the Journal of the American Medical Association Internal Medicine, 11 from the New England Journal of Medicine, 6 from the Annals of Internal Medicine, 5 from the Journal of the American Medical Association, and 13 from other journals. Twenty reported randomized controlled trials. Summary statistics included mean values (39 articles), category counts (38), and medians (28). Group comparisons were based on t tests (14 articles), χ2 tests (21), and nonparametric ranking tests (10). The relations between dependent and independent variables were analyzed with simple regression (6 articles), multivariate regression (11), and logistic regression (8). Nine studies reported odds ratios with 95% confidence intervals, and seven analyzed test performance using sensitivity and specificity calculations

  2. The International DORIS Service: Current Status and Future Plans

    Science.gov (United States)

    Soudarin, Laurent; Ferrage, Pascale; Saunier, Jérôme

    2017-04-01

    The International DORIS Service (IDS) was created in 2003 under the umbrella of the International Association of Geodesy (IAG) to foster scientific research related to the French DORIS tracking system and to deliver scientific products, mostly related to the International Earth rotation and Reference systems Service (IERS). Since its start, the organization has continuously evolved, leading to additional and improved operational products from an expanded set of DORIS Analysis Centers. IDS is now based on a reinforced structure with two Data Centers, six Analysis Centers, several associated groups and a Combination Center. Using the experience gained in the preparation of the ITRF2008 and ITRF2014, many improvements were made both in data analysis and on technical aspects. This presentation addresses the organizational aspects of the IDS and the recent achievements made by its components. We also discuss the future plans in terms of new products and activities.

  3. Using research metrics to evaluate the International Atomic Energy Agency guidelines on quality assurance for R&D

    Energy Technology Data Exchange (ETDEWEB)

    Bodnarczuk, M.

    1994-06-01

    The objective of the International Atomic Energy Agency (IAEA) Guidelines on Quality Assurance for R&D is to provide guidance for developing quality assurance (QA) programs for R&D work on items, services, and processes important to safety, and to support the siting, design, construction, commissioning, operation, and decommissioning of nuclear facilities. The standard approach to writing papers describing new quality guidelines documents is to present a descriptive overview of the contents of the document. I will depart from this approach. Instead, I will first discuss a conceptual framework of metrics for evaluating and improving basic and applied experimental science as well as the associated role that quality management should play in understanding and implementing these metrics. I will conclude by evaluating how well the IAEA document addresses the metrics from this conceptual framework and the broader principles of quality management.

  4. Who is an astronaut? The inadequacy of current international law

    Science.gov (United States)

    Lyall, F.

    2010-06-01

    The concept of 'astronaut' as found in law in the 'space treaties' and elsewhere does not fit well with the modern proposals for commercial space tourism. Will the 'rescue and return' provisions apply to commercial flights? Many national laws will apply to space tourism but for the future the international legal regime should be reconsidered. Finally what may happen in a crisis in space?

  5. The Place of Culture in the Current International Relations

    Directory of Open Access Journals (Sweden)

    Constantin Frosin

    2011-05-01

    Full Text Available Culture and international relations easily appear to be mutually contradictory terms. To speak of "culture" is to invoke the creative capacities of human beings, to point, for example, to the constitutive role of values and visions, to the power of language and aesthetic expression, to communities great and small engaged in reconstructing normative aspirations and reshaping the possibilities for a decent way of life. To speak of "international relations," by contrast, is to draw upon an altogether bleaker account of the human condition, to refer to missiles and bombs, trade figures and debts, statesmanship and diplomacy, intrigue and force. It is to echo assertions about naked power and the sacrifice of cultural creativity and normative aspiration to the supposedly more enduring determinations of survival or supremacy. From the dark depths of international relations, the term culture takes on an aura of frivolity. It appears to refer to the idealistic and utopian, to the veneer of civilized decency that is always stripped away by the harsh realities of power politics and international conflict. This work aims at showing the contrary.

  6. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs.

    NARCIS (Netherlands)

    Burgers, J.S.; Grol, R.P.T.M.; Klazinga, N.S.; Makela, M.; Zaat, J.O.M.

    2003-01-01

    OBJECTIVE: To describe systematically the structures and working methods of guideline programs. DESIGN: Descriptive survey using a questionnaire with 32 items based on a framework derived from the literature. Answers were tabulated and checked by participants. STUDY PARTICIPANTS: Key informants of 1

  7. Thyroid function disorders--Guidelines of the Netherlands Association of Internal Medicine.

    NARCIS (Netherlands)

    Muller, A.F.; Berghout, A.; Wiersinga, W.M.; Kooy, A.; Smits, J.W.; Hermus, A.R.M.M.

    2008-01-01

    Thyroid function disorders are common with a female to male ratio of 4 to 1. In adult women primary hypothyroidism and thyrotoxicosis have a prevalence of 3.5/1000 and 0.8/1000, respectively. This guideline is aimed at secondary care providers especially internists, but also contains relevant inform

  8. 'Incorporating the OECD Guidelines in International Investment Agreements: Turning a Soft Law Obligation into Hard Law?

    NARCIS (Netherlands)

    Zee, van der E.L.

    2013-01-01

    This article has been written as a response to two recent developments. First, as a response to the recent update of the Organisation for Economic Co-operation and Development (OECD) Guidelines on 25 May 2011, which seem to have taken a form based on human rights due diligence. Second, as a response

  9. Guidelines and policies on collection of biological specimens in the Philippines. Philippine Congress, International Convention on Biodiversity.

    Science.gov (United States)

    Madulid, D A

    1996-04-01

    In October, 1993, 16 months after the United Nations approved the International Convention on Biodiversity held in Rio de Janeiro, June, 1992, the Philippine Congress ratified and adopted the Convention. This is a manifestation of the full support of the Philippines for the principles and policies adopted by the UN body on the conservation of biodiversity, sustainable development of biological resources and equitable sharing of benefits between users and owners of biodiversity resources. The Philippine scientific community has long recognized the need for and importance of a national guideline and policy with regard to the collection of plants and animals in the Philippines for scientific or commercial purposes. A series of consultative meetings were held by representatives of government agencies, non-government organizations, private organizations, academic and private persons concerned with biodiversity conservation to formulate national guidelines that regulate the collection of plant and animal specimens in the country. Guidelines were unanimously adopted by various government agencies and academia and a Memorandum of Agreement (MOA) was signed on September 28, 1990. Very recently a new document was drafted, specifically to serve as a guideline for those who desire to undertake sample collecting in the Philippines for biodiversity prospecting. The document is now being reviewed by government departments and agencies and will be presented to the President of the Philippines for signing as an Executive Order (EO). Once signed, this EO will serve as a national policy for bioprospecting in the country. The Philippines is one of the countries in Southeast Asia that has endorsed the adoption of regional guidelines on the collection of plant and animal organisms for drug development. The ASEAN Agreement on the Conservation of Nature and Natural Resources (1985). The Manila Declaration (1992) and lately, the Melaka Accord (1994), all of which were signed by various

  10. Defining the “International Community” in the context of current International Relations

    OpenAIRE

    Kpakpo-Amadote, Jean-Claude Gilbert

    2011-01-01

    The "International Community" is a concept that evolves constantly depending on the issues, the context or the situation it is referred to. Today's "International Community" is not comparable to what was perceived as the "International Community" in the years that followed the Second World War. It will probably not be comparable to the "International Community" of the future because of the constant changes of our world due to globalization, interests of States and threats on peace and interna...

  11. The management of compound leg injuries in the West Midlands (UK): are we meeting current guidelines?

    Science.gov (United States)

    Allison, K; Wong, M; Bolland, B; Peart, F; Porter, K

    2005-07-01

    The joint British Association of Plastic Surgeons and British Orthopaedic Association (BAPS/BOA) guidelines for the management of patients with open tibia fractures were published in 1991 and 1997 and provided a synopsis of injury epidemiology and best care. We present a retrospective review of 66 patients treated over a 2-year period (January 2001-February 2003) at a regional plastic surgery unit. There were 33 direct admissions and 33 transfers from other hospitals in which the average delay in transfer was 7.8 days (1-28) and in whom 26 (79%) patients had already undergone surgery. Plastic surgeons were involved in 46 (62%) of the 66 patient cohort and 27 (82%) transferred patients. The delay after admission until soft tissue cover was 3.8 days (0-15). Twenty-nine (44%) complications were recorded, 20 (69%) of these were in the transferred group and additional orthopaedic intervention was needed in 11 (42%) of patients who had been operated on in other hospitals. Despite widespread dissemination and teaching of the BAPS/BOA guidelines, complex extremity trauma is often not managed well in our region. There are unacceptable delays in admission, late communication, poor note keeping and follow up. The initial surgery/fixation is often sub-optimal and soft tissue reconstruction has to be considered at the least advantageous time period for the patient, leading to an increased hospital stay and complications.

  12. International Counter-Terrorism:Inspiration from Current Predicament

    Institute of Scientific and Technical Information of China (English)

    Li Wei; Yang Mingjie; Chen Jiejun; Gao Ying; Shi Gang

    2004-01-01

    @@ The September 11 attacks have spurred international counterterrorism onto a new level of state security strategy for many countries in intensifying the war on terror from varied angles, in a multi-layered, omni-dimensional way. Strange enough, terrorist activities have become all the more rampant in spite of such full-scale, worldwide clampdowns- a paradox indeed. This merits in-depth explorations into the underlying problems for seeking feasible solutions in response to the needs of theoretical research and the fight against terrorists. We have therefore invited experts from the China Institutes of Contemporary International Relations for discussions on the present anti-terrorist dilemma. It is our hope that their views may be of some help to relevant scholars and antiterror fighters.

  13. Theoretical Modeling of Internal Hydraulic Jump in Density Currents

    CERN Document Server

    Firoozabadi, Bahar; Aryanfar, Asghar; Afshin, Hossein

    2013-01-01

    In this paper, we propose an analytical framework for internal hydraulic jumps. Density jumps or internal hydraulic jumps occur when a supper critical flow of water discharges into a stagnant layer of water with slightly different density. The approach used here is control volume method which is also used to analyze ordinary hydraulic jumps. The important difference here is that entrainment is taken into account. Using conservation equations with the aid of some simplifying assumptions we come to an equation that gives jump downstream height as function of jump upstream characteristics and the entrainment. To determine the magnitude of downstream height we use an experimental equation for calculating the entrainment. Finally we verify our framework by comparing the height that we gain from the derived equation with some experimental data.

  14. Appropriate small dam management for minimizing catchment-wide safety threats: International benchmarked guidelines and demonstrative cases studies

    Science.gov (United States)

    Pisaniello, John D.; Tingey-Holyoak, Joanne; Burritt, Roger L.

    2012-01-01

    Small dam safety is generally being ignored. The potential for dam failure resulting in catastrophic consequences for downstream communities, property, and the environment, warrants exploration of the threats and policy issues associated with the management of small/farm dams. The paper achieves this through a comparative analysis of differing levels of dam safety assurance policy: absent, driven, strong, and model. A strategic review is undertaken to establish international dam safety policy benchmarks and to identify a best practice model. A cost-effective engineering/accounting tool is presented to assist the policy selection process and complement the best practice model. The paper then demonstrates the significance of the small-dam safety problem with a case study of four Australian States,policy-absent South Australia, policy-driven Victoria, policy-strong New South Wales, and policy-modelTasmania. Surveys of farmer behavior practices provide empirical evidence of the importance of policy and its proper implementation. Both individual and cumulative farm dam failure threats are addressed and, with supporting empirical evidence, the need for "appropriate" supervision of small dams is demonstrated. The paper adds to the existing international dam policy literature by identifying acceptable minimum level practice in private/farm dam safety assurance policy as well as updated international best practice policy guidelines while providing case study demonstration of how to apply the guidelines and empirical reinforcement of the need for "appropriate" policy. The policy guidelines, cost-effective technology, and comparative lessons presented can assist any jurisdiction to determine and implement appropriate dam safety policy.

  15. The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future

    OpenAIRE

    McAlister, Finlay A; Campbell, Norman R.C.; Zarnke, Kelly; Levine, Mitchell; Graham, Ian D

    2001-01-01

    CLINICIANS ARE EXPOSED to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian c...

  16. APA guidelines: their importance and a plan to keep them current: 2013 annual report of the Policy and Planning Board.

    Science.gov (United States)

    2014-01-01

    When guidelines are approved by APA, they become association policy, and it is imperative that they remain current. The revision of guidelines poses several challenges to the association. These challenges range from the availability and allocation of resources to support the complicated processes involved in developing and updating these policies to the lack of a clearly defined process that includes identification of tasks, assignments of responsibilities, and so forth. For this reason, the APA Board of Directors asked the Policy and Planning Board (P&P) to work with the boards of the four directorates (i.e., the Education Directorate, the Practice Directorate, the Public Interest Directorate, and the Science Directorate) to create a proposal that would (a) make recommendations with regard to how the review and revision of guidelines documents might best be accomplished in accordance with the APA Strategic Plan and existing policies and procedures and (b) make suggestions regarding the association resources that might be required. The Board of Directors approved the proposed review process in December 2013. 2014 APA, all rights reserved

  17. Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches

    Directory of Open Access Journals (Sweden)

    Dobke Marek

    2017-01-01

    Full Text Available The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD orthopedic and plastic surgery team (2011–2016 and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management.

  18. Current international intercomparison measurement on radon and its progeny

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Keizo [Kyoto Univ., Kumatori, Osaka (Japan). Research Reactor Inst.

    1996-12-01

    The international intercomparison measurement on radon and its progeny was held between the EML of USDOE and several Japanese organisations, using the radon test chamber installed in EML. Japanese results of radon concentration by the active method using the ionization chamber or scintillation cell and the passive method using the solid track detector were about 5% small compared to that of EML. On the results of radon progeny, there were not any large systematic differences between EML and Japanese participants in spite of wide range of deviation except for the results at the condition of low aerosol density. (author)

  19. Guidelines for the recording and evaluation of pharmaco-sleep studies in man: the International Pharmaco-EEG Society (IPEG).

    Science.gov (United States)

    Jobert, Marc; Wilson, Frederick J; Roth, Thomas; Ruigt, Gé S F; Anderer, Peter; Drinkenburg, Wilhelmus H I M; Bes, Frederik W; Brunovsky, Martin; Danker-Hopfe, Heidi; Freeman, Jon; van Gerven, Joop M A; Gruber, Georg; Kemp, Bob; Klösch, Gerhard; Ma, Junshui; Penzel, Thomas; Peterson, Barry T; Schulz, Hartmut; Staner, Luc; Saletu, Bernd; Svetnik, Vladimir

    2013-01-01

    The International Pharmaco-EEG Society (IPEG) presents guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-sleep data in man. Over the past years, technical and data-processing methods have advanced steadily, thus enhancing data quality and expanding the palette of sleep assessment tools that can be used to investigate the activity of drugs on the central nervous system (CNS), determine the time course of effects and pharmacodynamic properties of novel therapeutics, hence enabling the study of the pharmacokinetic/pharmacodynamic relationship, and evaluate the CNS penetration or toxicity of compounds. However, despite the presence of robust guidelines on the scoring of polysomnography -recordings, a review of the literature reveals inconsistent -aspects in the operating procedures from one study to another. While this fact does not invalidate results, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. The present guidelines are intended to assist investigators, who are using pharmaco-sleep measures in clinical research, in an effort to provide clear and concise recommendations and thereby to standardise methodology and facilitate comparability of data across laboratories. Copyright © 2013 S. Karger AG, Basel.

  20. Guidelines for the recording and evaluation of pharmaco-EEG data in man: the International Pharmaco-EEG Society (IPEG).

    Science.gov (United States)

    Jobert, Marc; Wilson, Frederick J; Ruigt, Gé S F; Brunovsky, Martin; Prichep, Leslie S; Drinkenburg, Wilhelmus H I M

    2012-01-01

    The International Pharmaco-EEG Society (IPEG) presents updated guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-EEG data in man. Since the publication of the first pharmaco-EEG guidelines in 1982, technical and data processing methods have advanced steadily, thus enhancing data quality and expanding the palette of tools available to investigate the action of drugs on the central nervous system (CNS), determine the pharmacokinetic and pharmacodynamic properties of novel therapeutics and evaluate the CNS penetration or toxicity of compounds. However, a review of the literature reveals inconsistent operating procedures from one study to another. While this fact does not invalidate results per se, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. Moreover, this shortcoming hampers reliable comparisons between outcomes of studies from different laboratories and hence also prevents pooling of data which is a requirement for sufficiently powering the validation of novel analytical algorithms and EEG-based biomarkers. The present updated guidelines reflect the consensus of a global panel of EEG experts and are intended to assist investigators using pharmaco-EEG in clinical research, by providing clear and concise recommendations and thereby enabling standardisation of methodology and facilitating comparability of data across laboratories. Copyright © 2012 S. Karger AG, Basel.

  1. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries.

    Science.gov (United States)

    Davis, Kourtney J; Landis, Sarah H; Oh, Yeon-Mok; Mannino, David M; Han, MeiLan K; van der Molen, Thys; Aisanov, Zaurbek; Menezes, Ana M; Ichinose, Masakazu; Muellerova, Hana

    2015-01-01

    Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians' knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists. Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios. Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; Psurvey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic practices was reported; however, gaps in the application of COPD-treatment recommendations were observed, warranting further evaluation to understand potential barriers to adopt guideline recommendations.

  2. Palliative care in amyotrophic lateral sclerosis: a review of current international guidelines and initiatives.

    LENUS (Irish Health Repository)

    Bede, Peter

    2011-04-01

    Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative condition. Optimal management requires a palliative approach from diagnosis with emphasis on patient autonomy, dignity and quality of life.

  3. International migration flows. Framework for understanding and current features.

    Directory of Open Access Journals (Sweden)

    Colectivo IOÉ

    2016-10-01

    Full Text Available The present article aims to outline a framework for the understanding of the present international migratory flows as well as to outline their main traits. In order to do this, we first group together the different migratory flows produced since the sixteenth century up to the mid seventies in the twentieth  century, stopping then for a closer look at the present situation which register the impact of economic globalization, translating it into an increase of said flows and, above all, to their enormous diversification. To end, we make a brief balance of the present period and a critical evaluation on the meaning of one of the flows which attracts most attention, economic migrations south-north, because these are the ones which have the most impact on developed countries.

  4. Magnetic force microscopy/current contrast imaging: A new technique for internal current probing of ICs

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, A.N.; Cole, E.I. Jr.; Dodd, B.A.; Anderson, R.E.

    1993-09-01

    This invited paper describes recently reported work on the application of magnetic force microscopy (MFM) to image currents in IC conductors [1]. A computer model for MFM imaging of IC currents and experimental results demonstrating the ability to determine current direction and magnitude with a resolution of {approximately} 1 mA dc and {approximately} 1 {mu}A ac are presented. The physics of MFM signal generation and applications to current imaging and measurement are described.

  5. International Rules for Precollege Science Research: Guidelines for Science Fairs. June 1995-May 1996.

    Science.gov (United States)

    Science Service, Inc., Washington, DC.

    This document presents the international rules for precollege science research. Sections include: (1) Quick Rules Reference; (2) Highlights for 1995-96; (3) International Science and Engineering Fair (ISEF) Category Descriptions; (4) Display and Safety Regulations; (5) Eligibility; (6) Requirements; (7) Limitations; (8) Continuation of Projects;…

  6. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

    DEFF Research Database (Denmark)

    Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard;

    2014-01-01

    BACKGROUND: Timely treatment of acute malnutrition in children 500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm...

  7. Current issues of international law on offshore abandonment, with special reference to the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Zhiguo [Univ. of Dundee, Scotland (United Kingdom)

    1997-11-01

    This article attempts to provide an up-to-date overview of the recent developments of international law on offshore abandonment. It scrutinizes the current issues and debates on the subject at both international and national levels, with special reference to the legislation and practice in the United Kingdom. Through a study of the current issues and trends in international law and policy developments, the articles undertakes to provide, where possible, practical considerations as to the possible resolution of some of the prominent problems faced by the international community in general, and some member states in particular. The future direction of international abandonment law also is briefly outlined.

  8. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....

  9. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....

  10. [Therapeutic strategies. Evolution and current status of the European Guidelines on Cardiovascular disease prevention].

    Science.gov (United States)

    Guijarro, Carlos; García-Díaz, Juan de Dios

    2013-01-01

    The European Guidelines on Dyslipidaemias (2011) and Cardiovascular Prevention (2012) have incorporated important changes. Firstly, it highlights the identification of a group of "very high risk" patients: patients with atherosclerotic disease in any vascular area, diabetes with associated risk factors, advanced chronic renal failure, or a SCORE estimate >10%. Patients with diabetes and no other risk factors, moderate renal failure, severe hypertension, genetic dyslipidaemias, or a SCORE estimate 5-10%, are considered as "high risk". The HDL cholesterol and triglycerides levels are considered as modulators of risks, but not therapeutic objectives per se. The therapeutic objectives are set at LDL cholesterol levels < 70 mg/dl (or at least a reduction of at least 50%) for patients at very high risk, and an LDL < 100 mg/dl for high risk patients. As well as the changes in lifestyle, pharmacological treatment with statins is the focal point of lipid lowering treatments. Other pharmacological options may be considered if the treatment with the maximum tolerable doses of statins do not achieve the therapeutic objectives. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

  11. Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Yahalom, Joachim, E-mail: yahalomj@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Li, Ye-Xiong [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Tsang, Richard [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2015-05-01

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.

  12. International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Brett W., E-mail: coxb@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Spratt, Daniel E. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lovelock, Michael [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Bilsky, Mark H. [Department of Surgery, Division of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lis, Eric [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ryu, Samuel [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States); Sheehan, Jason [Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Gerszten, Peter C. [Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania (United States); Chang, Eric [Department of Radiation Oncology, University of Southern California Keck School of Medicine, Health Sciences Campus, Los Angeles, California (United States); Gibbs, Iris; Soltys, Scott [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Sahgal, Arjun [Department of Radiation Oncology, Princess Margaret Hospital and the Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario (Canada); Deasy, Joe [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Flickinger, John; Quader, Mubina [Department of Radiation Oncology, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania (United States); Mindea, Stefan [Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (United States); and others

    2012-08-01

    Purpose: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. Methods and Materials: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery. Each set of volumes was imported into the Computational Environment for Radiotherapy Research. Quantitative analysis was performed using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) with kappa statistics calculating agreement between physicians. Optimized confidence level consensus contours were identified using histogram agreement analysis and characterized to create target volume definition guidelines. Results: Mean STAPLE agreement sensitivity and specificity was 0.76 (range, 0.67-0.84) and 0.97 (range, 0.94-0.99), respectively, for gross tumor volume (GTV) and 0.79 (range, 0.66-0.91) and 0.96 (range, 0.92-0.98), respectively, for clinical target volume (CTV). Mean kappa agreement was 0.65 (range, 0.54-0.79) for GTV and 0.64 (range, 0.54-0.82) for CTV (P<.01 for GTV and CTV in all cases). STAPLE histogram agreement analysis identified optimal consensus contours (80% confidence limit). Consensus recommendations include that the CTV should include abnormal marrow signal suspicious for microscopic invasion and an adjacent normal bony expansion to account for subclinical tumor spread in the marrow space. No epidural CTV expansion is recommended without epidural disease, and circumferential CTVs encircling the cord should be used only when the vertebral body, bilateral pedicles/lamina, and spinous process are all involved or there is extensive metastatic

  13. Biosolids disposal: An international overview of current and future trends

    Energy Technology Data Exchange (ETDEWEB)

    Evans, B

    1993-03-01

    The current trend in wastewater treatment is toward optimization, reuse, and beneficial use of biosolids. Key considerations in the selection of a sludge management process include long-term viability, sludge quality, markets for sludge-derived products, storage requirements, and whether the project will be able to obtain approvals. Beneficial uses of biosolids include agriculture and landscaping, construction materials, and energy; emerging technologies for utilizing sludges include biobrick production, animal feed production, vermiculture, pyrolysis of sludge to produce oil, manufacturing cement using sludge, and sludge liming for use in agriculture. An important use of sludge in Canada will be the use of solids as fertilizer in cleared-out areas of forest. A review is presented of practices in sludge disposal and utilization in Canada, the USA, Europe, and Japan. Some future trends are also noted. 4 tabs.

  14. Recommendations for international gambling harm-minimisation guidelines : comparison with effective public health policy

    NARCIS (Netherlands)

    Gainsbury, Sally M; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-01-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of

  15. Recommendations for international gambling harm-minimisation guidelines : comparison with effective public health policy

    NARCIS (Netherlands)

    Gainsbury, Sally M; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-01-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basi

  16. Recommendations for international gambling harm-minimisation guidelines: comparison with effective public health policy

    NARCIS (Netherlands)

    Gainsbury, S.M.; Blankers, M.; Wilkinson, C.; Schelleman-Offermans, K.; Cousijn, J.

    2014-01-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basi

  17. Atopic Dermatitis in Children: Current Clinical Guidelines for Diagnosis and Therapy

    Directory of Open Access Journals (Sweden)

    L. S. Namazova-Baranova

    2016-01-01

    Full Text Available Atopic dermatitis is a chronic multifactorial skin disease that is common enough in childhood. The article presents the current data on epidemiology and dynamics of incidence of pathological symptoms, pathogenesis basics, and key factors of the disease development, shows the current classification of the disease. The authors consider in detail the key principles of the diagnosis and peculiarities of a clinical aspect depending on age. Algorithms of a therapeutic approach, as well as basics of an individual hypoallergenic diet are proposed. General recommendations and possible prognosis for pediatric patients with atopic dermatitis are given.

  18. Investigation of assumptions underlying current safety guidelines on EM-induced nerve stimulation

    Science.gov (United States)

    Neufeld, Esra; Vogiatzis Oikonomidis, Ioannis; Iacono, Maria Ida; Angelone, Leonardo M.; Kainz, Wolfgang; Kuster, Niels

    2016-06-01

    An intricate network of a variety of nerves is embedded within the complex anatomy of the human body. Although nerves are shielded from unwanted excitation, they can still be stimulated by external electromagnetic sources that induce strongly non-uniform field distributions. Current exposure safety standards designed to limit unwanted nerve stimulation are based on a series of explicit and implicit assumptions and simplifications. This paper demonstrates the applicability of functionalized anatomical phantoms with integrated coupled electromagnetic and neuronal dynamics solvers for investigating the impact of magnetic resonance exposure on nerve excitation within the full complexity of the human anatomy. The impact of neuronal dynamics models, temperature and local hot-spots, nerve trajectory and potential smoothing, anatomical inhomogeneity, and pulse duration on nerve stimulation was evaluated. As a result, multiple assumptions underlying current safety standards are questioned. It is demonstrated that coupled EM-neuronal dynamics modeling involving realistic anatomies is valuable to establish conservative safety criteria.

  19. Review of current typhoid fever vaccines, cross-protection against paratyphoid fever, and the European guidelines.

    Science.gov (United States)

    Zuckerman, Jane N; Hatz, Christoph; Kantele, Anu

    2017-10-01

    Typhoid and paratyphoid fever remain a global health problem, which - in non-endemic countries - are mainly seen in travelers, particularly in VFRs (visiting friends and relatives), with occasional local outbreaks occurring. A rise in anti-microbial resistance emphasizes the role of preventive measures, especially vaccinations against typhoid and paratyphoid fever for travelers visiting endemic countries. Areas covered: This state-of-the-art review recapitulates the epidemiology and mechanisms of disease of typhoid and paratyphoid fever, depicts the perspective of non-endemic countries and travelers (VFRs), and collectively presents current European recommendations for typhoid fever vaccination. We provide a brief overview of available (and developmental) vaccines in Europe, present current data on cross-protection to S. Paratyphi, and aim to provide a background for typhoid vaccine decision-making in travelers. Expert commentary: European recommendations are not harmonized. Experts must assess vaccination of travelers based on current country-specific recommendations. Travel health practitioners should be aware of the issues surrounding vaccination of travelers and be motivated to increase awareness of typhoid and paratyphoid fever risks.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-15

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

  1. The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines.

    Science.gov (United States)

    Moore, Linda W; Byham-Gray, Laura D; Scott Parrott, J; Rigassio-Radler, Diane; Mandayam, Sreedhar; Jones, Stephen L; Mitch, William E; Osama Gaber, A

    2013-04-01

    The actual dietary protein intake of adults without and with different stages of chronic kidney disease is not known. To evaluate this we performed cross-sectional analyses of 16,872 adults (20 years of age and older) participating in the National Health and Nutrition Examination Survey 2001-2008 who completed a dietary interview by stage of kidney disease. Dietary protein intake was assessed from 24-h recall systematically collected using the Automated Multiple Pass Method. Complex survey analyses were used to derive population estimates of dietary protein intake at each stage of chronic kidney disease. Using dietary protein intake of adults without chronic kidney disease as the comparator, and after adjusting for age, the mean dietary protein intake was 1.30 g/kg ideal body weight/day (g/kgIBW/d) and was not different from stage 1 or stage 2 (1.28 and 1.25 g/kgIBW/d, respectively), but was significantly different in stage 3 and stage 4 (1.22 and 1.13 g/kgIBW/d, respectively). These mean values appear to be above the Institute of Medicine requirements for healthy adults and the NKF-KDOQI guidelines for stages 3 and 4 chronic kidney disease. Thus, the mean dietary protein intake is higher than current guidelines, even after adjusting for age.

  2. Australian survey of current practice and guideline use in adult cancer pain assessment and management: The community nurse perspective.

    Science.gov (United States)

    Phillips, Jane L; Lovell, Melanie; Luckett, Tim; Agar, Meera; Green, Anna; Davidson, Patricia

    2015-01-01

    Cancer pain remains a major public health concern. Despite effective treatments being available to manage the majority of cancer pain, this debilitating symptom is frequently under treated. As cancer has becomes a chronic disease a range of health professionals, including community nurses in Australia are increasingly caring for people living with cancer related pain. Yet, little is known about community nurses capacity to assess and manage cancer pain in accordance with best available evidence. This study aimed to: identify the barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; identify if cancer pain guidelines are currently used; identify barriers and facilitators to guideline use; and establish the need for Australian cancer pain guidelines. This article reports on community nurses' perceptions of managing cancer pain in the community setting. A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders seeking the views and experiences of health professionals involved in caring for people living with cancer pain. Descriptive statistics were used to summarise the quantitative data, and thematic content analysis were used to describe the qualitative data. Sixty-two community nurses responded to the survey, representing 29% of the total sample. These participants reported high levels of adherence to accepted cancer pain management practices in their workplace, with 71% nominating the Palliative Care Therapeutic Guideline V.3 as being most frequently used to manage community patients' cancer related pain. Key barriers to effective cancer pain management in the community were: difficulties accessing non-pharmacological interventions (89%), lack of coordination by multiple providers (89%), and impact of distance on ability to access pain-related services for patients (86%). A range of system, health professional and consumer barriers limit

  3. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries

    DEFF Research Database (Denmark)

    Malmgren, Barbro; Andreasen, Jens O; Flores, Marie Therese;

    2012-01-01

    Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group...

  4. Clinical guidelines.

    Science.gov (United States)

    Uppal, Elaine

    2016-01-01

    This article is part of the Advancing practice series which is aimed at exploring practice issues in more depth, considering topics that are frequently encountered and facilitating the development of new insights. Elaine Uppal focuses on the importance of all midwives developing guideline writing skills to ensure that local, national and international midwifery/maternity guidelines are up to date, relevant and reflect midwifery knowledge alongside 'gold' standard evidence. The article aims to consider the development, use and critical appraisal of clinical guidelines. It will define and explain guidelines; discuss their development and dissemination; and consider issues relating to their use in practice. Techniques to critique and develop guidelines using the AGREE tool will be outlined in the form of practice challenges to be undertaken by the individual or in a group.

  5. Evaluation of Functional Lower Urinary Tract Dysfunction in Children: Are the Physicians Complying with the Current Guidelines?

    Directory of Open Access Journals (Sweden)

    Mesrur Selcuk Silay

    2013-01-01

    were used for statistical analyses. Results. Of the 117 departments a total of 93 have completed the survey (n: 58 urology; n: 35 paediatric nephrology. Routine use of a questionnaire with validated symptom scoring system was found to be 13.9%. Of the participants, only 38.7% were asking all of the patients to fill the bladder diary. During treatment, only 24.7% were applying standard urotherapy for every patient. Almost half of the clinicians (45.1% believed that they were personally insufficient during the evaluation of those children. Finally, 86% reported that children with LUTD were not adequately approached. Conclusions. Evaluation of LUTD in children is not complying with the current guidelines. General approach for those children needs to be revisited by the clinicians.

  6. Conformity to the surviving sepsis campaign international guidelines among physicians in a general intensive care unit in Nairobi.

    Science.gov (United States)

    Mung'ayi, V; Karuga, R

    2010-08-01

    There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Cross sectional observational study. The general intensive care unit, Aga Khan University Hospital,Nairobi. Admitting physicians from all specialties in the general intensive care unit. The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.

  7. SOME CONSIDERATIONS OVER THE INTERNAL CONTROL IN THE CONTEXT OF CURRENT ACCOUNTANCY REGULATIONS

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    Lenghel Dorin Radu

    2012-12-01

    Full Text Available Through the hereby study we set ourselves on an analysis over the internal control and the ways of implementation of it. The final purpose of our research is represented by the characteristics of the internal control system in the context of current accountancy regulations. The accomplishment of such goal has forced us to research the current literature in the area and also the legal regulations over internal control. Of course, the accomplishment of such a research was possible only after a pertinent analysis over the opinions expressed in specialty literature regarding this area. Our research wants to be with a theoretical and applicative character. It is based on analysing the internal control system, the methodology of internal control and the steps of internal control. We express our belief that the implementation of the internal control in a very exact manner comes as an aid to the company management and lead to the accomplishment of managerial objectives and policies. In what it regards the result of our research there can be drawn the following conclusions: from the legal regulations (OMFP nr. 3055/2009, there is no clear conclusion over the procedures and policies of implementation of internal control applicable to an economical entity; also there are not presented in a detailed way the types (forms of internal control, being presented in the legal regulations only a classification of them after the time in which they are exercised (before, during or after the finishing of the operations; also in the legal regulations there is developed a certain way of internal control, represented by the financial and accounting internal control, as if the other forms of internal control do not exist; in what regards the components of internal control, these are presented in another way, but similar to already known models of internal control (Coso and Coco; also in the legal regulations there are presented the general objectives of internal control

  8. Utilization study of antidiabetic agents in a teaching hospital of Sikkim and adherence to current standard treatment guidelines

    Directory of Open Access Journals (Sweden)

    Sushrut Varun Satpathy

    2016-01-01

    Full Text Available Objective: Diabetes has gradually emerged as one of the most serious public health problems in our country. This underlines the need for timely disease detection and decisive therapeutic intervention. This prospective cross-sectional observational study aims at analyzing the utilization pattern of antidiabetic agents in a remote North-East Indian tertiary care teaching hospital in the perspective of current standard treatment guidelines. Materials and Methods: Diabetic patients receiving antidiabetic medication, both as outpatients and inpatients in our hospital over a period of 12 months (May 2013–May 2014, were included in this study. The data obtained were sorted and analyzed on the basis of gender, type of therapy, and hospital setting. Results: A total of 310 patients were included in the study. Metformin was the single most frequently prescribed antidiabetic agent (66.8% followed by the sulfonylureas group (37.4%. Insulin was prescribed in 23.2% of the patients. Combination antidiabetic drug therapy (65.1% was used more frequently than monotherapy (34.8%. The use of biguanides (P < 0.0001 and sulfonylureas (P = 0.02 in combination was significant as compared to their use as monotherapy. A total of 48% of all antidiabetic combinations used, comprised metformin and sulfonylureas (n = 96. Insulin use was significantly higher as monotherapy and in inpatients (P< 0.0001. The utilization of drugs from the National List of Essential Medicines was 51.2%, while 11% of antidiabetics were prescribed by generic name. Conclusion: The pattern of utilization largely conforms to the current standard treatment guidelines. Increased use of generic drugs is an area with scope for improvement.

  9. Current role of rufinamide in the treatment of childhood epilepsy: literature review and treatment guidelines.

    Science.gov (United States)

    Coppola, Giangennaro; Besag, Frank; Cusmai, Raffaella; Dulac, Olivier; Kluger, Gerhard; Moavero, Romina; Nabbout, Rima; Nikanorova, Marina; Pisani, Francesco; Verrotti, Alberto; von Stülpnagel, Celina; Curatolo, Paolo

    2014-11-01

    The literature on the efficacy and safety of rufinamide in childhood-onset epilepsy syndromes currently includes approximately 600 paediatric patients. This paper summarizes the views of a panel of experienced European epileptologists with regard to the current role of rufinamide in the treatment of childhood epilepsies. Rufinamide is effective in decreasing the seizure frequency in the Lennox-Gastaut syndrome (LGS), especially tonic and atonic seizures. It might consequently be preferred to other drugs as a second-line treatment for LGS when drop-attacks are frequent. The mean responder rate in the published studies is 38% with seizure freedom achieved in 2.4% of patients. Rufinamide has shown some efficacy in epileptic encephalopathies other than LGS. It can be also effective as adjunctive therapy in children and adolescents with drug-resistant partial seizures. The available data suggest that rufinamide has an acceptable risk/benefit ratio with quite a low risk of aggravating seizures. Common adverse effects (somnolence, nausea and vomiting) are usually mild and self-limiting; they are more frequently observed during titration than in the maintenance phase, suggesting that low escalation rates might be associated with fewer adverse effects. Rufinamide appears to have a favourable cognitive profile compared with other antiepileptic drugs. Rufinamide is only approved for adjunctive treatment of seizures associated with LGS in children 4 years of age and older. There are very few data on rufinamide treatment at the onset of LGS or early in the course of the disorder; whether early treatment will improve outcome has yet to be determined. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  10. International Guidelines for Privacy in Genomic Biobanking (or the Unexpected Virtue of Pluralism).

    Science.gov (United States)

    Thorogood, Adrian; Zawati, Ma'n H

    2015-01-01

    This article reviews international privacy norms governing human genomic biobanks and databases, and how they address issues related to consent, secondary use, de- identification, access, security, and governance. A range of international instruments were identified, varying in substance - e.g., human rights, data protection, research ethics, biobanks, and genetics - and legal character. Some norms detail processes for broad consent, namely, that even where potential participants cannot consent to specific users and uses, they should be given clear information on access policies, procedures, and governance structures. Some also give guidance about the conditions under which secondary use of data and samples without consent is appropriate, e.g., where consent is impracticable. International norms exhibit a confusing range of terminology relating to de-identification. They also continue to rely heavily on consent and anonymity as the basis for privacy protection, though governance is becoming more prominent. It may not be fatal that such a plurality of norms apply to biobanking; what is essential is that governance be built on shared values, our common interest in the success of genomic research, and practical tools that incentivize responsible, global sharing.

  11. Intern doctors’ views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh

    Directory of Open Access Journals (Sweden)

    Hoque R

    2015-08-01

    Full Text Available Rozina Hoque,1 Asma Mostafa,2 Mainul Haque3 1Department of Pharmacology, 2Department of Anatomy, Chattagram Maa O Shishu Hospital Medical College, Agrabad, Chittagong, Bangladesh; 3Unit of Pharmacology, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia Background: Bacterial resistance due to antibiotic misuse is reported every day. Such threat calls for a consensus to develop new strategies to prevent the development of antibiotic resistance of bacteria. Medical doctors must play a pivotal role to control and prevent the misuse of antibiotics. There were complaints that prescribers are lacking behind in updates and advancement in the field. To address such knowledge gap, a study was conducted to know the views of interns on the current antibiotic resistance situation in a teaching hospital in Bangladesh. Methods: This study was a cross-sectional, randomized, and questionnaire-based survey. Interns of the medicine, gynecology, and surgery departments of Chattagram Maa O Shishu Hospital Medical College were the study population. Results: Out of 50 respondents, 98% would like more education on antibiotic selection. All respondents believed that prescribing inappropriate or unnecessary antibiotics was professionally unethical. Ninety percent of the participants were confident in making an accurate diagnosis of infection. Eighty-four percent of them were confident about dosage schedule. In all, 98% participants thought that antibiotic resistance is a national problem and 64% of the respondents thought that same problem also existed in their hospital. Study participants were of the view that 41%–60% of antibiotic usages are irrational in Bangladesh. Fifty-eight percent of the study population thought that antimicrobial resistance (AR would be a greater problem in the future. Conclusion: The interns believe that there is a knowledge gap on AR. More emphasis should be given to AR and its implications in the undergraduate

  12. German Guidelines.

    Science.gov (United States)

    Kruis, Wolfgang; Nguyen, Gia P; Leifeld, Ludger

    2016-10-01

    Because of its frequency, diverticular disease is a burden on health care systems. Only few formal guidelines covering all aspects of the disease exist. Here, some selected statements from the German guidelines are given. The guidelines include significant recommendations for the diagnosis and management of diverticular disease. Both diagnosis and management depend definitely on clear definitions of the situation of an individual patient. Therefore, a new classification is proposed that is based on earlier suggestions. An internationally established classification would not only enable better patient care but could also lead to studies with comparable results.

  13. [Current recommendations about the diagnosis and treatment of testosterone deficit syndrome: Clinical guidelines].

    Science.gov (United States)

    Valero Rosa, José; Márquez López, Javier; Campos Hernández, Pablo; Puigvert Martínez, Ana; Prieto Castro, Rafael

    2013-09-01

    Testosterone deficit syndrome (TDS) is a clinical and biochemical syndrome associated with advanced age and characterized by some typical symptoms and decrease in serum testosterone levels, which can affect multiple organs and systems, deteriorating the quality of life of the males who suffer it. Due to the low specificity of the clinical picture, as well as that of the commonly used questionnaires, when there is a diagnostic suspicion, serum testosterone determination is necessary, without a current universally accepted determination method. The increased survival of males in the western world and their demand of a better quality of life,including the preservation of sexual activity, up to increasingly more advanced ages: together with the appearance of new ways of testosterone delivery, make this entity, clinical-biochemical, acquirean increasingly greater importance. From a therapeutic point of view, testosterone replacement therapy has precise indications, with individualized evaluation in each patient on the basis of risk/benefit, and with an adequate, well defined follow up, that will allow the control of possible adverse events. TRT is recommended in patients with diminished testosterone associated with muscle mass and strength loss, decrease of bone density of the lumbar spine or diminished libido and quality of erection. Contraindications for therapy would include active or non treated prostate cancer, PSA >4 ng/ml before evaluation, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe LUTS due to BPH.

  14. A New International Standard for "Actions from Waves and Currents on Coastal Structures"

    DEFF Research Database (Denmark)

    Tørum, Alf; Burcharth, Hans F.; Goda, Yoshimi

    2007-01-01

    The International Organization for Standardization (ISO) is going to issue a new standard concerning "Actions from Waves and Currents on Coastal Structures," which becomes the first international standard in coastal engineering. It is composed of a normative part (29 pages), an informative part (80...... standard on coastal engineering practice....

  15. Are patients with COPD treated with NIV in accordance with national guidelines? An internal audit.

    Science.gov (United States)

    Titlestad, Ingrid L; Olsen, Fanny; Sandqvist, Hanna M; Pourbazargan, Melvin M; Fretheim, Håvard H; Lassen, Annmarie T; Vestbo, Jørgen

    2014-01-01

    Non-invasive ventilation (NIV) as an add-on modality to medical treatment has been recommended in national guidelines for patients acutely admitted with chronic obstructive pulmonary disorder (COPD) exacerbation and hypercapnic respiratory failure. To address concerns regarding whether NIV is used appropriately, we conducted an audit of COPD patients admitted to a university hospital in Denmark. Data from medical records were retrieved for two cohorts in 2010: 1) all patients admitted to the Medical Emergency Ward with the diagnosis of COPD, and 2) all patients receiving NIV regardless of their diagnosis at the Respiratory Ward. Demographic data and outcome of treatment were registered. Cohort 1 comprised 804 admissions fulfilling criteria for COPD at evaluation, and of the 804 admissions, NIV was initiated in 151 (18.7%) admissions. In 42 additional cases (5.2%), initial mild respiratory acidosis was registered at admission, fulfilling criteria for NIV treatment; and, in 36 cases, the clinical status was reported as improved or not reported at all; no deaths were observed. In cohort 2, 124 admissions were registered that comprised 110 admissions with COPD and 14 without a diagnosis of COPD (of which half had a 'not-to-intubate' order). The indication for NIV treatment was met in 92.7% of the COPD admissions. NIV was initiated in 18.8% of the COPD admissions, and in an additional 5.2%, NIV criteria were met without initiation. In 82.3% of the admissions receiving NIV, a COPD diagnosis and correct criteria for NIV treatment were met.

  16. Gastroesophageal reflux disease management according to contemporary international guidelines: A translational study

    Institute of Scientific and Technical Information of China (English)

    Fabio Pace; Gabriele Riegler; Annalisa de Leone; Patrizia Dominici; Enzo Grossi; the EMERGE Study Group

    2011-01-01

    AIM: To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor (PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease (GERD) patients.METHODS: Five hundred and seventy seven patients with heartburn were recruited. After completing a psychometric tool to assess quality of life (PGWBI) and a previously validated GERD symptom questionnaire (QUID), patients were grouped into those with esophagitis (EE, n = 306) or without mucosal damage (NERD, n = 271) according to endoscopy results. The study started with a 2-wk period of high dose omeprazole (omeprazole test); patients responding to this PPI test entered an acute phase (3 mo) of treatment with any PPI at the standard dose. Finally, those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period.RESULTS: The test was positive in 519 (89.9%) patients, with a greater response in EE patients (96.4%) compared with NERD patients (82.6%) (P = 0.011). Both the percentage of completely asymptomatic patients, at 3 and 6 mo, and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients (P < 0.01). Finally, the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population.CONCLUSION: Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition, we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.

  17. [Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011].

    Science.gov (United States)

    Szczepaniak-Chicheł, Ludwina; Tykarski, Andrzej

    2012-10-01

    Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists - obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary

  18. Association between the Adherence to the International Guidelines for Cancer Prevention and Mammographic Density.

    Directory of Open Access Journals (Sweden)

    Adela Castelló

    Full Text Available Mammographic density (MD is considered a strong predictor of Breast Cancer (BC. The objective of the present study is to explore the association between MD and the compliance with the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR recommendations for cancer prevention.Data of 3584 women attending screening from a population-based multicenter cross-sectional study (DDM-Spain collected from October 7, 2007 through July 14, 2008, was used to calculate a score that measures the level of compliance with the WCRF/AICR recommendations: R1Maintain adequate body weight; R2Be physically active; 3RLimit the intake of high density foods; R4Eat mostly plant foods; R5Limit the intake of animal foods; R6Limit alcohol intake; R7Limit salt and salt preserved food intake; R8Meet nutritional needs through diet. The association between the score and MD (assessed by a single radiologist using a semi-quantitative scale was evaluated using ordinal logistic models with random center-specific intercepts adjusted for the main determinants of MD. Stratified analyses by menopausal status and smoking status were also carried out.A higher compliance with the WCRF/AICR recommendations was associated with lower MD (OR1-unit increase = 0.93 95%CI:0.86;0.99. The association was stronger in postmenopausal women (OR = 0.91 95%CI:0.84;0.99 and nonsmokers (OR = 0.87;95%CI:0.80;0.96 for nonsmokers, OR = 1.01 95%CI:0.91;1.12 for smokers, P-interaction = 0.042. Among nonsmokers, maintaining adequate body weight (OR = 0.81 95%CI:0.65;1.01, practicing physical activity (OR = 0.68 95%CI:0.48;0.96 and moderating the intake of high-density foods (OR = 0.58 95%CI:0.40;0.86 and alcoholic beverages (OR = 0.76 95%CI:0.55;1.05 were the recommendations showing the strongest associations with MD.postmenopausal women and non-smokers with greater compliance with the WCRF/AICR guidelines have lower MD. These results may provide guidance to design specific

  19. Remotely-Supervised Transcranial Direct Current Stimulation (tDCS for Clinical Trials: Guidelines for Technology and Protocols

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    2015-03-01

    Full Text Available The effect of transcranial direct current stimulation (tDCS is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: 1 training of staff in tDCS treatment and supervision, 2 assessment of the user’s capability to participate in tDCS remotely, 3 ongoing training procedures and materials including assessments of the user and/or caregiver, 4 simple and fail-safe electrode preparation techniques and tDCS headgear, 5 strict dose control for each session, 6 ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol, with corresponding corrective steps as required, 7 monitoring for treatment-emergent adverse effects, 8 guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population’s level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.

  20. [Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators].

    Science.gov (United States)

    Garcia, Rita de Cassia Maria; Calderón, Néstor; Ferreira, Fernando

    2012-08-01

    The objective of this study is to propose a generic program for the management of urban canine populations with suggestion of performance indicators. The following international guidelines on canine population management were revised and consolidated: World Health Organization, World Organisation for Animal Health, World Society for the Protection of Animals, International Companion Animal Management Coalition, and the Food and Agriculture Organization. Management programs should cover: situation diagnosis, including estimates of population size; social participation with involvement of various sectors in the planning and execution of strategies; educational actions to promote humane values, animal welfare, community health, and responsible ownership (through purchase or adoption); environmental and waste management to eliminate sources of food and shelter; registration and identification of animals; animal health care, reproductive control; prevention and control of zoonoses; control of animal commerce; management of animal behavior and adequate solutions for abandoned animals; and laws regulating responsible ownership, prevention of abandonment and zoonoses. To monitor these actions, four groups of indicators are suggested: animal population indicators, human/animal interaction indicators, public service indicators, and zoonosis indicators. The management of stray canine populations requires political, sanitary, ethologic, ecologic, and humanitarian strategies that are socially acceptable and environmentally sustainable. Such measures must also include the control of zoonoses such as rabies and leishmaniasis, considering the concept of "one health," which benefits both the animals and people in the community.

  1. International Guidelines on Human Rights and Drug Control: A Tool for Securing Women's Rights in Drug Control Policy.

    Science.gov (United States)

    Schleifer, Rebecca; Pol, Luciana

    2017-06-01

    Discrimination and inequality shape women's experiences of drug use and in the drug trade and the impact of drug control efforts on them, with disproportionate burdens faced by poor and otherwise marginalized women. In recent years, UN member states and UN drug control and human rights entities have recognized this issue and made commitments to integrate a 'gender perspective' into drug control policies, with 'gender' limited to those conventionally deemed women. But the concept of gender in international law is broader, rooted in socially constructed and culturally determined norms and expectations around gender roles, sex, and sexuality. Also, drug control policies often fail to meaningfully address the specific needs and circumstances of women (inclusively defined), leaving them at risk of recurrent violations of their rights in the context of drugs. This article explores what it means to 'mainstream' this narrower version of gender into drug control efforts, using as examples various women's experiences as people who use drugs, in the drug trade, and in the criminal justice system. It points to international guidelines on human rights and drug control as an important tool to ensure attention to women's rights in drug control policy design and implementation.

  2. Allermatch™, a webtool for the prediction of potential allergenicity according to current FAO/WHO Codex alimentarius guidelines

    Directory of Open Access Journals (Sweden)

    Nap Jan

    2004-09-01

    Full Text Available Abstract Background Novel proteins entering the food chain, for example by genetic modification of plants, have to be tested for allergenicity. Allermatch™ http://allermatch.org is a webtool for the efficient and standardized prediction of potential allergenicity of proteins and peptides according to the current recommendations of the FAO/WHO Expert Consultation, as outlined in the Codex alimentarius. Description A query amino acid sequence is compared with all known allergenic proteins retrieved from the protein databases using a sliding window approach. This identifies stretches of 80 amino acids with more than 35% similarity or small identical stretches of at least six amino acids. The outcome of the analysis is presented in a concise format. The predictive performance of the FAO/WHO criteria is evaluated by screening sets of allergens and non-allergens against the Allermatch databases. Besides correct predictions, both methods are shown to generate false positive and false negative hits and the outcomes should therefore be combined with other methods of allergenicity assessment, as advised by the FAO/WHO. Conclusions Allermatch™ provides an accessible, efficient, and useful webtool for analysis of potential allergenicity of proteins introduced in genetically modified food prior to market release that complies with current FAO/WHO guidelines.

  3. Allermatch, a webtool for the prediction of potential allergenicity according to current FAO/WHO Codex alimentarius guidelines.

    Science.gov (United States)

    Fiers, Mark W E J; Kleter, Gijs A; Nijland, Herman; Peijnenburg, Ad A C M; Nap, Jan Peter; van Ham, Roeland C H J

    2004-09-16

    Novel proteins entering the food chain, for example by genetic modification of plants, have to be tested for allergenicity. Allermatch http://allermatch.org is a webtool for the efficient and standardized prediction of potential allergenicity of proteins and peptides according to the current recommendations of the FAO/WHO Expert Consultation, as outlined in the Codex alimentarius. A query amino acid sequence is compared with all known allergenic proteins retrieved from the protein databases using a sliding window approach. This identifies stretches of 80 amino acids with more than 35% similarity or small identical stretches of at least six amino acids. The outcome of the analysis is presented in a concise format. The predictive performance of the FAO/WHO criteria is evaluated by screening sets of allergens and non-allergens against the Allermatch databases. Besides correct predictions, both methods are shown to generate false positive and false negative hits and the outcomes should therefore be combined with other methods of allergenicity assessment, as advised by the FAO/WHO. Allermatch provides an accessible, efficient, and useful webtool for analysis of potential allergenicity of proteins introduced in genetically modified food prior to market release that complies with current FAO/WHO guidelines.

  4. Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena, E-mail: lena.specht@regionh.dk [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Christie Hospital NHS Trust, Manchester (United Kingdom); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen (Denmark); Constine, Louis S. [Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Eich, Hans Theodor [Department of Radiation Oncology, University of Münster (Germany); Girinsky, Theodore [Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif (France); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mauch, Peter [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Mikhaeel, N. George [Department of Clinical Oncology and Radiotherapy, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States)

    2014-07-15

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the

  5. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms

    NARCIS (Netherlands)

    Joosen, Margot C. W.; Brouwers, Evelien P. M.; van Beurden, Karlijn M.; Terluin, Berend; Ruotsalainen, Jani H.; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J. L.; van Weeghel, Jaap

    2015-01-01

    Background We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. Methods To identify eligible guidelines, we systematically searched National Guide

  6. Task 5. Grid interconnection of building integrated and other dispersed photovoltaic power systems. International guideline for the certification of photovoltaic system components and grid-connected systems

    Energy Technology Data Exchange (ETDEWEB)

    Bower, W.

    2002-02-15

    This report for the International Energy Agency (IEA) made by Task 5 of the Photovoltaic Power Systems (PVPS) programme presents a guideline for the certification of photovoltaic system components and grid-connected systems. The mission of the Photovoltaic Power Systems Programme is to enhance the international collaboration efforts which accelerate the development and deployment of photovoltaic solar energy. Task 5 deals with issues concerning grid-interconnection and distributed PV power systems. This generic international guideline for the certification of photovoltaic system components and complete grid-connected photovoltaic systems describes a set of recommended methods and tests that may be used to verify the integrity of hardware and installations, compliance with applicable standards/codes and can be used to provide a measure of the performance of components or of entire systems. The guideline is to help ensure that photovoltaic installations are both safe for equipment as well as for personnel when used according to the applicable installation standards and codes. The guideline may be used in any country using the rules stipulated by the applicable standards and codes and by applying them to the guideline's recommended tests. This document uses examples for some tests but does not specify exact test set-ups, equipment accuracy, equipment manufacturers or calibration procedures.

  7. Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines Vertigem Posicional Paroxística Benigna: comparação de duas recentes diretrizes internacionais

    Directory of Open Access Journals (Sweden)

    André Luís dos Santos Silva

    2011-04-01

    Full Text Available Benign Paroxysmal Positional Vertigo (BPPV is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. AIM: the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. METHOD: Study design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS and the other by the American Academy of Neurology (AAN. The similarities were presented in different tables. RESULTS: Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. CONCLUSIONS: Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.A Vertigem Posicional Paroxística Benigna (VPPB é caracterizada por tontura rotatória com duração de segundos e tratada com manobras cefálicas. Para sistematizar a conduta e conduzir os clínicos no atual conhecimento no seu controle, sociedades internacionais desenvolveram diretrizes. OBJETIVO: Discutir de forma prática e didática o estado da arte da abordagem atualmente disponível para VPPB. MATERIAL E MÉTODOS: Revisão assistemática com análise crítica comparando os resultados de duas recentes diretrizes internacionais a respeito da avaliação e controle da VPPB. Uma pesquisa foi elaborada pela American Academy of Otolaryngology (AAO-HNS e a outra preparada pela American Academy of Neurology (AAN. Os tópicos em

  8. Validation in Support of Internationally Harmonised OECD Test Guidelines for Assessing the Safety of Chemicals.

    Science.gov (United States)

    Gourmelon, Anne; Delrue, Nathalie

    Ten years elapsed since the OECD published the Guidance document on the validation and international regulatory acceptance of test methods for hazard assessment. Much experience has been gained since then in validation centres, in countries and at the OECD on a variety of test methods that were subjected to validation studies. This chapter reviews validation principles and highlights common features that appear to be important for further regulatory acceptance across studies. Existing OECD-agreed validation principles will most likely generally remain relevant and applicable to address challenges associated with the validation of future test methods. Some adaptations may be needed to take into account the level of technique introduced in test systems, but demonstration of relevance and reliability will continue to play a central role as pre-requisite for the regulatory acceptance. Demonstration of relevance will become more challenging for test methods that form part of a set of predictive tools and methods, and that do not stand alone. OECD is keen on ensuring that while these concepts evolve, countries can continue to rely on valid methods and harmonised approaches for an efficient testing and assessment of chemicals.

  9. The impact of the 2005 International Society of Urological Pathology consensus guidelines on Gleason grading - a matched-pair analysis.

    Science.gov (United States)

    Berg, Kasper D; Thomsen, Frederik B; Nerstrøm, Camilla; Røder, Martin A; Iversen, Peter; Toft, Birgitte G; Vainer, Ben; Brasso, Klaus

    2016-06-01

    To investigate whether the International Society of Urological Pathology (ISUP) 2005 revision of the Gleason grading system has influenced the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), as the new guideline implies that some prostate cancers previously graded as Gleason score 6 (3 + 3) are now considered as 7 (3 + 4). A matched-pair analysis was conducted. In all, 215 patients with Gleason score 6 or 7 (3 + 4) prostate cancer on biopsy who underwent RP before 31 December 2005 (pre-ISUP group), were matched 1:1 by biopsy Gleason score, clinical tumour category, PSA level, and margin status to patients undergoing RP between 1 January 2008 and 31 December 2011 (post-ISUP group). Patients were followed until BCR defined as a PSA level of ≥0.2 ng/mL. Risk of BCR was analysed in a competing-risk model. The median follow-up was 9.5 years in the pre-ISUP group and 4.8 years in the post-ISUP group. The 5-year cumulative incidences of BCR were 34.0% and 13.9% in the pre-ISUP and post-ISUP groups, respectively (P ISUP Gleason score 6 and post-ISUP Gleason score 7 (3 + 4) (P = 0.34). In a multiple Cox-proportional hazard regression model, ISUP 2005 grading was a strong prognostic factor for BCR within 5 years of RP (hazard ratio 0.34; 95% confidence interval 0.22-0.54; P < 0.001). The revision of the Gleason grading system has reduced the risk of BCR after RP in patients with biopsy Gleason score 6 and 7 (3 + 4). This may have consequences when comparing outcomes across studies and historical periods and may affect future treatment recommendations. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  10. Editorial: can China master the guideline challenge?

    Directory of Open Access Journals (Sweden)

    Yang Kehu

    2013-01-01

    Full Text Available Abstract China is experiencing increased health care use and expenditures, without sufficient controls to ensure quality and value. Transparent, cost-conscious and patient-centered guidelines based on the best available evidence could help establishing these quality and practice measures. We examined how guidelines could support the Chinese health reform. Specifically, we summarized the current state of the art and related challenges in guideline development and explored possible solutions in the context of the Chinese health reform. China currently lacks capacity for evidence-based guideline development and coordination by a central agency. Most Chinese guideline users rely on recommendations developed by professional groups that lack demonstration of transparency (including conflict of interest management and evidence synthesis and quality. These deficiencies appear larger than in other regions of the world. In addition, misperceptions about the role of guidelines in assisting practitioners as opposed to providing rules requiring adherence, and a perception that traditional Chinese medicine (TCM cannot be appropriately incorporated in guidelines are present. China’s capacity could be strengthened by a central guideline agency to provide or coordinate evidence synthesis for guideline development and to oversee the work of guideline developers. China can build on what is known and work with the international community to develop methods to meet the challenges of evidence-based guideline development.

  11. Care of critically ill surgical patients using the 80-hour Accreditation Council of Graduate Medical Education work-week guidelines: a survey of current strategies.

    Science.gov (United States)

    Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E

    2006-06-01

    As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.

  12. Current activity guidelines for CABG patients are too restrictive: comparison of the forces exerted on the median sternotomy during a cough vs. lifting activities combined with valsalva maneuver.

    Science.gov (United States)

    Parker, R; Adams, J L; Ogola, G; McBrayer, D; Hubbard, J M; McCullough, T L; Hartman, J M; Cleveland, T

    2008-06-01

    The current activity guidelines for coronary artery bypass graft surgery (CABG) patients are overly restrictive, hindering recovery. As the sternotomy repair must withstand repeated coughs during convalescence, this provides a benchmark for the force tending to separate the incision that can be tolerated. Nine volunteers performed 5 weightlifting activities (lifting 5 lbs [2.3 kg], lifting a 25-lb simulated grandchild [11.4 kg], lifting a 30-lb suitcase [13.6 kg], lifting two 20-lb weights [18.2 kg], and lifting a gallon of milk to a counter [3.7 kg]), plus coughing. Valsalva forces were detected using a mouthpiece configured with an Ashcroft Inc. expiratory pressure gauge (model N10-120CMW). Three measurements were taken for each activity to calculate the mean internal forces while external forces on the sternotomy were calculated using vector algebra. Total force exerted on the sternotomy by the cough was compared to the total force exerted by each of the 5 activities using paired T-tests. The cough exerted a significantly greater force across the median sternotomy (mean 27.5 kg-mass) than any of the five weightlifting activities ( P force on the median sternotomy incision than a cough. The strength of the repair is significantly greater than is implied by the recommendation to "not lift more than 5 lbs".

  13. The "Diagnostic Guideline for Anxiety and Challenging Behaviour" for Persons with Intellectual Disabilities: Preliminary Outcomes on Internalizing Problems, Challenging Behaviours, Quality of Life and Clients' Satisfaction

    Science.gov (United States)

    Pruijssers, Addy; Meijel, Berno; Maaskant, Marian; Teerenstra, Steven; van Achterberg, Theo

    2017-01-01

    Background: People with intellectual disabilities are vulnerable to develop psychopathology (in particular anxiety) and related challenging behaviour. Method: A comparative multiple case study with an experimental and a control condition. Results: The application of the guideline showed a trend of decreases of internalizing problems (P = 0.07) and…

  14. A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.

    Science.gov (United States)

    Lutgens, Maurice; van Oijen, Martijn; Mooiweer, Erik; van der Valk, Mirthe; Vleggaar, Frank; Siersema, Peter; Oldenburg, Bas

    2014-11-01

    Colonoscopic surveillance for neoplasia is recommended for patients with inflammatory bowel disease (IBD)-related colitis. However, data on cost-effectiveness predate current international guidelines. To compare cost-effectiveness based on contemporary data between the surveillance strategies of the American Gastroenterological Association (AGA) and British Society of Gastroenterology (BSG). We constructed a Markov decision model to simulate the clinical course of IBD patients. We compared the 2 surveillance strategies for a base case of a 40-year-old colitis patient who was followed for 40 years. AGA surveillance distinguishes 2 groups: a high-risk group with annual surveillance and an average-risk group with biannual surveillance. BSG surveillance distinguishes 3 risk groups with yearly, 3-year, or 5-year surveillance. Patients could move from a no-dysplasia state with colonoscopic surveillance to 1 of 3 states for which proctocolectomy was indicated: (1) dysplasia/local cancer, (2) regional/metastasized cancer, or (3) refractory disease. After proctocolectomy, a patient moved to a no-colon state without surveillance. Direct costs of medical care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. BSG surveillance dominated AGA surveillance with $9846 per QALY. Both strategies were equally effective with 24.16 QALYs, but BSG surveillance was associated with lower costs because of fewer colonoscopies performed. Costs related to IBD, surgery, or cancer did not affect cost-effectiveness. The model depends on the accuracy of derived data, and the assumptions that were made to reflect real-life situations. Study conclusions may only apply to the U.S. health care system. The updated risk-profiling approach for surveillance of IBD colorectal carcinoma by the BSG guideline appears to be more cost-effective. Copyright © 2014. Published by Elsevier Inc.

  15. Govt. Pubs.: Internal Auditing in Federal, State, and Local Governments.

    Science.gov (United States)

    Knight, Susan; Wilson, Guy

    1980-01-01

    Lists reports, monographs, and journal articles of the last five years that deal with internal auditing at various governmental levels, including the growth of the internal audit, the development of guidelines, current practices, types of audit, and current issues. (FM)

  16. Govt. Pubs.: Internal Auditing in Federal, State, and Local Governments.

    Science.gov (United States)

    Knight, Susan; Wilson, Guy

    1980-01-01

    Lists reports, monographs, and journal articles of the last five years that deal with internal auditing at various governmental levels, including the growth of the internal audit, the development of guidelines, current practices, types of audit, and current issues. (FM)

  17. Australian survey of current practice and guideline use in adult cancer pain assessment and management: perspectives of oncologists.

    Science.gov (United States)

    Luckett, Tim; Davidson, Patricia Mary; Boyle, Frances; Liauw, Winston; Agar, Meera; Green, Anna; Lovell, Melanie

    2014-06-01

    Cancer pain continues to be undertreated in up to half of cases, despite the availability of evidence-based guidelines. This study aimed to: (i) identify barriers and facilitators to adult cancer pain assessment and management, as perceived by Australian health professionals; (ii) establish the perceived need for new Australian guidelines and implementation strategy; (iii) identify which guidelines are used; (iv) identify barriers and facilitators to guideline use. This article focuses on the perceptions of responding oncologists. A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders. Comments were coded independently by two researchers. In all 76 oncologists self-reported high concordance with evidence-based recommendations, except validated pain scales. Perceived barriers to pain management included insufficient non-pharmacological interventions, access to /coordination between services, and time. Only 22 percent of respondents reported using pain guidelines. Perceived barriers to guideline use included lack of access, awareness and any single standard. Respondents were generally supportive of new Australian guidelines and especially an implementation strategy. Barriers to evidence-based practice and guideline use identified by our survey might be addressed via a clinical pathway that gives step-by-step guidance on evidence-based practice along with a framework for evaluation. Particular attention should be paid to promoting use of validated scales, patient education and non-pharmacological interventions, training of an appropriately skilled workforce and improving care coordination. Challenges are discussed. © 2012 Wiley Publishing Asia Pty Ltd.

  18. Contemporary Atrial Fibrillation Management: A Comparison of the Current AHA/ACC/HRS, CCS, and ESC Guidelines.

    Science.gov (United States)

    Andrade, Jason G; Macle, Laurent; Nattel, Stanley; Verma, Atul; Cairns, John

    2017-08-01

    In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Clinical management of familial hypercholesterolemia: new insights from international guidelines and recent studies

    Directory of Open Access Journals (Sweden)

    Anthony S. Wierzbicki

    2014-12-01

    Full Text Available This review article assesses the clinical features, diagnosis and management of familial hypercholesterolemia (FH. FH is mostly an autosomally dominantly inherited with an incidence of 1 in 250. Tendon xanthomata are pathognomonic. Untreated FH is associated with 100-200 fold increase in risk of cardiovascular disease (CVD. FH is diagnosed by screening for elevated low density lipoprotein cholesterol (LDL-C and confirmed by DNA techniques. Once index cases have been identified cascade family screening should occur. FH is primarily treated with high dose statin therapy. This reduces progression of surrogate markers of coronary arterial disease and registry studies show a 70% long-term decrease in CVD mortality. The justification for other lipidlowering therapies e.g. ezetimibe relies on the high population attributable risk of LDL-C in FH. Novel therapies with greater LDL-C reducing actions such as proprotein convertase subtilisin kexin-9 inhibitors show promise in FH Children with FH should be identified through cascade screening but drug treatment is dependent on LDL-C and family history. They should be managed in specialist paediatric units or in family clinics. Cases of homozygous FH are rare. This orphan condition should be managed in specialist centers with a combination of drug therapy, apheresis and liver transplantation. Novel therapies for the treatment of homozygous FH such as mipomersen and lomitapide are gradually coming into use FH is a common underdiagnosed condition. Current, let alone future, therapies are extremely effective in reducing both LDL-C and CVD events in patients with FH. Identification and treatment of FH should be a feature of preventative CVD medicine programmes.

  20. A wavelet-based method to discriminate internal faults from inrush currents using correlation coefficient

    Energy Technology Data Exchange (ETDEWEB)

    Vahidi, B.; Ghaffarzadeh, N.; Hosseinian, S.H. [Dept. of Electrical Engineering, Amirkabir University of Technology, Tehran (Iran)

    2010-09-15

    In this paper a new method based on discrete wavelet transform and correlation coefficient is presented for digital differential protection. The algorithm includes offline and online operations. In offline operation, discrete wavelet transform is used to decompose typical three-phase differential currents for inrush current. Then an index is defined and computed. The index is based on the sum of the energy of detail coefficients at level 5 of three-phase differential currents at each half cycle. The online operation consists of capturing the three-phase differential currents using 10 kHz sampling rate, decomposing it by db1. Finally, the inrush current and internal fault is detected based on correlation coefficients of the computed index of pre-stored typical inrush current and a recorded indistinct signal. The effectiveness of the approach is tested using numerous inrush and internal fault currents. Simulations are used to confirm the aptness and the capability of the proposed method to discriminate inrush current from internal fault. (author)

  1. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries

    Directory of Open Access Journals (Sweden)

    Davis KJ

    2014-12-01

    Full Text Available Kourtney J Davis,1 Sarah H Landis,2 Yeon-Mok Oh,3 David M Mannino,4 MeiLan K Han,5 Thys van der Molen,6 Zaurbek Aisanov,7 Ana M Menezes,8 Masakazu Ichinose,9 Hana Muellerova11Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium; 2Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 3University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 4University of Kentucky College of Public Health, Lexington, KY, USA; 5Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 6University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 7Pulmonology Research Institute, Moscow, Russia; 8Federal University of Pelotas, Pelotas, Brazil; 9Tohoku University Graduate School of Medicine, Sendai, JapanAim: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs and respiratory specialists.Materials and methods: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios.Results: Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001 to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001. Respiratory

  2. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

    Science.gov (United States)

    Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-04-25

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

  3. Background current affects the internal wave structure of the northern South China Sea

    Institute of Scientific and Technical Information of China (English)

    Shuqun Cai; Xiaomin Long; Danpeng Dong; Shengan Wang

    2008-01-01

    The internal wave modal equations are solved with the consideration of background currents.Analytical and numerical solutions of some specific examples,including observations in the northern South China Sea(SCS),are obtained to investigate the effect of background current on internal wave vertical structure.The effects of current shear and curvature on intemal wave vertical structure are evaluated separately.It is found that the phase speed and wave structure are modified by background currents,the current shear has little effect on wave structure.whilst the current curvature Could have a strong impact on the wave structure.The extent of the effect by the current curvature on the wave structure depends on the magnitudes of current curvature,relative wave speed,and buoyancy frequency,sometimes the effect by the current curvature may even cause the wave to attenuate severely with depth.A new method to obtain the real eigenfunction with depth in the case that the waves become evanescent is also put forward.It is shown that the residual tidal current in the northern SCS is strong enough to cause the wave to attenuate severely at the upper layer.

  4. [Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].

    Science.gov (United States)

    Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

    2006-01-01

    Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.

  5. Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group.

    Science.gov (United States)

    Knowles, Charles H; De Giorgio, Roberto; Kapur, Raj P; Bruder, Elisabeth; Farrugia, Gianrico; Geboes, Karel; Gershon, Michael D; Hutson, John; Lindberg, Greger; Martin, Joanne E; Meier-Ruge, William A; Milla, Peter J; Smith, Virpi V; Vandervinden, Jean Marie; Veress, Béla; Wedel, Thilo

    2009-08-01

    The term gastrointestinal neuromuscular disease describes a clinically heterogeneous group of disorders of children and adults in which symptoms are presumed or proven to arise as a result of neuromuscular, including interstitial cell of Cajal, dysfunction. Such disorders commonly have impaired motor activity, i.e. slowed or obstructed transit with radiological evidence of transient or persistent visceral dilatation. Whilst sensorimotor abnormalities have been demonstrated by a variety of methods in these conditions, standards for histopathological reporting remain relatively neglected. Significant differences in methodologies and expertise continue to confound the reliable delineation of normality and specificity of particular pathological changes for disease. Such issues require urgent clarification to standardize acquisition and handling of tissue specimens, interpretation of findings and make informed decisions on risk-benefit of full-thickness tissue biopsy of bowel or other diagnostic procedures. Such information will also allow increased certainty of diagnosis, facilitating factual discussion between patients and caregivers, as well as giving prognostic and therapeutic information. The following report, produced by an international working group, using established consensus methodology, presents proposed guidelines on histological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology. The report addresses the main areas of histopathological practice as confronted by the pathologist, including suction rectal biopsy and full-thickness tissue obtained with diagnostic or therapeutic intent. For each, indications, safe acquisition of tissue, histological techniques, reporting and referral recommendations are presented.

  6. Effect of Upward Internal Flow on Dynamics of Riser Model Subject to Shear Current

    Institute of Scientific and Technical Information of China (English)

    CHEN Zheng-shou; KIM Wu-joan; XIONG Cong-bo

    2012-01-01

    Numerical study about vortex-induced vibration (VIV) related to a flexible riser model in consideration of internal flow progressing inside has been performed.The main objective of this work is to investigate the coupled fluid-structure interaction (FSI) taking place between tensioned riser model,external shear current and upward-progressing internal flow (from ocean bottom to surface).A CAE technology behind the current research which combines structural softwàre with the CFD technology has been proposed.According to the result from dynamic analysis,it has been found that the existence of upward-progressing internal flow does play an important role in determining the vibration mode (/dominant frequency),vibration intensity and the magnitude of instantaneous vibration amplitude,when the velocity ratio of internal flow against external current is relatively high.As a rule,the larger the velocity of internal flow is,the more it contributes to the dynamic vibration response of the flexible riser model.In addition,multi-modal vibration phenomenon has been widely observed,for asymmetric curvature along the riser span emerges in the case of external shear current being imposed.

  7. Excerpts from the 1st international NTNU symposium on current and future clinical biomarkers of cancer

    DEFF Research Database (Denmark)

    Robles, Ana I; Olsen, Karina Standahl; Tsui, Dana W T;

    2016-01-01

    The goal of biomarker research is to identify clinically valid markers. Despite decades of research there has been disappointingly few molecules or techniques that are in use today. The "1st International NTNU Symposium on Current and Future Clinical Biomarkers of Cancer: Innovation and Implement......The goal of biomarker research is to identify clinically valid markers. Despite decades of research there has been disappointingly few molecules or techniques that are in use today. The "1st International NTNU Symposium on Current and Future Clinical Biomarkers of Cancer: Innovation...

  8. Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS.

    Science.gov (United States)

    Porwit, A; van de Loosdrecht, A A; Bettelheim, P; Brodersen, L Eidenschink; Burbury, K; Cremers, E; Della Porta, M G; Ireland, R; Johansson, U; Matarraz, S; Ogata, K; Orfao, A; Preijers, F; Psarra, K; Subirá, D; Valent, P; van der Velden, V H J; Wells, D; Westers, T M; Kern, W; Béné, M C

    2014-09-01

    Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.

  9. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines.

    Science.gov (United States)

    Eichenfield, Lawrence F; Ahluwalia, Jusleen; Waldman, Andrea; Borok, Jenna; Udkoff, Jeremy; Boguniewicz, Mark

    2017-04-01

    Atopic dermatitis (AD) is a chronic pruritic inflammatory disease that commonly presents in the pediatric population. Although definitions and diagnosis of AD have largely been agreed upon, allergists and dermatologists have similar and divergent approaches to the management of AD. This review facilitated integration of the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology Joint Task Force 2012 AD Practice Parameter and the 2014 American Academy of Dermatology guidelines to highlight the basic principles of AD management and discuss therapies and management of AD from the distinct perspectives of the allergist and dermatologist. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  10. Effect of background parabolic current on characteristics and energetics of internal solitary waves by numerical simulation

    Institute of Scientific and Technical Information of China (English)

    L Haibin; XIE Jieshuo; YAO Yuan; XU Jiexin; CHEN Zhiwu; HE Yinghui; CAI Shuqun

    2016-01-01

    Based on modifications of the observed background parabolic current in upper layer of the northeastern South China Sea (SCS), the effects of eight kinds of background currents on the characteristics and energy conversion of internal solitary waves (ISWs) are investigated by an Internal Gravity Wave (IGW) model. It is found that, although the background current has little effect on the number of the generated ISWs, it reduces the resulted phase speed of ISW. When the background parabolic current appears with its lower boundary near or above the main thermocline, the ISW amplitude and the depth of the isopycnal undergoing maximum displacement increase;when the background parabolic current curvature is reduced, the ISW amplitude and the ratio of baroclinic to barotropic energy reduce, whilst the phase speed of ISW, the baroclinic energy, and the ratio of baroclinic kinetic energy (KE) to available potential energy (APE) increase; when the lower boundary of background parabolic current extends down to the seabed and the background current curvature is reduced, the ISW amplitude and phase speed decrease, whilst the barotropic kinetic energy, the baroclinic energy and the ratio of KE to APE increase. At a whole depth, when the lower background current curvature is reduced and the upper current curvature is increased, the ISW amplitude, and phase speed, the ratio of baroclinic to barotropic energy, the baroclinic energy, and the ratio of KE to APE all increase.

  11. Near-surface current meter array measurements of internal gravity waves

    Energy Technology Data Exchange (ETDEWEB)

    Jones, H.B.E. [Lawrence Livermore National Lab., CA (United States)

    1994-11-15

    We have developed various processing algorithms used to estimate the wave forms produced by hydrodynamic Internal Waves. Furthermore, the estimated Internal Waves are used to calculate the Modulation Transfer Function (MTF) which relates the current and strain rate subsurface fields to surface scattering phenomenon imaged by radar. Following a brief discussion of LLNL`s measurement platform (a 10 sensor current meter array) we described the generation of representative current and strain rate space-time images from measured or simulated data. Then, we present how our simulation capability highlighted limitations in estimating strain rate. These limitations spurred the application of beamforming techniques to enhance our estimates, albeit at the expense of collapsing our space-time images to 1-D estimates. Finally, we discuss progress with regard to processing the current meter array data captured during the recent Loch Linnhe field trials.

  12. [Update on Current Care Guideline: Physical activity and exercise training for adults in sickness and in health].

    Science.gov (United States)

    Rauramaa, Rainer; Kukkonen-Harjula, Katriina; Arokoski, Jari; Hohtari, Hannele; Ketola, Eeva; Kettunen, Jyrki; Komulainen, Pirjo; Kujala, Urho; Laukkanen, Jari; Pylkkänen, Liisa; Savela, Salla; Savonen, Kai; Tikkanen, Heikki

    2016-01-01

    The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

  13. Coupled Numerical Study of Turbidity Currents, Internal Hydraulic Jump and Morphological Signatures

    Science.gov (United States)

    Hu, P.; Cao, Z.; He, Z.; Gareth, P.

    2013-12-01

    Abstract: The last two decades have seen intensive experimental and numerical studies of the occurrence condition of internal hydraulic jump in turbidity currents and the induced morphological signatures (Garcia and Parker 1989; Kostic and Parker 2006). Yet there are two critical issues that remain insufficiently or inappropriately addressed. First, depositional turbidity currents are imposed on steep slopes in both flume experiments and numerical cases, exclusively based on a configuration consisting of an upstream sloping portion and a downstream horizontal portion linked by a slope break. This appears physically counterintuitive as steep slope should favour self-accelerating erosional turbidity currents (Parker et al. 1986). The second issue concerns the numerical studies. There exist significant interactions among the current, sediment transport and bed topography. Due to the slope break in bed, the current may experience an internal hydraulic jump, leaving morphological signatures on the bed, which in turn affects the current evolution. Nevertheless, simplified decoupled models are exclusively employed in previous numerical investigations, in which the interactions are either partly or completely ignored without sufficient justification. The present paper aims to address the above-mentioned two issues relevant to the occurrence condition of the internal hydraulic jump and the induced morphological signatures. A recently developed well-balanced coupled numerical model for turbidity currents (Hu et al. 2012) is applied. In contrast to previous studies, erosional turbidity currents will be imposed at the upstream boundary, which is much more typical of the field. The effects of sediment size, bed slope decrease, and upstream and downstream boundary conditions are revealed in detail. In addition, the evolution of turbidity currents over a bed characterized by gradual decrease in slope is also discussed. References Garcia, M. H., and Parker, G. (1989). Experiments

  14. The Rise of International Relations Programs in the Brazilian Federal Universities: Curriculum Specificities and Current Challenges

    Science.gov (United States)

    Ferreira, Marcos Alan S. V.

    2016-01-01

    The aim of this reflection is to study the new international relations (IR) programs introduced by Brazilian federal universities, looking comparatively at their curriculum specificities and current challenges. In recent years, Brazil has seen an increase of IR programs launched in several regions. Since 2003, the Ministry of Education is in the…

  15. International Cartilage Repair Society (ICRS) Recommended Guidelines for Histological Endpoints for Cartilage Repair Studies in Animal Models and Clinical Trials.

    Science.gov (United States)

    Hoemann, Caroline; Kandel, Rita; Roberts, Sally; Saris, Daniel B F; Creemers, Laura; Mainil-Varlet, Pierre; Méthot, Stephane; Hollander, Anthony P; Buschmann, Michael D

    2011-04-01

    Cartilage repair strategies aim to resurface a lesion with osteochondral tissue resembling native cartilage, but a variety of repair tissues are usually observed. Histology is an important structural outcome that could serve as an interim measure of efficacy in randomized controlled clinical studies. The purpose of this article is to propose guidelines for standardized histoprocessing and unbiased evaluation of animal tissues and human biopsies. Methods were compiled from a literature review, and illustrative data were added. In animal models, treatments are usually administered to acute defects created in healthy tissues, and the entire joint can be analyzed at multiple postoperative time points. In human clinical therapy, treatments are applied to developed lesions, and biopsies are obtained, usually from a subset of patients, at a specific time point. In striving to standardize evaluation of structural endpoints in cartilage repair studies, 5 variables should be controlled: 1) location of biopsy/sample section, 2) timing of biopsy/sample recovery, 3) histoprocessing, 4) staining, and 5) blinded evaluation with a proper control group. Histological scores, quantitative histomorphometry of repair tissue thickness, percentage of tissue staining for collagens and glycosaminoglycan, polarized light microscopy for collagen fibril organization, and subchondral bone integration/structure are all relevant outcome measures that can be collected and used to assess the efficacy of novel therapeutics. Standardized histology methods could improve statistical analyses, help interpret and validate noninvasive imaging outcomes, and permit cross-comparison between studies. Currently, there are no suitable substitutes for histology in evaluating repair tissue quality and cartilaginous character.

  16. EVALUATION OF THE CONFORMITY OF CARDIOVASCULAR THERAPY TO CURRENT CLINICAL GUIDELINES IN THE IMPROVEMENT OF OUTCOMES IN PATIENTS AFTER STROKE (ACCORDING TO THE LIS-2 REGISTER

    Directory of Open Access Journals (Sweden)

    A. Yu. Suvorov

    2015-01-01

    Full Text Available Aim. To study the conformity of preventative therapy prescribed to patients during a hospital stay and at a discharge to clinical guidelines using a special algorithm, and to assess the impact of the results on a long-term mortality based on the LIS-2 register (Lyubertsy study of mortality in patients after cerebral stroke.Material and methods. The scales to assess the quality of cardiovascular care for the prevention of recurrent stroke along with the prevention of recurrent ischemic attacks index (PRIA index for this assessment were developed according to current clinical guidelines. Analysis of the therapy was performed using PRIA index on survived hospital patients from LIS-2 register (N=753. The impact of PRIA index results on a long-term mortality (Me=2.3 years was studied.Results. Based upon the results of the assessment obtained with PRIA index, higher treatment conformity to clinical guidelines resulted in a significantly better long-term survival. Non-conformity to clinical guidelines was due to the lack of prescription of drugs with proven efficacy and irrational choice of preventive therapy. Median of treatment quality assessment was 44.4% (22.2; 44.4.Conclusion. Low conformity of preventive therapy to clinical guidelines is found in the LIS-2 register. The algorithm for the assessment of preventive cardiovascular therapy quality allows identifying limitations in the prevention of recurrent stroke, and can serve as an example of implementation of evidence-based medicine in clinical practice.

  17. 脑出血相关治疗指南与临床现状%Guideline and current status on prevention and treatment of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    宋水江; 戴加勇; 汤永国

    2013-01-01

    The AHA/ASA guideline for intracerebral hemorrhage has been published nearly 2 years,however,the clinicians pay much less attention to it than the guideline of cerebral ischemia.At present there's big gaps between the status of control for intracerebral hemorrhage and guideline.Based on the analysis of current situation,comparing with the requirements of guideline,we hope to make the treatment of intracerebral hemorrhage in our country accord with the principle of guideline,making more patients benefit from the treatment.%美国心脏协会(AHA)和美国卒中学会(ASA)制定的《自发性脑出血诊疗指南》发表已逾3年,但临床医生对于脑出血指南的重视程度远不如缺血性脑血管病指南.目前有关脑出血的防治现状与指南存在较大差距.文章通过对现状的分析,对照指南的要求,希望能使中国脑出血的治疗更符合指南的精神,使更多脑出血患者从治疗中获益.

  18. ANALYSIS OF SCIENTIFIC RESEARCHES IN PHARMACEUTICAL PROMOTION GLOBALLY: TOWARDS INTERNATIONALLY DEVELOPING PRACTICALLY-ORIENTED GUIDELINES FOR PHARMACEUTICAL COMPANIES

    Directory of Open Access Journals (Sweden)

    M. M. Bahlol

    2016-01-01

    Full Text Available Purpose. Pharmaceutical industry is transnational and globally important. Many pharmaceutical companies operate their business in multinational and international forms in different countries. Diverse researches from different countries indicated and confirmed marketing promotion importance in pharmaceutical field. Therefore, marketing promotion and its effects are a very important issue that should be globally investigated in real life and evidence context. We oriented our research according to these scientific and practical values.Methodology. We reviewed pharmaceutical marketing promotion researches from more than 25 different countries, e.g., USA, Canada, Italy, France, Russia, India, Egypt and Syria where we employed our knowledge of three widely spread languages, i.e., English, Russian and Arabic. Such language variation supports us with large and variable amount of scientific knowledge, deep understanding and ability of analysis. Some studies investigated average response to pharmaceutical marketing promotion and few studies took into consideration heterogeneity in their effects with respect to advertising medium or drug characteristics.Originality. We investigated empirical evidences of pharmaceutical marketing promotion that can be directed to either consumer or healthcare professionals.Findings. We extracted, gathered and associated information of pharmaceutical promotion globally which oriented us to several evidence and practical facts with regard to employing promotion tools in different definite situations pertinent to main directions; their welfare and health enhancing effects and adverse effects. Practical Implications- Consequently, we developed practically-oriented guidelines for companies concerning pharmaceutical promotion globally ate the end of this paper.

  19. Internal currents in PEMFC during start-up or shut-down

    Energy Technology Data Exchange (ETDEWEB)

    Maranzana, G.; Lottin, O.; Moyne, C.; Dillet, J.; Lamibrac, A.; Mainka, J.; Didierjean, S. [Nancy Univ. - CNRS (France). LEMTA

    2010-07-01

    Experiments show that the internal currents that occur during PEMFC start-up can reach up to 1 Acm{sup -2}. This is far more important than the expected order of magnitude of the current densities associated with carbon oxidation, which is only of a few mAcm{sup -2}. The predominant phenomenon that explains the internal currents is the charge and discharge of the double layer capacitances. A simple model with constant values of the electric parameters yields numerical results close to the experimental ones. It also explains the transient voltage rise (over the steady state open circuit voltage) that is sometimes observed experimentally shortly after the fuel cell start up. (orig.)

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

    Science.gov (United States)

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

    2017-01-01

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

  1. Protection of the African Lion: A Critical Analysis of the Current International Legal Regime

    Directory of Open Access Journals (Sweden)

    Samantha Watts

    2016-04-01

    Full Text Available This article looks at the current international regime that pertains to the African lion, a species that needs adequate protection across its range (a range that does not adhere to state boundaries. This analysis comes at a time when threats such as habitat and prey loss, retaliatory killing, trophy hunting and trade, are all impacting the remaining populations of African lions. The species is in danger of rapid population decline and possible extinction in the near future. Two decades ago there was an abundance of African lions, roughly 100 000, on the continent. But at present there are less than 32 000, while some believe there to be as little as 15 000 left. This decline is mainly due to the threats noted above. African lions are currently listed as "vulnerable" on the International Union for Conservation of Nature Red List of Threatened Species. This listing is being contested by commentators who believe that the species now requires an "endangered" status. African lion populations, and the threats to the species, extend across state boundaries. Therefore, international law is of particular importance in providing conservation and protection measures to the species. Creating conservation obligations at a global level allows for more uniform action, implementation and enforcement of legislation at regional and local levels. Therefore this article looks at each threat to African lion populations in detail and then assesses the international legal regime pertaining to each of these threats, and whether that regime is adequate. The Convention on Biological Diversity, Convention on the Conservation of Migratory Species, Convention on International Trade in Endangered Species of Wild Fauna and Flora and the Convention on Wetlands of International Importance are but some of the international instruments that are analysed. This article outlines the arguments that the international legal framework is not acceptable for the protection of the species

  2. The management of cytotoxic drug wastes in Shiraz, Iran: an overview of all government and private chemotherapy settings, and comparison with national and international guidelines.

    Science.gov (United States)

    Askarian, Mehrdad; Momeni, Mohsen; Danaei, Mina

    2013-06-01

    Excessive use of cytotoxic drugs owing to a dramatic increase in malignancy incidence leads to the production of high amounts of cytotoxic wastes. In Iran, management of hazardous wastes has been neglected in recent decades. The aim of this study was to determine the amount of intravenous cytotoxic drug wastes, their collection and disposal status in chemotherapy wards, and to compare the current status with standard guidelines in Shiraz, Iran. This cross-sectional study was performed using data collected during 2 consecutive months, from 22 June to 22 August 2011, in all 13 chemotherapy wards in Shiraz. The amount of prescribed drugs, drugs waste, collection and disposal status of cytotoxic drugs were recorded. We then compared the current status of waste collection and disposal in our samples with our national guideline. The prescription of cytotoxic drugs and the amount of total drugs waste reached approximately 6 and 0.2 kilograms respectively. Total vials volume was calculated to be approximately 1000 l in order to estimate the volume of containers required for the encapsulation method. The results demonstrated that the current status of cytotoxic waste collection and disposal is inappropriate, and none of the facilities under study followed our guidelines perfectly. The adherence to all recommendations and guidelines was poorer in private wards than in government-run ones. The management of cytotoxic wastes is inappropriate and our existing national guidelines are lacking. Suggestions for the best management of cytotoxic waste are revising the existing guidelines, allocating a sufficient budget, training healthcare workers, providing multiple administration options of cytotoxic drugs and accomplishing a surveillance system.

  3. Internal end-effect problem in a linear asynchronous MHD machine with arbitrary current load

    Energy Technology Data Exchange (ETDEWEB)

    Vilnitis, A.Ya.

    1977-01-01

    The internal end-effect problem in a bilateral linear asynchronous engine is solved by variation of constants for a surface current load of any type, including discrete conductors. Mathematically correct formulae for this case are given for computing the mechanical force on wound coils and the active power. Known methods of end-effect compensation are examined. The requirements for the surface load of inductors were found for the case where the requirements may be limited to an internal problem and scattering along the magnetic circuit ends.

  4. Internal oscillating current-sustained RF plasmas: Parameters, stability, and potential for surface engineering

    DEFF Research Database (Denmark)

    Ostrikov, K.; Tsakadze, E.L.; Tsakadze, Z.L.;

    2005-01-01

    plasma parameters by the optical and Langmuir probes are presented. It is shown that the spatial profiles of the electron density, the effective electron temperature and plasma potential feature a great deal of the radial and axial uniformity compared with conventional sources of inductively coupled......A new source of low-frequency (0.46 MHz) inductively coupled plasmas sustained by the internal planar "unidirectional" RF current driven through a specially designed internal antenna configuration has been developed. The experimental results of the investigation of the optical and global argon...... applications and surface engineering. (c) 2005 Elsevier B.V. All rights reserved....

  5. Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations

    Directory of Open Access Journals (Sweden)

    Noe Garin Escriva

    2014-11-01

    Full Text Available Introduction: Recreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines. Materials and Methods: Last 12-month prevalence drug use was obtained from the European Monitoring Centre for Drugs and Drug Addiction for the four most consumed drugs (cannabis, cocaine, amphetamines, ecstasys. Consumption rates were collected and analyzed by country and age. Principal HIV guidelines were assessed to identify the degree of incorporation of drug use issues at three levels: transmission risk, adherence to the HAART and management of interactions. Guidelines: (a WHO; (b EACS; (c BHIVA; (d US DHHS; (e IAS-USA; (f GESIDA; (g French CPG; (h Italian CPG. Results: Data on drugs of abuse consumption was obtained from 29 European countries, with results showing relevant drug utilization in Europe. Cannabis was the most frequent drug across all countries, with 10 countries over 5% of prevalence over the last year. Other drugs prevalence accounted for about 0.5–1%, reaching up to: 2.1% for cocaine in Spain, 1.4% for ecstasy in the Netherlands and 1.1% for amphetamines in Estonia. 15–24 and 25–34 years old subgroups had the highest prevalence, although notable use of cannabis and cocaine was also found in the 35–44 and 45–54 subgroups. From the eight guidelines assessed, six considered recreational drugs at any point. Recommendations for specific drugs were given in 50% of the guidelines. From those guidelines addressing drug consumption: three assessed risk habits which related to transmission risk, six appraised issues on adherence to HAART and five comprised data on

  6. Adherence to current guidelines for chronic obstructive pulmonary disease (COPD among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids

    Directory of Open Access Journals (Sweden)

    Asche CV

    2012-03-01

    Full Text Available Carl Victor Asche1,2, Shelah Leader3, Craig Plauschinat4, Swetha Raparla1, Ming Yan1, Xiangyang Ye1, Dave Young11Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, 2Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, Illinois, 3Formerly of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, 4Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USABackground: To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD with the combination of long-acting β2-agonist (LABA, long-acting muscarinic antagonist (LAMA or inhaled corticosteroids (ICS.Methods: The Geisinger Health System (GHS database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines.Results: A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the

  7. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening.

    Science.gov (United States)

    Smith, Robert A; Brooks, Durado; Cokkinides, Vilma; Saslow, Debbie; Brawley, Otis W

    2013-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, current ACS cancer screening guidelines are summarized, as are updated guidelines on cervical cancer screening and lung cancer screening with low-dose helical computed tomography. The latest data on the use of cancer screening from the National Health Interview Survey also are described, as are several issues related to screening coverage under the Patient Protection and Affordable Care Act of 2010.

  8. Yttrium-90 selective internal radiation therapy with glass microspheres for hepatocellular carcinoma: Current and updated literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Wolfgang; Alanic, Lourdes [Div. of Interventional Radiology, Dept. of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles (United States); Cho, Sung Ki [Div. of Interventional Radiology, Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Saab, Sammy [Div. of Hepatology, Dept. of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles (United States)

    2016-07-15

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

  9. Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Wolfgang; Alanis, Lourdes [Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095 (United States); Cho, Sung-Ki [Division of Interventional Radiology, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of); Saab, Sammy [Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA 90024 (United States)

    2016-11-01

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

  10. Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005 : Evaluation of the current guideline

    NARCIS (Netherlands)

    IJland, M.M.; Pereira, R.R.; Cornelissen, E.A.M.

    2008-01-01

    Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. The present Dutch guideline recommends 1 mg of vitamin K1 orally at birth, followed by a daily dose of 25 μg of vitamin K1 from 1 to 13 weeks of age for breastfed infants. Since the

  11. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.

    2015-01-01

    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  12. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.

    2015-01-01

    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  13. Identification of NSAID users at risk for gastrointestinal complications: a systematic review of current guidelines and consensus agreements.

    NARCIS (Netherlands)

    Tielemans, M.M.; Eikendal, T.; Jansen, J.B.M.J.; Oijen, M.G.H. van

    2010-01-01

    NSAIDs are among the most often used drugs worldwide. Numerous NSAID users are at risk for developing gastrointestinal complications. The purpose of this review was to identify and stratify risk factors for gastrointestinal complications in NSAID users documented in guidelines and consensus agreemen

  14. National and International Migration:Reflections on Literature and Some Current Research1

    Institute of Scientific and Technical Information of China (English)

    Nicholas Tapp(Wang Fuwen)

    2013-01-01

    This article gives a review on literature and some current research relevant to na-tional and international migration , and examines the connections between such research in a na-tional context , and the research on international migration .The approaches to migration in migra-tion studies are very complex , and the author suggested that we need to pay attention to all three approaches contrasted by Solinger:the one based on rational calculation , the one based on stress-ing the historico-structural conditions and the one based on social networking analysis .The au-thor also stresses the importance of a network approach taken from the sociology of John Urry in the studies of both national and international migration , and the need to see movement as prima-ry, and productive of place , as much recent anthropological literature has stressed .

  15. Implementation of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guideline Including Data From the Improved Reduction of Outcomes: Vytorin Efficacy International Trial

    Science.gov (United States)

    Ziaeian, Boback; Dinkler, John; Watson, Karol

    2015-01-01

    Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in developed countries. The management of blood cholesterol through use of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) in at-risk patients is a pillar of medical therapy for the primary and secondary prevention of cardiovascular disease. The recent 2013 American College of Cardiology/American Heart Association guideline on managing blood cholesterol provides an important framework for the effective implementation of risk-reduction strategies. The guideline identifies four cohorts of patients with proven benefits from statin therapy and streamlines the dosing and monitoring recommendations based on evidence from published, randomized controlled trials. Primary care physicians and cardiologists play key roles in identifying populations at elevated ASCVD risk. In providing a practical management overview of the current blood cholesterol guideline, we facilitate more informed discussions on treatment options between healthcare providers and their patients. PMID:26198559

  16. EAST equilibrium current profile reconstruction using polarimeter-interferometer internal measurement constraints

    Science.gov (United States)

    Qian, J. P.; Lao, L. L.; Liu, H. Q.; Ding, W. X.; Zeng, L.; Luo, Z. P.; Ren, Q. L.; Huang, Y.; Huang, J.; Brower, D. L.; Hanada, K.; Chen, D. L.; Sun, Y. W.; Shen, B.; Gong, X. Z.; Xiao, B. J.; Wan, B. N.

    2017-03-01

    The first equilibrium reconstruction of EAST current-density profile based on internal Faraday rotation measurements provided by the POlarimeter-INTerferometer (POINT) diagnostic is demonstrated using the EFIT equilibrium reconstruction code. EFIT incorporates 11 simultaneous line-integrated density and Faraday effect measurements from POINT to self-consistently reconstruct the equilibrium toroidal current density profile using a Faraday rotation reconstruction algorithm. It is shown that the POINT measurements can be applied to improve the accuracy of core plasma current density and q profile on EAST. Comparisons of magnetic surfaces and the q profile reconstructed using external magnetic data against those using magnetic and POINT data are presented. Equilibrium reconstructions using POINT data are found to be consistent with sawtooth phenomena. The sensitivity of equilibrium reconstruction to POINT measurements indicates Faraday rotation provides important constraints for determining the current profile.

  17. Current research and future directions in pattern identification: Results of an international symposium.

    Science.gov (United States)

    Lee, Myeong Soo; Lee, Ju Ah; Alraek, Terje; Bian, Zhao-Xiang; Birch, Stephen; Goto, Hirozo; Jung, Jeeyoun; Kao, Shung-Te; Moon, Sang-Kwan; Park, Bongki; Park, Kyung-Mo; You, Sooseong; Yun, Kyung-Jin; Zaslawski, Chris

    2016-12-01

    A symposium on pattern identification (PI) was held at the Korea Institute of Oriental Medicine (KIOM) on October 2, 2013, in Daejeon, South Korea. This symposium was convened to provide information on the current research in PI as well as suggest future research directions. The participants discussed the nature of PI, possible research questions, strategies and future international collaborations in pattern research. With eight presentations and an extensive panel discussion, the symposium allowed participants to discuss research methods in traditional medicine for PI. One speaker presented the topic, 'Clinical pattern differentiation and contemporary research in PI.' Two speakers presented current trends in research on blood stasis while the remaining five other delegates discussed the research methods and future directions of PI research. The participants engaged in in-depth discussions regarding the nature of PI, potential research questions, strategies and future international collaborations in pattern research.

  18. Internal bores and gravity currents in a two-fluid system

    CERN Document Server

    Maruyama, Kiyoshi

    2014-01-01

    In this paper, a unified theory of internal bores and gravity currents is presented within the framework of the one-dimensional two-layer shallow-water equations. The equations represent four basic physical laws: the theory is developed on the basis of these laws. Though the first three of the four basic laws are apparent, the forth basic law has been uncertain. This paper shows first that this forth basic law can be deduced from the law which is called in this paper the conservation law of circulation. It is then demonstrated that, within the framework of the equations, an internal bore is represented by a shock satisfying the shock conditions that follow from the four basic laws. A gravity current can also be treated within the framework of the equations if the front conditions, i.e. the boundary conditions to be imposed at the front of the current, are known. Basically, the front conditions for a gravity current also follow from the four basic laws. When the gravity current is advancing along a no-slip bou...

  19. Numerical analysis of internal solitary wave generation around a Island in Kuroshio Current using MITgcm.

    Science.gov (United States)

    Kodaira, Tsubasa; Waseda, Takuji

    2013-04-01

    We have conducted ADCP and CTD measurements from 31/8/2010 to 2/9/2010 at the Miyake Island, located approximately 180 km south of Tokyo. The Kuroshio Current approached the island in this period, and the PALSAR image showed parabolic bright line upstream of the island. This bright line may be a surface signature of large amplitude internal solitary wave. Although our measurements did not explicitly show evidence of the internal solitary wave, critical condition might have been satisfied because of the Kuroshio Current and strong seasonal thermocline. To discover the generation mechanism of the large amplitude internal solitary wave at the Miyake Island, we have conducted non-hydrostatic numerical simulation with the MITgcm. A simple box domain, with open boundaries at all sides, is used. The island is simplified to circular cylinder or Gaussian Bell whose radius is 3km at ocean surface level. The size of the domain is 40kmx40kmx500m for circular cylinder cases and 80kmx80kmx500m for Gaussian bell cases. By looking at our CTD data, we have chosen for initial and boundary conditions a tanh function for vertical temperature profile. Salinity was kept constant for simplicity. Vertical density profile is also described by tanh function because we adopt linear type of equation of state. Vertical velocity profile is constant or linearly changed with depth; the vertical mean speed corresponds to the linear phase speed of the first baroclinic mode obtained by solving the eigen-value problem. With these configurations, we have conducted two series of simulations: shear flow through cylinder and uniform flow going through Gaussian Bell topography. Internal solitary waves were generated in front of the cylinder for the first series of simulations with shear flow. The generated internal waves almost purely consisted of 1st baroclinic component. Their intensities were linearly related with upstream vertical shear strength. As the internal solitary wave became larger, its width

  20. Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the International Consensus Guidelines for the Management of IPMN.

    Science.gov (United States)

    Campbell, Naomi M; Katz, Seth S; Escalon, Joanna G; Do, Richard K

    2015-03-01

    Intraductal papillary mucinous neoplasms (IPMN) are being diagnosed with increasing frequency, necessitating an algorithm to help stratify patients into low- and high-risk groups, for follow-up versus more invasive evaluation. New evidence concerning their natural history and overall risk of malignancy has emerged since the 2006 International Association of Pancreatology consensus guidelines, prompting an update in 2012, that distinguishes radiologic 'worrisome features' from 'high-risk stigmata'. The aim of this article is to illustrate, with case examples, the variable imaging patterns of IPMN and how their radiologic features, such as cyst size and mural nodules, are interpreted in the context of the new 2012 guidelines. The 2012 and 2006 guidelines will be compared and discussed with reference to additional studies that have since been published. Despite these guidelines, lingering uncertainty remains about the natural history of IPMN, a source of unease to both radiologists and referring clinicians alike, mandating further refinement of clinical and radiologic parameters predictive of malignancy. Emerging data regarding the risk of extrapancreatic malignancy, as well as synchronous or metachronous pancreatic ductal adenocarcinoma remote in location from a branch duct IPMN are also reviewed. With the expanding research and evolving understanding of this clinicopathologic entity across the globe, radiologists will continue to play an important role in the management of patients with IPMN.

  1. Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations

    OpenAIRE

    Noe Garin Escriva; Cesar Velasco Muñoz; Jan Thomas De Pourcq; Belen Lopez Garcia; Josep Maria Haro Abad; Maria Antonia Mangues Bafalluy; Antoni Trilla Garcia

    2014-01-01

    Introduction: Recreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines. Materials and Methods: Last 12-month ...

  2. Current Statistics System Fails to Reflect New Changes in International Trade Activities

    Institute of Scientific and Technical Information of China (English)

    万光彩; 刘莉

    2007-01-01

    Today developed countries mainly participate in international trade via their foreign affiliates and intermediate goods are more frequently traded as a result of increasingly deepening international divisions of labour.Against this background,the current trade statistical system that is characterized by the statistical principle of cross-border trade and production,and the custom’s registration data collection method,greatly exaggerate the trade imbalance between China and America. Consequently,it is necessary for the Chinese nation to overcome the shortcomings of the current statistical system so as to evaluate more fairly the trade imbalance between China and America by referring to the Ownership-Based Framework of the complimentary statistical system under the US Current Account.This article, on the basis of the statistical principle of oumership,attempts to regulate the distorted trade imbalance resulting from the current trade statistical system,and aims for an increased understanding of the trade imbalance between China and America from a theoretical background,as well as from the points of view of practitioners and decision makers.

  3. Internal-short-mitigating current collector for lithium-ion battery

    Science.gov (United States)

    Wang, Meng; Le, Anh V.; Noelle, Daniel J.; Shi, Yang; Meng, Y. Shirley; Qiao, Yu

    2017-05-01

    Mechanical abuse often causes thermal runaway of lithium-ion battery (LIB). When a LIB cell is impacted, radial cracks can be formed in the current collector, separating the electrode into petals. As separator ruptures, the petals on positive and negative electrodes may contact each other, forming internal short circuit (ISC). In this study, we conducted an experimental investigation on LIB coin cells with current collectors modified by surface notches. Our testing results showed that as the current collector contained appropriate surface notches, the cracking mode of electrode in a damaged LIB cell could be adjusted. Particularly, if a complete circumferential crack was generated, the petals would be cut off, which drastically reduced the area of electrode involved in ISC and the associated heat generation rate. A parameterized study was performed to analysis various surface-notch configurations. We identified an efficient surface-notch design that consistently led to trivial temperature increase of ISC.

  4. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    DEFF Research Database (Denmark)

    Illidge, Tim; Specht, Lena; Yahalom, Joachim

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning...... tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles...... of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT...

  5. 国际临床指南评价工具的发展与启示%Development of international appraisal tools for clinical guidelines

    Institute of Scientific and Technical Information of China (English)

    张悦; 张士靖; 周志超; 吴梦佳

    2015-01-01

    The background,features,dimension and contents of 22 international appraisal tools for clinical guidelines were analyzed,and their history,evolution,rules and problems were described,in order to provide the evidence for developing appraisal tools for domestic clinical guidelines. In the study,it was found that the guideline evaluation tools have been classified and there is a constant strive to achieve the balance between comprehensiveness and practicability. But the existing evaluation tools are insufficient for clinical practical contents of guidelines. The scoring system should be improved. In addition,conflicts of interest,value choice and patients' involvement should be considered increasingly, and should become an important part of the guideline evaluation tools.%以22个指南评价工具为研究对象,分析了国际临床指南评价工具的出台背景和特点、维度和条目内容,介绍了国外临床指南评价工具的发展历程,演变过程、发展规律和存在的问题,为开发本土化的临床指南评价工具提供依据。研究发现指南评价工具出现明显分类;指南评价工具正力求在全面性和实用性之间达到平衡;现有评价工具对指南的临床内容评价不足,评分系统有待改进;指南评价应越来越多地考虑价值取向与利益冲突,考虑病人的意向与参与。

  6. Current Status of International Airborne Platform Data and Instrument Interface Standards

    Science.gov (United States)

    Freer, Matt; Webster, Chris; Freundinger, Larry

    2016-06-01

    Commission I of the International Society for Photogrammetric and Remote Sensing formed working group I/1 for the purpose of standardizing airborne platform interfaces. The primary mission of this working group is to promote the standardization of instrument interfaces, data formats, and supporting infrastructures; and to facilitate more efficient, flexible, and cost-effective international science flight operations. Within WGI/1 are a number of focused subgroups. This paper addresses the efforts of some of these subgroups having interdependent and overlapping interests; including the development of standard software interfaces for sensors, standardized approaches to management of information over potentially intermittent wireless data links, the development of standardized processing algorithms, and data archival format standards. The data in this report reflect the outcome of work-to-date in the current subgroups.

  7. An upper ocean current jet and internal waves in a Gulf Stream warm core ring

    Science.gov (United States)

    Joyce, T. M.; Stalcup, M. C.

    1984-01-01

    On June 22, 1982, the R/V Endeavor, while participating in a multi-ship study of a warm core ring 82B, encountered a strong front in the core of the ring. The vessel was headed on a radial section outward from ring center while a CTD was repeatedly raised and lowered between 10 and 300 m. Current profiles in the upper 100 m were obtained continuously with a Doppler acoustic profiling system. Above the shallow 45 m seasonal thermocline, a current jet of 4 km width was encountered having a central core of relatively light water and a maximum current of 1.1 m/s. This jet was both highly nonlinear and totally unexpected. A high frequency packet of directional internal waves was acoustically observed in the seasonal thermocline at the outer edge of the jet. Vertical velocities were large enough (6 cm/s) as to be directly observable in the Doppler returns. The waves were propagating from the northeast, parallel to the ship track, and orthogonal to the jet toward the center of the warm core ring. While a nonlinear, centrifugal term was required for the force balance of the jet, the high-frequency internal wave packet could be explained with linear, gravest-mode wave dynamics.

  8. The DOE Office of Environmental Management International Cooperative Program: Current Status and Plans for Expansion

    Energy Technology Data Exchange (ETDEWEB)

    Gerdes, Kurt D.; Han, Ana M.; Marra, James C.; Fox, Kevin M.; Peeler, David K.; Smith, Michael E.; Jannik, Gerald T.; Farfan, Eduardo B.; Kim, Dong-Sang; Vienna, John D.; Roach, Jay; Aloy, A. S.; Stefanovsky, S. V.; Bondarkov, M. D.; Lopukh, D. P.; Kim, Chenwoo

    2009-01-15

    The DOE-EM Office of Engineering and Technology is responsible for implementing EM’s international cooperative program. The Office of Engineering and Technology’s international efforts are aimed at supporting EM’s mission of risk reduction and accelerated cleanup of the environmental legacy of the nation's nuclear weapons program and government-sponsored nuclear energy research. To do this, EM pursues collaborations with government organizations, educational institutions, and private industry to identify and develop technologies that can address the site cleanup needs of DOE. Currently, DOE-EM is performing collaborative work with researchers at the Khlopin Radium Institute (KRI) and the SIA Radon Institute in Russia and the Ukraine’s International Radioecology Laboratory (IRL). Additionally, a task was recently completed with the Nuclear Engineering Technology Institute (NETEC) in South Korea. The objectives of these collaborations were to explore issues relating to high-level waste and to investigate technologies that could be leveraged to support EM site cleanup needs. In FY09, continued collaboration with the current partners is planned. Additionally, new research projects are being planned to expand the International Program. A collaborative project with Russian Electrotechnical University is underway to evaluate CCIM control and monitoring technologies. A Statement of Intent was recently signed between DOE-EM and the U.K. Nuclear Decommissioning Authority (NDA) to work cooperatively on areas of mutual interest. Under this umbrella, discussions were held with NDA representatives to identify potential areas for collaboration. Information and technical exchanges were identified as near-term actions to help meet the objectives of the Statement of Intent. Technical exchanges in identified areas are being pursued in FY09

  9. What's a Pregnant Woman to Eat? A Review of Current USDA Dietary Guidelines and MyPyramid

    OpenAIRE

    2006-01-01

    The purpose of this article is to clarify the nutritional recommendations for pregnant women in light of the new Food Guide Pyramid, known as “MyPyramid,” along with the Dietary Guidelines for Americans 2005 and recommendations by the Institute of Medicine. The differences between the Food Guide Pyramid (introduced in 1992) and the more recent, color-coded MyPyramid (introduced in 2005) are discussed. A list of nutritional recommendations for pregnant women is presented, which may serve as a ...

  10. Lack of current implantable cardioverter defibrillator guidelines application for primary prevention of sudden cardiac death in Latin American patients with heart failure: a cross-sectional study.

    Science.gov (United States)

    Gonzalez-Zuelgaray, Jorge; Pellizon, Oscar; Muratore, Claudio A; Oropeza, Elsa Silva; Rabinovich, Rafael; Ramos, José Luis; Tentori, Maria Cristina; Reyes, Nicolás; Aguayo, Rubén; Marin, Jorge; Peterson, Brett J

    2013-02-01

    This cross-sectional study evaluated the application of accepted international implantable cardioverter defibrillator (ICD) guidelines for primary prevention of sudden cardiac death in patients with heart failure. The PLASMA (Probabilidad de Sufrir Muerte Arritmica) study was designed to characterize management of cardiac patients in Latin America. Twelve centres included 1958 consecutively admitted patients in cardiology units in 2008 and 2009. Discharged patients were evaluated for primary prevention, ICD indication and prescription by general cardiologists. Of 1711 discharged patients, 1525 (89%) had data available for evaluating indication status. Class I indications for ICD therapy were met for 153 (10%) patients based on collected data. Only 20 (13%, 95% confidence interval: 7.7-18.4%) patients with indication were prescribed an ICD. Patients prescribed an ICD were younger than patients who were not prescribed an ICD (62 vs. 68 years, P < 0.01). The reasons given by cardiologists for not prescribing an ICD for 133 patients with an indication were: indication criteria not met (75%), life expectancy <1 year (9.7%), rejection by the patient (5.2%), no medical coverage paying for the device (3.7%), psychiatric patient (2.2%), and other reasons (4.2%). In Latin America, international guidelines for primary prevention ICD implantation are not well followed. The main reason is that cardiologists believe that patients do not meet indication criteria, even though study data confirm that criteria are met. This poses a significant challenge and underlines the importance of continuous and improved medical education.

  11. Current status of the international DECOVALEX project: thermal-hydraulic-mechanical couplings

    Energy Technology Data Exchange (ETDEWEB)

    Kang, C. H.; Hwang, Y. S.; Kim, J

    1998-01-01

    THM coupling is an important issue to assess the safety of the HLW repositories. In this art report the current status of the international DECOVALEX project was reviewed to understand the most updated R and D direction on the groundwater flow assessment coupled with the decay heat and mechanical stress around a repository. Important progresses of DECOVALEX I, II, III and 2 were studied. Results show that even though there are good agreements on the predictions of stress and temperature, still the prediction of flow in discrete fracture network is incomplete. (author). 21 refs., 28 tabs., 33 figs

  12. International round robin test of the retained critical current after double bending at room temperature of Ag-sheathed Bi-2223 superconducting wires

    Science.gov (United States)

    Yamada, Y.; Nishijima, G.; Osamura, K.; Shin, H. S.; Goldacker, W.; Breschi, M.; Ribani, P.

    2016-02-01

    An international round robin test was carried out in order to establish a test method for retained critical current after double bending at room temperature of Ag-sheathed Bi-2223 superconducting wires. Tests for commercial Bi-2223 tape were conducted by six laboratories using the same guidelines. The standard uncertainties (SUs) of measurands were evaluated for these four quantities: I C0, I C/I C080, I C/I C060, I C/I C050, where, I C0 is initial critical current and I C /I C0XX is critical current after XX mm bending. Using an F test to determine where the most scatter was generated in the test results it was found that the greatest scatter in the normalized critical current measurements came from inter-laboratory scatter. In a type-B uncertainty evaluation, the major contribution was from the bending diameter and measuring temperature. The relative SU tended to increase as the bending diameter decreased. A specific mandrel diameter corresponding to a retained critical current of 95% could be determined with a relative SU of 1.3%. In order to reduce the overall scatter, the temperature difference between the critical current measurements before and after bending should be small.

  13. International guidelines and standards for education and training to reduce the consequences of events that may threaten the health status of a community. A report of an Open International WADEM Meeting, Brussels, Belgium, 29-31 October, 2004.

    Science.gov (United States)

    Archer, Frank; Seynaeve, Geert

    2007-01-01

    The continued professionalization of the humanitarian workforce requires sound underpinning by appropriate educational programs. The international disaster medicine and emergency health community requested the World Association for Disaster and Emergency Medicine (WADEM) develop international standards and guidelines for the education and training for disaster medicine. The Working Group of the WADEM Education Committee prepared and circulated an Issues Paper to structure input on this significant international task. Subsequently, the Working Group facilitated an Open International Meeting convened in Brussels, Belgium, 2004. The "Issues Paper" also was used as a framework to structure this International Meeting, which utilized case studies selected to represent the scope of disaster medicine, and prepared a meeting consensus on a framework for disaster health and for related educational programs. The two-day Brussels meeting attracted 51 participants from 19 countries, representing 21 disciplines. Participants reinforced the need to address the development of international standards and guidelines on education and training in this emerging discipline. Participants supported the view that the term "Disaster Health" suggested a multidisciplinary approach that is a more inclusive contemporary and appropriate term to describe this field, although there were dissenting views. The meeting formulated a consensus view in support of a framework for "Disaster Health", which included: (1) primary disciplines; (2) support disciplines; (3) community response, resilience, and communication; and (4) socio-political context. The participants considered that this model lends itself to facilitating the development of educational programs in this field and believed that standards and guidelines initially should be developed in the "Core of Disaster Health" for undergraduates in relevant professions, for practicing professionals wishing to expand their practice in this field, and in

  14. Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information?

    Science.gov (United States)

    Hatley, Ross HM; Byrne, Sarah M

    2017-01-01

    Background To improve convenience to patients, there have been advances in the operation of nebulizers, resulting in fast treatment times and less drug lost to the environment. However, limited attention has been paid to the effects of these developments on the delivered dose (DD) and respirable delivered dose (RDD). Published pharmacopoeia and ISO testing guidelines for adult-use testing utilize a single breathing pattern, which may not be sufficient to enable effective comparisons between the devices. Materials and methods The DD of 5 mg of salbutamol sulfate into adult breathing patterns with inhalation:exhalation (I:E) ratios between 1:1 and 1:4 was determined. Droplet size was determined by laser diffraction and RDD calculated. Nine different nebulizer brands with different modes of operation (conventional, venturi, breath-enhanced, mesh, and breath-activated) were tested. Results Between the non-breath-activated nebulizers, a 2.5-fold difference in DD (~750–1,900 µg salbutamol) was found; with RDD, there was a more than fourfold difference (~210–980 µg). With increasing time spent on exhalation, there were progressive reductions in DD and RDD, with the RDD at an I:E ratio of 1:4 being as little as 40% of the dose with the 1:1 I:E ratio. The DD and RDD from the breath-activated mesh nebulizer were independent of the I:E ratio, and for the breath-activated jet nebulizer, there was less than 20% change in RDD between the I:E ratios of 1:1 and 1:4. Conclusion Comparing nebulizers using the I:E ratio recommended in the guidelines does not predict relative performance between the devices at other ratios. There was significant variance in DD or RDD between different brands of non-breath-activated nebulizer. In future, consideration should be given to revision of the test protocols included in the guidelines, to reflect more accurately the potential therapeutic dose that is delivered to a realistic spectrum of breathing patterns. PMID:28203110

  15. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

    DEFF Research Database (Denmark)

    Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard

    2014-01-01

    BACKGROUND: Timely treatment of acute malnutrition in children 500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm...... Circumference (MUAC) of malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ). METHODS: Secondary data from >11,000 Cambodian children, obtained by different surveys between...... 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ. FINDINGS: The secondary analysis showed that using the current WHO cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score (WHZ)

  16. Review of current international decision-making processes for newborn screening: lessons for Australia

    Directory of Open Access Journals (Sweden)

    Selina Carolyne Metternick-Jones

    2015-09-01

    Full Text Available Newborn bloodspot screening has been operating successfully in Australia for almost 50 years. Recently, the development of new technologies and treatments has led to calls for the addition of new conditions to the screening programs. Internationally it is recognized by governments that national policies for newborn screening should support transparent and evidence-based decision-making, and promote consistency between states within a country. Australia is lagging behind the international community, and currently has no national policies or decision-making processes, agreed by government, to support its newborn screening programs. In contrast, New Zealand (NZ, the United Kingdom (UK and the United States of America (US have robust and transparent processes to assess conditions for screening, which have been developed by, and have pathways to, government. This review provides detail on the current policy environment for newborn screening in Australia, highlighting that there are a number of risks to the programs resulting from the lack of a decision-making process. It also describes the processes used to assess conditions for newborn screening in the US, UK and NZ. These examples highlight the benefits of developing a national decision-making process, including ensuring that screening is evidence based and effective. These examples also provide models that might

  17. Modeling the Spin Motor Current of the International Space Station's Control Moment Gyroscopes

    Science.gov (United States)

    Pereira, Miguel A.

    2008-01-01

    The International Space Station (ISS) attitude control is provided by two means: The Russian Segment uses thrusters and the U.S. Segment uses double-gimbaled control moment gyroscopes (CMG). CMGs are used as momentum exchange devices, providing non propulsive attitude control for the vehicle. The CMGs are very important for the ISS program because, first, they save propellant - which needs to be transferred to the Station in special cargo vehicles - and, second, they provide the microgravity environment on the Station - which is necessary for scientific experiments planned for the ISS mission. Since 2002, when one of the CMG on the ISS failed, all CMGs are closely monitored. High gimbal rates, vibration spikes, unusual variations of spin motor current and bearing temperatures are of great concern, since these parameters are the CMG health indicators. The telemetry analysis of these and some other CMG parameters is used to determine constrains and make changes to the CMGs operation on board. These CMG limitations, in turn, may limit the ISS attitude control capabilities and may be critical to ISS operation. Therefore, it is important to know whether the CMG parameter is nominal or out of family, and why. The goal of this project is to analyze an important CMG parameter - spin motor current. Some operational decisions are made now based on the spin motor current signatures. The spin motor current depends on gimbal rates, ISS rates, and spin bearing friction. The spin bearing friction in turn depends on the bearing temperatures, wheel rates, normal load - which is a function of gimbal and wheel rates - lubrication, etc. The first task of this project is to create a spin motor current mathematical model based on CMG dynamics model and the current knowledge on bearing friction in microgravity.

  18. Modeling the Spin Motor Current of the International Space Station's Control Moment Gyroscopes

    Science.gov (United States)

    Pereira, Miguel A.

    2008-01-01

    The International Space Station (ISS) attitude control is provided by two means: The Russian Segment uses thrusters and the U.S. Segment uses double-gimbaled control moment gyroscopes (CMG). CMGs are used as momentum exchange devices, providing non propulsive attitude control for the vehicle. The CMGs are very important for the ISS program because, first, they save propellant - which needs to be transferred to the Station in special cargo vehicles - and, second, they provide the microgravity environment on the Station - which is necessary for scientific experiments planned for the ISS mission. Since 2002, when one of the CMG on the ISS failed, all CMGs are closely monitored. High gimbal rates, vibration spikes, unusual variations of spin motor current and bearing temperatures are of great concern, since these parameters are the CMG health indicators. The telemetry analysis of these and some other CMG parameters is used to determine constrains and make changes to the CMGs operation on board. These CMG limitations, in turn, may limit the ISS attitude control capabilities and may be critical to ISS operation. Therefore, it is important to know whether the CMG parameter is nominal or out of family, and why. The goal of this project is to analyze an important CMG parameter - spin motor current. Some operational decisions are made now based on the spin motor current signatures. The spin motor current depends on gimbal rates, ISS rates, and spin bearing friction. The spin bearing friction in turn depends on the bearing temperatures, wheel rates, normal load - which is a function of gimbal and wheel rates - lubrication, etc. The first task of this project is to create a spin motor current mathematical model based on CMG dynamics model and the current knowledge on bearing friction in microgravity.

  19. Current debates on end-of-life sedation: an international expert elicitation study.

    Science.gov (United States)

    Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

    2014-08-01

    End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

  20. AUTHOR GUIDELINES

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2014-12-01

    Full Text Available AUTHOR GUIDELINESIndian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/loginOnline SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.SectionsEditorial:On issues of current public health needAbout 1000 – 1200 wordsReferences: 5 – 10 (PubMed - Citation preferredInvited Commentary:Brief, provocative, opinionated communicationsOn issues of current public health needMain Text: 750-1000 words excluding referencesReferences: 5 – 10 (PubMed - Citation preferredOriginal Article:Articles from Original ResearchStructured abstract: 250 wordsMain Text: 2500 - 3000 words, IMRD formatKey Words: 5 - 8References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4*Certificate of clearance from respective Institutional Ethical Committee (IECReview Article:On subject of public health relevanceAbstract: 250 wordsMain Text: 2500 - 3000 wordsKey Words: 3 - 4References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4Short Communication / Article:Short report of a research project / outbreakMain Text : 1000 – 1200 wordsReferences: 10 – 15 (PubMed - Citation preferredTable / Figure: 01*Certificate of clearance from respective Institutional Ethical Committee (IECReport from the field

  1. Three Decades of International Guidelines for Environment-Related Education: A Critical Hermeneutic of the United Nations Discourse

    Science.gov (United States)

    Sauve, Lucie; Berryman, Tom; Brunelle, Renee

    2007-01-01

    The UNESCO-UNEP International Environmental Education Program (1975-1995) provided impetus for developing, legitimizing, and institutionalizing environmental education. More recently, UNESCO was mandated by the United Nations to carry out a worldwide shift towards education for sustainable development. As international organizations'…

  2. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting.

    Science.gov (United States)

    Gravholt, Claus H; Andersen, Niels H; Conway, Gerard S; Dekkers, Olaf M; Geffner, Mitchell E; Klein, Karen O; Lin, Angela E; Mauras, Nelly; Quigley, Charmian A; Rubin, Karen; Sandberg, David E; Sas, Theo C J; Silberbach, Michael; Söderström-Anttila, Viveca; Stochholm, Kirstine; van Alfen-van derVelden, Janielle A; Woelfle, Joachim; Backeljauw, Philippe F

    2017-09-01

    Turner syndrome affects 25-50 per 100,000 females and can involve multiple organs through all stages of life, necessitating multidisciplinary approach to care. Previous guidelines have highlighted this, but numerous important advances have been noted recently. These advances cover all specialty fields involved in the care of girls and women with TS. This paper is based on an international effort that started with exploratory meetings in 2014 in both Europe and the USA, and culminated with a Consensus Meeting held in Cincinnati, Ohio, USA in July 2016. Prior to this meeting, five groups each addressed important areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review of the literature. These four questions related to the efficacy and most optimal treatment of short stature, infertility, hypertension, and hormonal replacement therapy. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with The European Society for Pediatric Endocrinology, The Endocrine Society, European Society of Human Reproduction and Embryology, The American Heart Association, The Society for Endocrinology, and the European Society of Cardiology. The guideline has been formally endorsed by the European Society for Endocrinology, the Pediatric Endocrine Society, the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology and the Endocrine Society. Advocacy groups appointed representatives who participated in pre-meeting discussions and in the

  3. Accelerating improvements in nutritional and health status of young children in the Sahel region of Sub-Saharan Africa: review of international guidelines on infant and young child feeding and nutrition.

    Science.gov (United States)

    Wuehler, Sara E; Hess, Sonja Y; Brown, Kenneth H

    2011-04-01

    The United Nations Convention on the Rights of the Child holds governments responsible to ensure children's right to the highest attainable standard of health by providing breastfeeding support, and access to nutritious foods, appropriate health care, and clean drinking water. International experts have identified key child care practices and programmatic activities that are proven to be effective at reducing infant and young child undernutrition, morbidity, and mortality. Nevertheless, progress towards reducing the prevalence of undernutrition has been sporadic across countries of the Sahel sub-region of Sub-Saharan Africa. In view of this uneven progress, a working group of international agencies was convened to 'Reposition children's right to adequate nutrition in the Sahel.' The first step towards this goal was to organize a situational analysis of the legislative, research, and programmatic activities related to infant and young child nutrition (IYCN) in six countries of the sub-region: Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal. The purposes of this introductory paper are to review current information concerning the nutritional and health status of infants and young children in the Sahel and to summarize international guidelines on optimal IYCN practices. These guidelines were used in completing the above-mentioned situational analyses and encompass specific recommendations on: (i) breastfeeding (introduction within the first hour after birth, exclusivity to 6 months, continuation to at least 24 months); (ii) complementary feeding (introduction at 6 months, use of nutrient dense foods, adequate frequency and consistency, and responsive feeding); (iii) prevention and/or treatment of micronutrient deficiencies (vitamin A, zinc, iron and anaemia, and iodine); (iv) prevention and/or treatment of acute malnutrition; (v) feeding practices adapted to the maternal situation to reduce mother-to-child transmission of HIV; (vi) activities to ensure food

  4. The Role of Current Sheets in Solar Eruptive Events: An ISSI International Team Project

    Science.gov (United States)

    Suess, Steven T.; Poletto, Giannina

    2006-01-01

    Current sheets (CSs) are a prerequisite for magnetic reconnection. An International Space Science Institute (ISSI, of Bern, Switzerland) research team will work to empirically define current sheet properties in the solar atmosphere and their signatures in the interplanetary medium, and to understand their role in the development of solar eruptive events. The project was inspired by recently acquired ground and space based observations that reveal CS signatures at the time of flares and Coronal Mass Ejections (CMEs), in the chromosphere, in the corona and in the interplanetary medium. At the same time, theoretical studies predict the formation of CSs in different models and configurations, but theories and observational results have not yet developed an interaction efficient enough to allow us to construct a unified scenario. The team will generate synergy between observers, data analysts, and theoreticians, so as to enable a significant advance in understanding of current sheet behavior and properties. A further motivation for studying CSs is related to the expected electric fields in CSs that may be the source of solar energetic particles (SEPs). The team has 14 members from Europe and the US. The first meeting is in October 2006 and the second is late in 2007.

  5. International Standardization Activities for Optical Amplifiers

    Institute of Scientific and Technical Information of China (English)

    Haruo Okamura

    2003-01-01

    International standardization activities for Optical Amplifiers at IECTC86 and ITU-T SG15 are reviewed. Current discussions include Optical Amplifier safety guideline, Reliability standard, Rest methods of Noise and PMD, Definitions of Raman amplifier parameters and OA classification.

  6. International human rights law aspects of forced migrations, evictions and displacement: current issues and challenges

    OpenAIRE

    Scholten, Andrew

    2016-01-01

    The aim of this paper is an analysis of the categories of evictions, forced migrations and internal displacement in the context of international human rights law. Forced migrations and selected categories of internal displacement are important issues of international human rights law and international humanitarian law for more than forty years. The UDHR, adopted in 1948, does not contain any provisions related to forced human mobility and internal displacement. Despite this fact ...

  7. Would Current International Space Station (ISS) Recycling Life Support Systems Save Mass on a Mars Transit?

    Science.gov (United States)

    Jones, Harry W.

    2017-01-01

    The oxygen and water are recycled on the International Space Station (ISS) to save the cost of launching their mass into orbit. Usually recycling systems are justified by showing that their launch mass would be much lower than the mass of the oxygen or water they produce. Short missions such as Apollo or space shuttle directly provide stored oxygen and water, since the needed total mass of oxygen and water is much less than that of there cycling equipment. Ten year or longer missions such as the ISS or a future moon base easily save mass by recycling while short missions of days or weeks do not. Mars transit and long Mars surface missions have an intermediate duration, typically one to one and a half years. Some of the current ISS recycling systems would save mass if used on a Mars transit but others would not.

  8. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

    DEFF Research Database (Denmark)

    Froehlich, F; Harris, JK; Wietlisbach, V;

    2006-01-01

    in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were......BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice...... included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood...

  9. A Study of the Effects of the Current International Settlement of Internet

    Institute of Scientific and Technical Information of China (English)

    JIA Dan-hua; LIU Ying; WANG Liang-yuan

    2003-01-01

    From an economic angle, this paper analyzes and demonstrates the irrationality of the current Internet settlement of Interconnection ; then points out that the heavy charges for Internet interconnection from developing countries to the developed country can be thought of as one of the main and key reasons that restrict the balanced development of the Internet in the world, which causes the intensification of "digital divide", widens the gap between poor and rich countries and further aggravates the disequilibrium of the global economic development; and thus the conclusion is reached: the public policy selection should be made by the whole international society jointly for paying close attention and regulating settlement systems of Internet interconnection to dwindle "digital divide" throughout the world.

  10. Current trends in medical English education and the Japan College of Rheumatology International School.

    Science.gov (United States)

    Jego, Eric Hajime; Amengual, Olga

    2017-04-11

    In light of the present revolution happening in medical education in Japan as medical schools implement new curricula to conform to global standards, there is a growing demand for more internationalization and higher quality practical medical English education. In response, many institutions including governmental organizations, universities and academic associations are moving ahead with new initiatives to adapt to these changing demands. This paper reviews the current trends and innovations in medical English education in Japan. This paper also describes one initiative by the Japan College of Rheumatology (JCR) known as the JCR International School held yearly in Karuizawa. By examining recent trends and innovations in medical English education in Japan, the most relevant and applicable can be elucidated to illuminate a path forward for improved medical English education within the JCR.

  11. International Guidelines for Bioequivalence of Systemically Available Orally Administered Generic Drug Products: A Survey of Similarities and Differences

    OpenAIRE

    Davit, Barbara; Braddy, April C.; Conner, Dale P.; Yu, Lawrence X.

    2013-01-01

    The objective of this article is to discuss the similarities and differences among bioequivalence approaches used by international regulatory authorities when reviewing applications for marketing new generic drug products which are systemically active and intended for oral administration. We focused on the 13 jurisdictions and organizations participating in the International Generic Drug Regulators Pilot. These are Australia, Brazil, Canada, China, Chinese Taipei, the European Medicines Assoc...

  12. Incorporation of current ICRP recommendations in the GENMOD internal dosimetry code

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, R.B.; Dunford, D.W

    1998-07-01

    Genmod was initially developed by Johnson and Dunford to perform internal dose assessments and evaluate bioassay data using the methods described by the ICRP in Publications 26 and 30. The mainframe code, Genmod-MF was modified to implement the ICRP's new lung model, new weighting factors and new values for specific effective energy (SEE) available from M. Cristy and K.F. Eckerman, Oak Ridge Laboratories. Organ equivalent doses and effective dose for selected radionuclides employing the ICRP 30 general organ model have been verified, for ingestion and inhalation cases, against current ICRP publications, the internal dosimetry code LUDEP and mainframe codes. The PC version of Genmod has been rewritten to operate under the MS-Windows 95 system. A demonstration package has been developed that calculates doses and provides graphics for radionuclides where the ICRP's general organ model is appropriate. Data will be presented showing the differences and similarities in dose conversion factors using the ICRP 26/30 methodology and recommendations in ICRP Publication 60 onwards. (author)

  13. Incorporation of current ICRP recommendations in the Genmod internal dosimetry code

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, R.B.; Dunford, D.W

    1998-07-01

    Genmod was initially developed by Johnson and Dunford to perform internal dose assessments and evaluate bioassay data using the methods described by the ICRP in Publications 26 and 30. The mainframe code, Genmod-MF was modified to implement the ICRP's new lung model, new weighting factors and new values for specific effective energy (SEE) available from M. Cristy and K. F. Eckerman, Oak Ridge Laboratories. Organ equivalent doses and effective dose for selected radionuclides employing the ICRP 30 general organ model have been verified, for ingestion and inhalation cases, against current ICRP publications, the internal dosimetry code LUDEP and mainframe codes. The PC version of Genmod has been rewritten to operate under the MS-Windows95 system. A demonstration package has been developed that calculates doses and provides graphics for radionuclides where the ICRP's general organ model is appropriate. Data will be presented showing the differences and similarities in dose conversion factors using the ICRP 26/30 methodology and recommendations in ICRP Publication 60 onwards. (author)

  14. Development of site-specific sediment quality guidelines for North and South Atlantic littoral zones: comparison against national and international sediment quality benchmarks.

    Science.gov (United States)

    Choueri, R B; Cesar, A; Abessa, D M S; Torres, R J; Morais, R D; Riba, I; Pereira, C D S; Nascimento, M R L; Mozeto, A A; DelValls, T A

    2009-10-15

    We aimed to develop site-specific sediment quality guidelines (SQGs) for two estuarine and port zones in Southeastern Brazil (Santos Estuarine System and Paranaguá Estuarine System) and three in Southern Spain (Ría of Huelva, Bay of Cádiz, and Bay of Algeciras), and compare these values against national and traditionally used international benchmark values. Site-specific SQGs were derived based on sediment physical-chemical, toxicological, and benthic community data integrated through multivariate analysis. This technique allowed the identification of chemicals of concern and the establishment of effects range correlatively to individual concentrations of contaminants for each site of study. The results revealed that sediments from Santos channel, as well as inner portions of the SES, are considered highly polluted (exceeding SQGs-high) by metals, PAHs and PCBs. High pollution by PAHs and some metals was found in São Vicente channel. In PES, sediments from inner portions (proximities of the Ponta do Félix port's terminal and the Port of Paranaguá) are highly polluted by metals and PAHs, including one zone inside the limits of an environmental protection area. In Gulf of Cádiz, SQGs exceedences were found in Ria of Huelva (all analysed metals and PAHs), in the surroundings of the Port of Cádiz (Bay of Cádiz) (metals), and in Bay of Algeciras (Ni and PAHs). The site-specific SQGs derived in this study are more restricted than national SQGs applied in Brazil and Spain, as well as international guidelines. This finding confirms the importance of the development of site-specific SQGs to support the characterisation of sediments and dredged material. The use of the same methodology to derive SQGs in Brazilian and Spanish port zones confirmed the applicability of this technique with an international scope and provided a harmonised methodology for site-specific SQGs derivation.

  15. The impact of national and international guidelines on newborn care in the nurseries of Piedmont and Aosta Valley, Italy

    Directory of Open Access Journals (Sweden)

    Fabris Claudio

    2005-12-01

    Full Text Available Abstract Background Care procedures for preventing neonatal diseases are carried out according to nurseries' traditions and may be not consistent with the evidence based medicine issues. Methods A multi-centric survey was conducted in 2 Regions located in NW Italy (Piedmont and Aosta Valley in order to collect information on some healthy newborn care procedures. During 2001, a questionnaire was sent to the chief pediatrician in charge to the all 33 nurseries of the region asking the methods used during 2000 as prevention of ophthalmia neonatorum, early and late hemorrhagic disease of newborn, umbilical cord care and recommendations of vitamin D administration. Thereafter, during 2004 the same questionnaire was sent to the 34 chief pediatrician of nurseries to evaluate if the procedures were changed during 2003 according to guidelines. The nurseries care for 32,516 newborns in 2000 and 37,414 in 2003. Results Aminoglycoside eyes drops as prevention of ophthalmia neonatorum were the first choice in both periods (23 out 33 nurseries in 2000 and 24 out 34 in 2003 p > 0.05; the corresponding figures for newborns were18,984 out 32,516 newborns vs. 28,180 out of 37,414 p 0.05, (6,380 newborns, p 0.05. The numbers of parents of newborns who receive the recommendations of oral vitamin K during the first months life decreased from 2000 (25,516/30,606 to 2003 (29,808/37,414, p 0.05, the corresponding figures for Vitamin D were 15 and 14 (p > 0.05. Conclusion In the present study a large variability of procedures among the nurseries was observed. During the study periods, guidelines and evidence based medicine issues have only partially modified the neonatal care procedures In Piedmont and Aosta Valley nurseries. These observations suggest to implement local forum/consensus conference to standardized procedures as much as possible.

  16. Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Fahey, Frederic; Markelewicz, Robert; Grant, Frederick; Drubach, Laura; Treves, S. Ted [Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Boston Children' s Hospital, Boston, MA (United States); Harvard Medical School, Joint Program in Nuclear Medicine, Boston (United States); Zukotynski, Katherine [University of Toronto, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto (Canada); Harvard Medical School, Joint Program in Nuclear Medicine, Boston (United States); Zurakowski, David [Boston Children' s Hospital, Departments of Anesthesia and Surgery, Boston (United States); Falone, Anthony; Vitello, Marie; Cao, Xinhua [Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Boston Children' s Hospital, Boston, MA (United States); Vija, A.H.; Bhattacharya, Manojeet; Ding, Xinhong [Siemens Medical Solutions USA, Inc., Molecular Imaging, Malvern, PA (United States); Bar-Sever, Zvi [Schneider Children' s Medical Center, Petach Tikvah (Israel); Tel-Aviv University, Tel-Aviv (Israel); Gelfand, Michael [Cincinnati Children' s Hospital, Cincinnati, OH (United States)

    2014-12-15

    To determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP). A total of 40 infants between 10 and 270 days old (body mass 2.2 - 6.5 kg) had hepatobiliary scintigraphy during the period 2004 - 2010 following the intravenous administration of either {sup 99m}Tc-mebrofenin (18 patients) or {sup 99m}Tc-disofenin (22 patients). Due to the small size of these patients, they all received the minimum administered activity of 18.5 MBq consistent with the North American Consensus Guidelines. Six nuclear medicine physicians subjectively graded the acceptability of the image quality for clinical interpretation using a four-point scale (not acceptable, fair, good, excellent). Each physician independently graded seven image sets including the original study (full activity) and simulated reduced activity studies using binomial subsampling (50 % of full activity, 25 % of full activity and activity reduced by weight), with and without EPP. For full-activity studies, 98 % were deemed acceptable by the six physicians for clinical interpretation. The percentages of acceptable 50 % reduced activity studies with and without EPP were not significantly different from the percentage of acceptable full-activity studies (P = 0.193 and P = 0.998, respectively). The percentage of acceptable 25 % reduced activity studies without EPP was significantly different from the percentage of acceptable full-activity studies (P < 0.001); however, this difference vanished when EPP was applied (P = 0.482). The activity reduced by weight ranged from 1.85 to 4.81 MBq (10 % to 26 % of full dose) and the percentages of acceptable studies with and without EPP were significantly different from the percentage of acceptable full-activity studies (P < 0.001 and P = 0.02, respectively). Clinically interpretable hepatobiliary scintigraphy images can be obtained in infants when the

  17. Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia.

    Science.gov (United States)

    Widyahening, Indah S; Wangge, Grace; van der Graaf, Yolanda; van der Heijden, Geert J M G

    2017-02-01

    Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to. © 2016 The Authors

  18. Author Guidelines

    OpenAIRE

    Istadi Istadi

    2011-01-01

    AUTHOR GUIDELINES Indian Journal of Community Health (IJCH) accepts only online submission of manuscript(s) by using Open Journal software (OJS) at http://www.iapsmupuk.org/journal/index.php/IJCH/login Online SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH)? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly ...

  19. Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014.

    Science.gov (United States)

    Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na

    2015-08-26

    The current World Health Organization (WHO) guidelines on the quality, safety and efficacy of recombinant malaria vaccines targeting the pre-erythrocytic and blood stages of Plasmodium falciparum were adopted by the WHO Expert Committee on Biological Standardization in 2012 to provide guidance on the quality, nonclinical and clinical aspects of recombinant malaria vaccines. A WHO workshop was organised to facilitate implementation into African (national/regional) regulatory practices, of the regulatory evaluation principles outlined in the guidelines regarding quality aspects. The workshop was used also to share knowledge and experience on regulatory topics of chemistry, manufacturing and control with a focus on vaccines through presentations and an interactive discussion using a case study approach. The basic principles and concepts of vaccine quality including consistency of production, quality control and manufacturing process were presented and discussed in the meeting. By reviewing and practicing a case study, better understanding on the relationship between consistency of production and batch release tests of an adjuvanted pre-erythrocytic recombinant malaria vaccine was reached. The case study exercise was considered very useful to understand regulatory evaluation principles of vaccines and a suggestion was made to WHO to provide such practices also through its Global Learning Opportunities for Vaccine Quality programme.

  20. Trading certainty for speed - how much uncertainty are decisionmakers and guideline developers willing to accept when using rapid reviews: an international survey.

    Science.gov (United States)

    Wagner, Gernot; Nussbaumer-Streit, Barbara; Greimel, Judith; Ciapponi, Agustín; Gartlehner, Gerald

    2017-08-14

    Decisionmakers and guideline developers demand rapid syntheses of the evidence when time sensitive evidence-informed decisions are required. A potential trade-off of such rapid reviews is that their results can have less reliability than results of systematic reviews that can lead to an increased risk of making incorrect decisions or recommendations. We sought to determine how much incremental uncertainty about the correctness of an answer guideline developers and health policy decisionmakers are willing to accept in exchange for a rapid evidence-synthesis. Employing a purposive sample, we conducted an international web-based, anonymous survey of decisionmakers and guideline developers. Based on a clinical treatment, a public health, and a clinical prevention scenario, participants indicated the maximum risk of getting an incorrect answer from a rapid review that they would be willing to accept. We carefully reviewed data and performed descriptive statistical analyses. In total, 325 (58.5%) of 556 participants completed our survey and were eligible for analysis. The median acceptable incremental risk for getting an incorrect answer from a rapid review across all three scenarios was 10.0% (interquartile range [IQR] 5.0-15.0). Acceptable risks were similar for the clinical treatment (n = 313, median 10.0% [IQR 5.0-15.0]) and the public health scenarios (n = 320, median 10.0% [IQR 5.0-15.0]) and lower for the clinical prevention scenario (n = 312, median 6.5% [IQR 5.0-10.5]). Findings suggest that decisionmakers are willing to accept some trade-off in validity in exchange for a rapid review. Nevertheless, they expect the validity of rapid reviews to come close to that of systematic reviews.

  1. The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use.

    Science.gov (United States)

    Baron, Ralf; Allegri, Massimo; Correa-Illanes, Gerardo; Hans, Guy; Serpell, Michael; Mick, Gerard; Mayoral, Victor

    2016-12-01

    When peripheral neuropathic pain affects a specific, clearly demarcated area of the body, it may be described as localized neuropathic pain (LNP). Examples include postherpetic neuralgia and painful diabetic neuropathy, as well as post-surgical and post-traumatic pain. These conditions may respond to topical treatment, i.e., pharmaceutical agents acting locally on the peripheral nervous system, and the topical route offers advantages over systemic administration. Notably, only a small fraction of the dose reaches the systemic circulation, thereby reducing the risk of systemic adverse effects, drug-drug interactions and overdose. From the patient's perspective, the analgesic agent is easily applied to the most painful area(s). The 5% lidocaine-medicated plaster has been used for several years to treat LNP and is registered in approximately 50 countries. Many clinical guidelines recommend this treatment modality as a first-line option for treating LNP, particularly in frail and/or elderly patients and those receiving multiple medications, because the benefit-to-risk ratios are far better than those of systemic analgesics. However, some guidelines make only a weak recommendation for its use. This paper considers the positioning of the 5% lidocaine-medicated plaster in international treatment guidelines and how they may be influenced by the specific criteria used in developing them, such as the methodology employed by randomized, placebo-controlled trials. It then examines the body of evidence supporting use of the plaster in some prevalent LNP conditions. Common themes that emerge from clinical studies are: (1) the excellent tolerability and safety of the plaster, which can increase patients' adherence to treatment, (2) continued efficacy over long-term treatment, and (3) significant reduction in the size of the painful area. On this basis, it is felt that the 5% lidocaine-medicated plaster should be more strongly recommended for treating LNP, either as one component

  2. Guidelines for rating Global Assessment of Functioning (GAF

    Directory of Open Access Journals (Sweden)

    Aas IH Monrad

    2011-01-01

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

  3. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Illidge, Tim, E-mail: Tim.Illidge@ics.manchester.ac.uk [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Aleman, Berthe [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Constine, Louis [Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dharmarajan, Kavita [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Ricardi, Umberto [Radiation Oncology Unit, Department of Oncology, University of Torino, Torino (Italy); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2014-05-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.

  4. Guidelines for cytopathologic diagnosis of epithelioid and mixed type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology

    Science.gov (United States)

    Hjerpe, Anders; Ascoli, Valeria; Bedrossian, Carlos; Boon, Mathilde; Creaney, Jenette; Davidson, Ben; Dejmek, Annika; Dobra, Katalin; Fassina, Ambrogio; Field, Andrew; Firat, Pinar; Kamei, Toshiaki; Kobayashi, Tadao; Michael, Claire W.; Önder, Sevgen; Segal, Amanda; Vielh, Philippe

    2015-01-01

    To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma (MM). Cytopathologists involved in the International Mesothelioma Interest Group (IMIG) and the International Academy of Cytology (IAC), who have an interest in the field contributed to this update. Reference material includes peer-reviewed publications and textbooks. This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists, who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in cape town. During the previous IMIG biennial meetings, thorough discussions have resulted in published guidelines for the pathologic diagnosis of MM. However, previous recommendations have stated that the diagnosis of MM should be based on histological material only.[12] Accumulating evidence now indicates that the cytological diagnosis of MM supported by ancillary techniques is as reliable as that based on histopathology, although the sensitivity with cytology may be somewhat lower.[345] Recognizing that noninvasive diagnostic modalities benefit both the patient and the health system, future recommendations should include cytology as an accepted method for the diagnosis of this malignancy.[67] The article describes the consensus of opinions of the authors on how cytology together with ancillary testing can be used to establish a reliable diagnosis of MM. PMID:26681974

  5. Guidelines for cytopathologic diagnosis of epithelioid and mixed type malignant mesothelioma. Complementary statement from the International Mesothelioma Interest Group, also endorsed by the International Academy of Cytology and the Papanicolaou Society of Cytopathology

    Directory of Open Access Journals (Sweden)

    Anders Hjerpe

    2015-01-01

    Full Text Available To provide practical guidelines for the cytopathologic diagnosis of malignant mesothelioma (MM. Cytopathologists involved in the International Mesothelioma Interest Group (IMIG and the International Academy of Cytology (IAC, who have an interest in the field contributed to this update. Reference material includes peer-reviewed publications and textbooks. This article is the result of discussions during and after the IMIG 2012 conference in Boston, followed by thorough discussions during the 2013 IAC meeting in Paris. Additional contributions have been obtained from cytopathologists and scientists, who could not attend these meetings, with final discussions and input during the IMIG 2014 conference in cape town. During the previous IMIG biennial meetings, thorough discussions have resulted in published guidelines for the pathologic diagnosis of MM. However, previous recommendations have stated that the diagnosis of MM should be based on histological material only. [1],[2] Accumulating evidence now indicates that the cytological diagnosis of MM supported by ancillary techniques is as reliable as that based on histopathology, although the sensitivity with cytology may be somewhat lower. [3],[4],[5] Recognizing that noninvasive diagnostic modalities benefit both the patient and the health system, future recommendations should include cytology as an accepted method for the diagnosis of this malignancy. [6],[7] The article describes the consensus of opinions of the authors on how cytology together with ancillary testing can be used to establish a reliable diagnosis of MM.

  6. ANALYSIS OF SCIENTIFIC RESEARCHES IN PHARMACEUTICAL PROMOTION GLOBALLY: TOWARDS INTERNATIONALLY DEVELOPING PRACTICALLY-ORIENTED GUIDELINES FOR PHARMACEUTICAL COMPANIES

    OpenAIRE

    M. M. Bahlol; T. P. Lagutkina

    2016-01-01

    Purpose. Pharmaceutical industry is transnational and globally important. Many pharmaceutical companies operate their business in multinational and international forms in different countries. Diverse researches from different countries indicated and confirmed marketing promotion importance in pharmaceutical field. Therefore, marketing promotion and its effects are a very important issue that should be globally investigated in real life and evidence context. We oriented our research according ...

  7. Effect of bidirectional internal flow on fluid–structure interaction dynamics of conveying marine riser model subject to shear current

    Directory of Open Access Journals (Sweden)

    Zheng-Shou Chen

    2012-03-01

    Full Text Available This article presents a numerical investigation concerning the effect of two kinds of axially progressing internal flows (namely, upward and downward on fluid–structure interaction (FSI dynamics about a marine riser model which is subject to external shear current. The CAE technology behind the current research is a proposed FSI solution, which combines structural analysis software with CFD technology together. Efficiency validation for the CFD software was carried out first. It has been proved that the result from numerical simulations agrees well with the observation from relating model test cases in which the fluidity of internal flow is ignorable. After verifying the numerical code accuracy, simulations are conducted to study the vibration response that attributes to the internal progressive flow. It is found that the existence of internal flow does play an important role in determining the vibration mode (/dominant frequency and the magnitude of instantaneous vibration amplitude. Since asymmetric curvature along the riser span emerges in the case of external shear current, the centrifugal and Coriolis accelerations owing to up- and downward internal progressive flows play different roles in determining the fluid–structure interaction response. The discrepancy between them becomes distinct, when the velocity ratio of internal flow against external shear current is relatively high.

  8. Morphology and Frictional Characteristics Under Electrical Currents of Al203/Cu Composites Prepared by Internal Oxidation

    Institute of Scientific and Technical Information of China (English)

    Liu Ruihua; Song Kexing; Jia Shuguo; Xu Xiaofeng; Gao Jianxin; Guo Xiuhua

    2008-01-01

    Two AhO3/Cu composites containing 0.24 wt.% A1203 and 0.60 wt.% A1203 separately are prepared by internal oxidation.Effectsof sliding speed and pressure on the fi-ictional characteristics of the composites and copper against brass are investigated and compared.The changes in morphology of the sliding surface and subsurface are examined with scanning electron microscope (SEM) and energy dispersive X-ray spectrum (EDS).The results show that the wear resistance of the AI203/Cu composites is superior to that of copperunder the same conditions.Under a given electrical current,the wear rate of AI203/Cu composites decreases as the AleO3-content increases.However,the wear rates of the Al203/Cu composites and copper increase as the sliding speed and pressure increase under drysliding condition.The main wear mechanisms for AleO3/Cu composites are of abrasion and adhesion;for copper,it is adhesion,although wear by oxidation and electrical erosion can also be observed as the speed and pressure rise.

  9. Guidelines for Better Heart Health

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...

  10. Influence of Complete Coriolis Force on the Dispersion Relation of Ocean Internal-wave in a Background Currents Field

    Directory of Open Access Journals (Sweden)

    Liu Yongjun

    2015-01-01

    Full Text Available In this thesis, the influence of complete Coriolis force (the model includes both the vertical and horizontal components of Coriolis force on the dispersion relation of ocean internal-wave under background currents field are studied, it is important to the study of ocean internal waves in density-stratified ocean. We start from the control equation of sea water movement in the background of the non-traditional approximation, and the vertical velocity solution is derived where buoyancy frequency N(z gradually varies with the ocean depth z. The results show that the influence of complete Coriolis force on the dispersion relation of ocean internal-wave under background currents field is obvious, and these results provide strong evidence for the understanding of dynamic process of density stratified ocean internal waves.

  11. 12 CFR Appendix D to Part 325 - Capital Adequacy Guidelines for Banks: Internal-Ratings-Based and Advanced Measurement Approaches

    Science.gov (United States)

    2010-01-01

    ... transactions. Current exposure is also called replacement cost. Default—(1) Retail. (i) A retail exposure of a...-Ratings-Based and Advanced Measurement Approaches D Appendix D to Part 325 Banks and Banking FEDERAL... Advanced Measurement Approaches Part IGeneral Provisions Section 1Purpose, Applicability, Reservation...

  12. International guidelines for bioequivalence of systemically available orally administered generic drug products: a survey of similarities and differences.

    Science.gov (United States)

    Davit, Barbara; Braddy, April C; Conner, Dale P; Yu, Lawrence X

    2013-10-01

    The objective of this article is to discuss the similarities and differences among bioequivalence approaches used by international regulatory authorities when reviewing applications for marketing new generic drug products which are systemically active and intended for oral administration. We focused on the 13 jurisdictions and organizations participating in the International Generic Drug Regulators Pilot. These are Australia, Brazil, Canada, China, Chinese Taipei, the European Medicines Association, Japan, Mexico, Singapore, South Korea, Switzerland, the USA, and the World Health Organization. We began with a comparison of how the various jurisdictions and organizations define a generic product and its corresponding reference product. We then compared the following bioequivalence approaches: recommended bioequivalence study designs, method of pharmacokinetic calculations and bioequivalence acceptance limits, recommendations for modifying bioequivalence study designs and limits for highly variable drugs and narrow therapeutic index drugs, provisions for waiving bioequivalence study requirements (granting biowaivers), and implementation of the Biopharmaceutics Classification System. We observed that, overall, there are more similarities than differences in bioequivalence approaches among the regulatory authorities surveyed.

  13. Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study

    Directory of Open Access Journals (Sweden)

    Moheet Amir

    2009-09-01

    Full Text Available Abstract Background Teaching the content of clinical practice guidelines (CPGs is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States. Methods We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs. Results Of 434 programs responding (out of 839, 52%, 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%. The top two educational strategies used were didactic sessions (76% and journal clubs (64%. Auditing for adherence by residents was the primary evaluation strategy (44%, although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54% while the most important barrier was time constraints on faculty (56%. Conclusion Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.

  14. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2015-12-01

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

  15. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2016-06-01

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

  16. [Requirements for the prevention of nosocomial infections. German Guideline 2009 and reality. Current data from hospitals in Frankfurt am Main, Germany].

    Science.gov (United States)

    Heudorf, U; Exner, M

    2011-03-01

    In 2009, the new directive of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) entitled Human and Organizational Requirements for the Prevention of Nosocomial Infections was published, including detailed information on the needs of hygiene professionals in hospital settings. Compared to the needs calculated according to the above policy, the current staff hygiene health professionals (HHPs) in the hospitals of Frankfurt am Main (Frankfurt/M), Germany, was on average 27.6%: 36% in the large hospitals (>600 beds), 21.6% in medium hospitals (300-600 beds), and 19.8% in small hospitals (hospitals had a full-time hygienist. The demands of the KRINKO policy have not been met by any of the hospitals. Hospitals with lower percentages of hospital hygiene staff not only had a lower rating of hygienic quality, they also showed a lower usage of hand disinfection per patient-day. In Germany, there is currently a lack of trained HHPs and hygienists to meet the needs of the KRINKO policy. Therefore, the reactions of the hospitals in Frankfurt/M ranged from the establishment of additional jobs for HHPs to changes in structures and organization of hospital hygiene. Thus, the new KRINKO guideline in Frankfurt/M did not result in a wave of recruitment of health professionals, but at least resulted in organizational and structural improvements in hygiene.

  17. 世界各国高血压临床指南的现状分析和循证评价%Analysis on current status of clinical guidelines for hypertension in the world and evaluation on evidence-based clinical guidelines with Appraisal of Guidelines for Research and Evaluation instrument

    Institute of Scientific and Technical Information of China (English)

    唐海沁; 符赵鑫; 张勇; 丁琳; 李瑾

    2014-01-01

    Objective To assess and analyze the current status of clinical guidelines for hypertension in the world by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Methods The clinical guidelines for hypertension were identified and approved by searching China hownet,WANFANG database,PUBMED database,MEDLINE,Embase and related institutions and authorization web site from 1995 to January 2012,and relevant Web sites of agencies and organizations that produce and/or endorse guidelines.Names of the guidelines,published years and organizations,methodology of development and reference number were descriptively analyzed.AGREE instrument was used to evaluate the qualities of latest edited clinical guidelines for hypertension in countries all over the world.Results Nine guidelines were enrolled.The results showed that the hypertension guidelines scored the highest average of 88.4% for clarity of presentation and reliability field; for applicability fields,scored an average of 86.1%; the scope and goal field scored an average of 83.8%; participants field scored an average of 71.7%; editorial independence field scored an average of 64.1% ; rigor of development field scored the lowest average of 62.9%.The overall assessment showed that NICE 2011,Canada 2012,ESC 2009,Australia 2010 editions were the positively recommended guidelines,JNC7,Japan 2009,China Taiwan 2010,China 2010,South Africa 2011 editions were the recommended guidelines (still need to supplement and improve).No recommend or uncertain guide was found.Conclusions The quality of the hypertension guidelines is higher in general,but some common deficiency in the rigor of development and editorial independence in Asian and African guidelines formulated by the states still exists.There still exist certain gaps in evidence-based medical requirement.And the contents and quality are needed for further regulating and enhancing.A set of scientific systemic hypertension clinical guidelines

  18. Global health training and international clinical rotations during residency: current status, needs, and opportunities.

    Science.gov (United States)

    Drain, Paul K; Holmes, King K; Skeff, Kelley M; Hall, Thomas L; Gardner, Pierce

    2009-03-01

    Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.

  19. The ICC at the centre ofan international criminal justice system: current challenges

    Directory of Open Access Journals (Sweden)

    Teles, Patrícia Galvão

    2017-05-01

    Full Text Available The International Criminal Court (ICC has entered into its second decade of operations and has established itself at the centre of an international criminal justice system, comprising also domestic jurisdictions and other international courts and tribunals. However, many challenges continue to face the ICC and, indeed, such challenges are part of its own features and stem from the specificities of international law and relations. In this article, we shall discuss, in light of recent events, four of such challenges: 1 Universality; 2 Complementarity; 3 Cooperation; and 4 the Crime of Aggression. These challenges illustrate how the ICC and international criminal justice inhabit both the cultures of justice and politics and how these two aspects have to be taken into account in order for such challenges to be overcome, so that the mission of a permanent and central instrument for the fight against impunity, that historically started in Rome in 1998, becomes an inherent part of today’s world.

  20. Gaps in international nutrition and child feeding guidelines: a look at the nutrition and young child feeding education of Ghanaian nurses.

    Science.gov (United States)

    Davis, Jennie N; Brown, Helen; Ramsay, Samantha A

    2017-08-01

    To examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana's Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0-5 years. A qualitative study of semi-structured one-on-one and group interviews (n 21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions. KEEA public health clinics (n 12). Nurses (n 41) purposefully recruited from KEEA clinics. A model capturing nurses' nutrition and YCF education emerged with five major themes: (i) adequacy of nurses' basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses' delivery of nutrition and YCF information; (iii) nurses' evaluation of children's health status to measure education effectiveness; (iv) nurses' perceived barriers of caregivers' ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2-5 years. Nurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2-5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines.

  1. Patient-reported outcome measure for neuromyelitis optica: pretesting of preliminary instrument and protocol for further development in accordance with international guidelines

    Science.gov (United States)

    Moore, P; Jackson, C; Mutch, K; Methley, A; Pollard, C; Hamid, S; Jacob, A

    2016-01-01

    Objective This study outlines the development of a patient-reported outcome measure (PROM), an instrument to obtain self-reported health status for neuromyeltis optica (NMO), a disabling neurological condition. Design Development was conducted in accordance with international guidance for PROMs including systematic review of existing literature, item generation guided by qualitative interviews, health-related quality of life conceptual framework and clinical expert panel and cognitive interviews with NMO patients. Setting Participants were identified through a national NMO clinic in a tertiary NHS neurosciences service. Participants 15 individuals with NMO participated in cognitive interviews requiring review and ranking of proposed PROM items and qualitative feedback on content, layout and response options. Results Participants endorsed the draft instrument as reflecting their experience of the condition and as being easy to understand. Rating and ranking of item relevance and importance reduced the draft instrument from 106 to 48 items. Participant feedback on overlapping items eliminated a further 2 items and resulted in a preliminary instrument of 46 items. As a direct result of participant feedback ordering of the 10 domains was revised, a 4 option Likert scale was employed and a 4-week recall period for impact of symptoms was selected. Conclusions A 46-item instrument developed in accordance with international PROM development guidelines through literature review, developed by subject matter experts and refined through pretesting examining content validity provides a preliminary measure for assessing patient-report of health status in NMO. Further evaluation is proposed including sensitivity to clinical change, and international contributions to evaluating the measure are encouraged. PMID:27694484

  2. A modified beam-to-earth transformation to measure short-wavelength internal waves with an acoustic Doppler current profiler

    Science.gov (United States)

    Scotti, A.; Butman, B.; Beardsley, R.C.; Alexander, P.S.; Anderson, S.

    2005-01-01

    The algorithm used to transform velocity signals from beam coordinates to earth coordinates in an acoustic Doppler current profiler (ADCP) relies on the assumption that the currents are uniform over the horizontal distance separating the beams. This condition may be violated by (nonlinear) internal waves, which can have wavelengths as small as 100-200 m. In this case, the standard algorithm combines velocities measured at different phases of a wave and produces horizontal velocities that increasingly differ from true velocities with distance from the ADCP. Observations made in Massachusetts Bay show that currents measured with a bottom-mounted upward-looking ADCP during periods when short-wavelength internal waves are present differ significantly from currents measured by point current meters, except very close to the instrument. These periods are flagged with high error velocities by the standard ADCP algorithm. In this paper measurements from the four spatially diverging beams and the backscatter intensity signal are used to calculate the propagation direction and celerity of the internal waves. Once this information is known, a modified beam-to-earth transformation that combines appropriately lagged beam measurements can be used to obtain current estimates in earth coordinates that compare well with pointwise measurements. ?? 2005 American Meteorological Society.

  3. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....

  4. Cyberbullying among Youth: A Comprehensive Review of Current International Research and Its Implications and Application to Policy and Practice

    Science.gov (United States)

    Cassidy, Wanda; Faucher, Chantal; Jackson, Margaret

    2013-01-01

    Cyberbullying research is rapidly expanding with many studies being published from around the world in the past five or six years. In this article we review the current international literature published in English, with particular attention to the following themes: The relationship of cyberbullying to the more traditional face-to-face bullying,…

  5. Cyberbullying among Youth: A Comprehensive Review of Current International Research and Its Implications and Application to Policy and Practice

    Science.gov (United States)

    Cassidy, Wanda; Faucher, Chantal; Jackson, Margaret

    2013-01-01

    Cyberbullying research is rapidly expanding with many studies being published from around the world in the past five or six years. In this article we review the current international literature published in English, with particular attention to the following themes: The relationship of cyberbullying to the more traditional face-to-face bullying,…

  6. Airglow Observation with IMAP/ VISI on the International Space Station: Current status and simulation

    Science.gov (United States)

    Perwitasari, S.; Sakanoi, T.; Yamazaki, A.; Otsuka, Y.; Akiya, Y.; Saito, A.

    2012-12-01

    The Visible and near-Infrared Spectral Imager (VISI) of the IMAP mission was launched successfully by H-IIB/HTV3 on July 21 2012. At this moment HTV3 is docked onto the International Space Station (ISS), and VISI is scheduled to be installed on the exposed facility within a week. VISI will be operated in the nightside hemisphere in the range of +/- 51 deg. GLAT, and measure the airglow emissions of OI at 630 nm, the OH Meinel band at 730 nm and the O2 atmospheric band (0-0) at 762 nm at an altitude of ~400 km with typical spatial resolution of 16 - 50 km. Since the influence of cloud reflections of moonlight is overlapped with the airglow pattern in the visible wavelength range, the precise subtraction of the cloud influence is a key issue of this mission. Therefore, a simulation work to study on how much the surface albedo on the cloud top will affect the data is critically important. The height profiles of volume emission rates were estimated for O2 and OH airglows with the MSIS models, and then the airglow intensities were integrated along the line-of-sight direction. The cloud pattern was estimated based on the realistic data measured with a geostationary climate satellite. The simulation result shows that for OH Meinel at 730 nm, the moonlight reflection during the first/last quarter will increase the brightness of the airglow by factor of 1.5-2 and ~5 for full moon phase. Meanwhile, for O2 atmospheric band (0-0) at 762 nm, the simulation result shows that there's no significant (structured) background, even during the full moon phase. We will report the quantitative effect of cloud albedo on the airglow pattern, and discuss the physical parameters those expected to be derived from the VISI data. Concerning on the operation of VISI, we will carry out the initial function check by the middle of August, and start nominal observation within a few months. Thus, we will also report the current status and initial result of VISI.

  7. Practice guidelines for tumor marker use in the clinic.

    Science.gov (United States)

    Sturgeon, Catharine

    2002-08-01

    Increasing interest in implementing the practice of evidence-based medicine in oncology has encouraged the development of clinical guidelines, many of which include recommendations about the appropriate use of serum tumor markers. Recent national and international guidelines relating to the use of tumor markers in germ cell, colorectal, breast, ovarian, prostate, lung, neuroendocrine, and thyroid cancers were identified from the scientific literature and other sources and tabulated. Guideline recommendations developed by national and international groups and relating to the use of tumor markers for specific cancers are reviewed and compared, considering the recommendations made for their use in screening, diagnosis, prognosis, and monitoring of therapy. Potential advantages and disadvantages of clinical guidelines, how best to implement them, and means of auditing their effectiveness are also considered. Excellent clinical guidelines, including recommendations for the most appropriate use of tumor markers, are already available for many cancers. Many questions relating to optimal use of these important tests remain to be answered, but current guidelines already contain much valuable information and advice. Further dissemination and implementation of the guidelines should encourage better use of tumor markers in clinical practice. Careful audit studies are also required to establish the impact of these guidelines on the practice of evidence-based medicine.

  8. Guideline.gov: A Database of Clinical Specialty Guidelines.

    Science.gov (United States)

    El-Khayat, Yamila M; Forbes, Carrie S; Coghill, Jeffrey G

    2017-01-01

    The National Guidelines Clearinghouse (NGC), also known as Guideline.gov, is a database of resources to assist health care providers with a central depository of guidelines for clinical specialty areas in medicine. The database is provided free of charge and is sponsored by the U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality. The guidelines for treatment are updated regularly, with new guidelines replacing older guidelines every five years. There are hundreds of current guidelines with more added each week. The purpose and goal of NGC is to provide physicians, nurses, and other health care providers, insurance companies, and others in the field of health care with a unified database of the most current, detailed, relevant, and objective clinical practice guidelines.

  9. The Current Situation and Future Prospects of International Relations in Japanese Higher Education Related Engineering Field

    Science.gov (United States)

    Taguchi, Shigenori

    With ongoing globalization, the role of higher education in developing excellent human resources who can play an active role in international society, among other things is becoming increasingly important. Recently, the international competition among higher education institutions to recruit the best and brightest students has been heating up increasingly. In this section, we present the outline of recent trend of internationalization in higher education with reference to policy of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) .

  10. Are recommendations for psychological treatment of borderline personality disorder in current U.K. guidelines justified? Systematic review and subgroup analysis.

    Science.gov (United States)

    Omar, Hussein; Tejerina-Arreal, Maria; Crawford, Mike J

    2014-08-01

    Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder.

  11. Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women’s Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy

    Directory of Open Access Journals (Sweden)

    Holly Ockenden

    2016-11-01

    Full Text Available The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey, related to women’s knowledge and perceptions of the current gestational weight gain guidelines (GWG, as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7 and pilot testing items in a small sample (n = 5 of pregnant women and recent mothers (target population. Test re-test reliability was assessed among a sample (n = 71 of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC, those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15–25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.

  12. International Human Rights Treaties in Central American Jurisdictions: Interpretative Guidelines and Principles for the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families

    Directory of Open Access Journals (Sweden)

    Alfonso Chacón Mata

    2017-06-01

    Full Text Available As part of the Institute for Latin American Studies (IDELA project on Current Migration Trends in Latin America, an analysis of the regional regulations on human rights is conducted in this paper in order to highlight efforts for an interpretative harmonization, and to ulteriorly study the possibilities of building regional regulations. The scope of the international human rights law is reviewed, since the international treaties protecting such rights include the protection of migrants as a vulnerable social group within this perspective

  13. Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions.

    Science.gov (United States)

    Esakki, Saravanan; MacDermid, Joy; Vajravelu, Saipriya

    2016-09-01

    Background: American Academy of Orthopaedic Surgeons (AAOS) distal radius fracture (DRF) clinical practice guidelines (CPG) are readily available to clinicians, patients, and policymakers. International Classification of Functioning, Disability, and Health (ICF) provides a framework for describing the impact of health conditions. The International Classification of Diseases-10th Revision (ICD-10) is a classification system to classify health conditions as specific disease or disorders. The aim of this study is to analyze and describe the scope and focus of the AAOS DRF CPG using the ICF and ICD-10 as a basis for content analysis, and to compare the content of the CPG with the ICF hand core sets as the reference standard. Methods: Established linking rules were used by 2 independent raters to analyze the 29 recommendations of the AAOS DRF CPG. ICD-10 codes were assigned in the same process. Summary linkage statistics were used to describe the results for ICF and the hand core sets. Results: Among the 29 recommendations of the AAOS DRF CPG, 5 meaningful concepts were linked to the ICF codes. Of these, 5 codes appeared on the comprehensive ICF core set and only 3 codes appeared in the brief ICF core set, and 7 conditions were covered in ICD-10 codes. Conclusions: The AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the ICD-10 and ICF. It does not address activity or participation (disability), and is not well linked to key concepts relevant to hand conditions.

  14. Comparison of the Treatment Implications of American Society of Hypertension and International Society of Hypertension 2013 and Eighth Joint National Committee Guidelines: an analysis of National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Murthy, Venkatesh L; Shah, Ravi V; Rubenfire, Melvyn; Brook, Robert D

    2014-08-01

    Multiple guidelines and statements related to hypertension have recently been published. Much discord has arisen from discrepant treatment and target systolic blood pressure thresholds for individuals aged 60 to 79 years of Hypertension and International Society of Hypertension 2013. We sought to evaluate the public health implications of these differences using data from the 2005 to 2010 National Health and Nutrition Examination Survey (NHANES) cycles. NHANES is an ongoing survey designed to allow characterization of the US population and subpopulations. We found that only .2.4% (95% confidence interval, 1.5.3.2%) of adults aged 60 to 79 years had indications for antihypertensive treatment under the more stringent American Society of Hypertension and International Society of Hypertension 2013 guideline but not under Eighth Joint National Committee. About 65.7% (95% confidence interval, 62.4.69.0%) of adults aged 60 to 79 years had indications for treatment under both guidelines. Furthermore, those with indications for treatment under American Society of Hypertension and International Society of Hypertension 2013 but not under Eighth Joint National Committee generally had higher systolic blood pressure and less favorable lipid profiles compared with those with indications for treatment under both guidelines. Importantly, a larger group, comprising 21.0% (95% confidence interval, 18.7.23.2%) of adults aged 60 to 79 years, had either untreated or inadequately treated hypertension and represents an important group for continued efforts.

  15. The AGREE Enterprise: a decade of advancing clinical practice guidelines.

    Science.gov (United States)

    Makarski, Julie; Brouwers, Melissa C

    2014-08-15

    The original AGREE (Appraisal of Guidelines for REsearch and Evaluation) Instrument was published in 2003, and its revision, the AGREE II, in 2009. Together, they filled an important gap in the guideline and quality of care fields. Ten years later, the AGREE Enterprise reflects on a trajectory of projects and international collaboration that have contributed to advancing the science and quality of practice guidelines and the uptake of AGREE/AGREE II. The AGREE Enterprise has undertaken activities to improve the tool and to develop resources to support its use. Since 2003, the uptake and adoption of AGREE by the international community has been swift and broad. A total of 33 language translations of the original AGREE Instrument and the current AGREE II are available and were initiated by the international community. A recent scan of the published literature identified over 600 articles that referenced the AGREE tools. The AGREE tools have been widely received and applied, with several organizations having incorporated the AGREE as part of their formal practice guideline programs. Since its redevelopment in 2010, the AGREE Enterprise website (www.agreetrust.org) continues to experience steady increases in visitors per month and currently has over 10,000 registered users. The AGREE Enterprise has contributed to the advancements of guidelines through research activities and international participation by scientific and user communities. As we enter a new decade, we look forward to ongoing collaborations and contributing to further advancements to improve quality of care and health care systems.

  16. The Interaction of Short-Wavelength Internal Waves with a Background Current,

    Science.gov (United States)

    1982-12-01

    challenging feature of the internal wave field is its maintenance of high and uniform energy levels. A central difficulty arises from our poor...coefficient of the Taylor-Goldstein equation. The asymptotic predicitions (dashed lines), obtained by neglecting the curvature term U/(c- U) in the Taylor

  17. International consensus on use of focused ultrasound for painful bone metastases : Current status and future directions

    NARCIS (Netherlands)

    Huisman, Merel; ter Haar, Gail; Napoli, Alessandro; Hananel, Arik; Ghanouni, Pejman; Lövey, György; Nijenhuis, Robbert J; van den Bosch, Maurice A A J; Rieke, Viola; Majumdar, Sharmila; Marchetti, Luca; Pfeffer, Raphael M; Hurwitz, Mark D

    2015-01-01

    Focused ultrasound surgery (FUS), in particular magnetic resonance guided FUS (MRgFUS), is an emerging non-invasive thermal treatment modality in oncology that has recently proven to be effective for the palliation of metastatic bone pain. A consensus panel of internationally recognised experts in

  18. International consensus on use of focused ultrasound for painful bone metastases : Current status and future directions

    NARCIS (Netherlands)

    Huisman, Merel; ter Haar, Gail; Napoli, Alessandro; Hananel, Arik; Ghanouni, Pejman; Lövey, György; Nijenhuis, Robbert J; van den Bosch, Maurice A A J; Rieke, Viola; Majumdar, Sharmila; Marchetti, Luca; Pfeffer, Raphael M; Hurwitz, Mark D

    2015-01-01

    Focused ultrasound surgery (FUS), in particular magnetic resonance guided FUS (MRgFUS), is an emerging non-invasive thermal treatment modality in oncology that has recently proven to be effective for the palliation of metastatic bone pain. A consensus panel of internationally recognised experts in f

  19. International consensus on use of focused ultrasound for painful bone metastases : Current status and future directions

    NARCIS (Netherlands)

    Huisman, Merel; ter Haar, Gail; Napoli, Alessandro; Hananel, Arik; Ghanouni, Pejman; Lövey, György; Nijenhuis, Robbert J; van den Bosch, Maurice A A J|info:eu-repo/dai/nl/182981630; Rieke, Viola; Majumdar, Sharmila; Marchetti, Luca; Pfeffer, Raphael M; Hurwitz, Mark D

    2015-01-01

    Focused ultrasound surgery (FUS), in particular magnetic resonance guided FUS (MRgFUS), is an emerging non-invasive thermal treatment modality in oncology that has recently proven to be effective for the palliation of metastatic bone pain. A consensus panel of internationally recognised experts in f

  20. Long term stability of rh-Cu/Zn-superoxide dismutase (SOD)-liposomes prepared by the cross-flow injection technique following International Conference on Harmonisation (ICH)-guidelines.

    Science.gov (United States)

    Vorauer-Uhl, Karola; Wagner, Andreas; Katinger, Hermann

    2002-07-01

    The current market position of liposomes as drug carriers is still being discussed with regard to large scale production, product characterisation and the stability of the dispersions. In this study, long term stability of liposomal suspensions with encapsulated rh-Cu/Zn-superoxide dismutase was tested according to the International Conference on Harmonisation (ICH) recommendations. The guidelines of the ICH provide general requirements for stability testing for registration and export in particular. The Institute of Applied Microbiology has examined a process to produce large amounts of pharmaceutical-grade liposomes for the treatment of inflammatory diseases by topical application. For the evaluation of its long-term storage stability, liposomal stability and protein stability were tested under appropriate conditions. Therefore, size alterations of the vesicles, protein release and protein activity were evaluated. During the observation period, neither significant alterations of the liposomes nor any protein degradation could be detected. In the light of these findings our liposomal formulations seem to provide chemical, physical and biological stability according to the definitions of the ICH. Appropriate lipid compounds and environmental factors, in combination with an optimised process and adequate storage conditions, facilitate the production of liposome dispersions suitable as drug carriers on the market.

  1. Current International Flow Cytometric Practices for the Detection and Monitoring of Paroxysmal Nocturnal Haemoglobinuria (PNH) clones: A UK NEQAS Survey.

    Science.gov (United States)

    Fletcher, Matthew; Whitby, Liam; Whitby, Alison; Barnett, David

    2016-03-02

    Background Paroxysmal Nocturnal Haemoglobinuria (PNH) is a rare acquired genetic disorder, with an incidence of approximately 1.3 new cases per million population per year. Evidence from the UK National External Quality Assessment Service for Leucocyte Immunophenotyping (UK NEQAS LI) programme suggested major discrepancies on how PNH testing is undertaken. To investigate this we surveyed laboratories in the UK NEQAS LI PNH programme and report here the findings. Method A questionnaire was distributed to all centres registered in UK NEQAS LI flow cytometry programmes (n=1587). Comprising several subsections, it covered the majority of clinical flow cytometric practices. Participants completed a general section and then the subsections relevant to their laboratory repertoire. One subsection contained 34 questions regarding practices in PNH clone detection. Results A total of 105 laboratories returned results for the PNH section; the results demonstrated lack of consensus in all areas of PNH testing. Variation was seen in gating and testing strategies, sensitivity levels and final reporting of test results. Several incorrect practices were highlighted such as inappropriate antibody selection and failure to wash the red blood cells (RBCs) prior to analysis. Conclusion Despite the availability of consensus guidelines there appears to be no agreement in the detection and monitoring of PNH. We found only fourteen centres using methods compatible with the International Clinical Cytometry Society guidelines. Of specific note we found that no two laboratories used the same method. This technical variation could lead to incorrect diagnoses, highlighting the need for better adoption and understanding of consensus practices. This article is protected by copyright. All rights reserved.

  2. Current models of care for disorders of sex development - results from an International survey of specialist centres

    DEFF Research Database (Denmark)

    Kyriakou, Andreas; Dessens, Arianne; Bryce, Jillian

    2016-01-01

    BACKGROUND: To explore the current models of practice in centres delivering specialist care for children with disorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and the I-DSD Registry, was performed in the last quarter of 2014. RESULTS: A total...... a local DSD registry and 40 (53 %) shared their data in a multicentre DSD registry. Attendance in local, national and international DSD-related educational programs was reported by 69, 78 and 84 % clinicians, respectively. Participation in audits/quality improvement exercises in DSD care was reported...... hydroxysteroid dehydrogenase 3 deficiency by 50 and 55 % clinicians, respectively. CONCLUSION: DSD centres report a high level of interaction at an international level, have access to specialist staff and are increasingly relying on molecular genetics for routine diagnostics. The quality of care provided...

  3. Measurements of slope currents and internal tides on the Continental Shelf and slope off Newport Beach, California

    Science.gov (United States)

    Rosenberger, Kurt J.; Noble, Marlene A.; Norris, Benjamin

    2014-01-01

    An array of seven moorings housing current meters and oceanographic sensors was deployed for 6 months at 5 sites on the Continental Shelf and slope off Newport Beach, California, from July 2011 to January 2012. Full water-column profiles of currents were acquired at all five sites, and a profile of water-column temperature was also acquired at two of the five sites for the duration of the deployment. In conjunction with this deployment, the Orange County Sanitation District deployed four bottom platforms with current meters on the San Pedro Shelf, and these meters provided water-column profiles of currents. The data from this program will provide the basis for an investigation of the interaction between the deep water flow over the slope and the internal tide on the Continental Shelf.

  4. Identification of Magnetizing Inrush and Internal Short-Circuit Fault Current in V/x-Type Traction Transformer

    Directory of Open Access Journals (Sweden)

    Y. H. Li

    2013-01-01

    Full Text Available This paper deals with the fault diagnosis methodology for the V/x-type traction transformer in railway passenger-dedicated lines. A kind of the protection methodology to combine empirical mode decomposition (EMD, energy weight, and information entropy is proposed. This method can sensitively reflect the dynamic information changes of traction transformer differential current, so it can not only effectively identify internal short-circuit fault current from magnetizing inrush but also better identify fault current accompanied with magnetizing inrush. In this method, the differential current is decomposed by EMD and the energy weight of each intrinsic mode function (IMF is calculated, and the feature vector of the fault pattern recognition is obtained by constructing IMF energy entropy. The field-measured data illustrate that the new method not only has the advantages of high sensitivity, faster identification speed, and clear concept but also is available for the diagnosis of the complicated dynamic system.

  5. Verification of gyrokinetic particle simulation of current-driven instability in fusion plasmas. I. Internal kink mode

    Energy Technology Data Exchange (ETDEWEB)

    McClenaghan, J.; Lin, Z.; Holod, I.; Deng, W.; Wang, Z. [University of California, Irvine, California 92697 (United States)

    2014-12-15

    The gyrokinetic toroidal code (GTC) capability has been extended for simulating internal kink instability with kinetic effects in toroidal geometry. The global simulation domain covers the magnetic axis, which is necessary for simulating current-driven instabilities. GTC simulation in the fluid limit of the kink modes in cylindrical geometry is verified by benchmarking with a magnetohydrodynamic eigenvalue code. Gyrokinetic simulations of the kink modes in the toroidal geometry find that ion kinetic effects significantly reduce the growth rate even when the banana orbit width is much smaller than the radial width of the perturbed current layer at the mode rational surface.

  6. Using International Law to Defuse Current Controversies in the South and East China Seas

    Science.gov (United States)

    2015-02-01

    rights and the general rights of the international community to use the seas as media for commerce and other peaceful purposes  A recognition...that an inhabited island that otherwise meets the tests in Article 121 of the LOS Convention of being able to support “human habitation ” or...like straits) to enact unilateral claims in order to protect their marine resources and their coastal populations. Malaysia in particular has had to

  7. How to measure the international development of palliative care? A critique and discussion of current approaches.

    Science.gov (United States)

    Loucka, Martin; Payne, Sheila; Brearley, Sarah

    2014-01-01

    A number of research projects have been conducted that aim to gather data on the international development of palliative care. These data are important for policy makers and palliative care advocates. The aim of this article was to provide a critical comparative analysis of methodological approaches used to assess the development and status of palliative care services and infrastructure at an international level. A selective literature review that focused on the methodological features of eight identified reports was undertaken. Reviewed reports were found to differ in adopted methodologies and provided uneven amounts of methodological information. Five major methodological limitations were identified (lack of theory, use of experts as source of information, grey literature, difficulties in ranking, and the problematic nature of data on service provision). A set of recommendations on how to deal with these issues in future research is provided. Measuring the international development of palliative care is a difficult and challenging task. The results of this study could be used to improve the validity of future research in this field. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  8. Inflight Microbial Monitoring - An Alternative Method to Culture Based Detection Currently Used on the International Space Station

    Science.gov (United States)

    Khodadad, Christina L.; Birmele, Michele N.; Hummerick, Mary E.; Roman, Monsi; Smith, David J.

    2015-01-01

    Microorganisms including potential human pathogens have been detected on the International Space Station (ISS). The potential to introduce new microorganisms occurs with every exchange of crew or addition of equipment or supplies. Current microbial monitoring methods require enrichment of microorganisms and a 48-hour incubation time resulting in an increase in microbial load, detecting a limited number of unidentified microorganisms. An expedient, low-cost, in-flight method of microbial detection, identification, and enumeration is warranted.

  9. Exercise in patients with hypertrophic cardiomyopathy: A review of current evidence, national guideline recommendations and a proposal for a new direction to fitness.

    Science.gov (United States)

    Hindieh, Waseem; Adler, Arnon; Weissler-Snir, Adaya; Fourey, Dana; Harris, Sarah; Rakowski, Harry

    2017-04-01

    Hypertrophic cardiomyopathy is a common genetic disorder with a prevalence of 1:500 in the general population. Amongst a varied spectrum of clinical presentations, the most feared complication of this cardiac disorder is sudden cardiac death. Although only a minority of patients with hypertrophic cardiomyopathy who suffer sudden cardiac death or resuscitated cardiac arrest do so during exercise, strenuous physical activity is regarded as an important trigger for these tragic outcomes. Furthermore, during exercise, patients with hypertrophic cardiomyopathy may develop augmentation of left ventricular outflow tract obstruction, myocardial ischemia, diastolic dysfunction and/or inappropriate vasodilation in non-exercising vascular beds. This in turn may lead to exertional dyspnea, chest pain or syncope. Accordingly, patients with hypertrophic cardiomyopathy are disqualified from competitive sports and in many cases are recommended to avoid strenuous physical activity of any kind. Nevertheless, avoidance of physical activity comes with a price. The positive effects of regular exercise have been extensively reported to convey a wide range of benefits including reduced cardiovascular events, weight reduction and improved wellbeing. Therefore, finding the right exercise level that will offer some of the benefits of physical activity without increasing the risk of sudden cardiac death is of utmost importance. In this review, we discuss the current evidence for and against exercise in this patient population and review national guideline recommendations. We also propose alternative fitness strategies including a novel fitness program implemented by our hypertrophic cardiomyopathy center which may be of particular usefulness for hypertrophic cardiomyopathy patients. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working ...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....... Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...

  11. Effects of Tidal Currents on Nonlinear Internal Solitary Waves in the South China Sea

    Institute of Scientific and Technical Information of China (English)

    FAN Zhisong; SHI Xingang; Antony K. Liu; LIU Hailong; LI Peiliang

    2013-01-01

    The propagation and fission process of intemal solitary waves (ISWs) with amplitudes of about 170m are simulated in the northeast of the South China Sea (NSCS) by using the generalized Korteweg-de Vries (KdV) equation under continuous stratification.More attention is paid to the effects of the ebb and flood background currents on the fission process of ISWs.This kind of background current is provided by the composed results simulated in terms of monthly mean baroclinic circulation and barotropic tidal current.It is found that the obtained relation of the number of fission solitons to the water depth and stratification is roughly in accordance with the fission law derived by Djordjevic and Redekopp in 1978; however,there exists obvious difference between the effects of the ebb and flood background currents on the wave-lengths of fission solitons (defined as the distance between two neighboring peaks of ISWs).The difference in nonlinearity coefficient α between the ebb and flood background currents is a main cause for the different wave-lengths of fission solitons.

  12. Internal pinch instability at the edge of an inviscid current sheet

    CERN Document Server

    Priede, Jānis

    2015-01-01

    This paper presents numerical analysis a pinch-type instability in a semi-infinite planar layer of inviscid conducting liquid bounded by solid walls and carrying a uniform electric current. The instability resembles the Tayler instability in astrophysics and can presumably disrupt the operation of the recently developed liquid metal batteries (Wang et al. 2014 Nature 514, 348). We show that the instability in liquid metals, which are relatively poor conductors, significantly differs from that in a well conducting fluid. In the latter, instability is dominated by the current perturbation resulting from the advection of the magnetic field. In the former, the instability is dominated by the magnetic field perturbation resulting from the diffusion of the electric current perturbation. As a result, in liquid metals, instability develops on the magnetic response time scale, which depends on the conductivity, and is much longer than the Alfv\\'en time scale, on which the instability develops in a well conducting flui...

  13. A novel algorithm for discrimination between inrush current and internal faults in power transformer differential protection based on discrete wavelet transform

    Energy Technology Data Exchange (ETDEWEB)

    Eldin, A.A. Hossam; Refaey, M.A. [Electrical Engineering Department, Alexandria University, Alexandria (Egypt)

    2011-01-15

    This paper proposes a novel methodology for transformer differential protection, based on wave shape recognition of the discriminating criterion extracted of the instantaneous differential currents. Discrete wavelet transform has been applied to the differential currents due to internal fault and inrush currents. The diagnosis criterion is based on median absolute deviation (MAD) of wavelet coefficients over a specified frequency band. The proposed algorithm is examined using various simulated inrush and internal fault current cases on a power transformer that has been modeled using electromagnetic transients program EMTDC software. Results of evaluation study show that, proposed wavelet based differential protection scheme can discriminate internal faults from inrush currents. (author)

  14. Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey

    Science.gov (United States)

    Regan, Julie; Walshe, Margaret; McMahon, Barry P.

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

  15. Existence of a current price as a precondition for abstract method for calculating damages in international and Serbian sales law

    Directory of Open Access Journals (Sweden)

    Fišer-Šobot Sandra

    2014-01-01

    Full Text Available If the contract is avoided and there is a current price for the goods, the party claiming damages may recover the difference between the price fixed by the contract and the current price at specific time and at specific place. Abstract calculation of loss is possible only when the contract goods have current price. Current price is the price generally charged for such goods sold under comparable circumstances in the trade concerned. According to the CISG and Serbian Law of Obligations, for the determination of the current price is relevant time of avoidance. This general rule is not applicable in international sales law when the party claiming damages has avoided the contract after taking over the goods. In that case, the current price at the time of taking over shall be applicable instead of the current price at the time of avoidance. Current price rule contained in the Art. 76(2 of the CISG presupposes that the current price is the price prevailing at the place where the delivery of the goods should have been made, or if there is no current price at the place, the price at such other place as serves as a reasonable substitute, making due allowance for differences in the cost of transporting the goods. Pursuant to Art. 524(2 Of Serbian Law of Obligations, however, relevant is the price in the market of the place of effecting the transaction. Formulation place of effecting the transaction is unclear and vague and can create different problems. Therefore, this rule should be amended and the relevant place should be the place of delivery.

  16. Hamiltonian Approach to Internal Wave-Current Interactions in a Two-Media Fluid with a Rigid Lid

    CERN Document Server

    Compelli, Alan

    2016-01-01

    We examine a two-media 2-dimensional fluid system consisting of a lower medium bounded underneath by a flatbed and an upper medium with a free surface with wind generated surface waves but considered bounded above by a lid by an assumption that surface waves have negligible amplitude. An internal wave driven by gravity which propagates in the positive $x$-direction acts as a free common interface between the media. The current is such that it is zero at the flatbed but a negative constant, due to an assumption that surface winds blow in the negative $x$-direction, at the lid. We are concerned with the layers adjacent to the internal wave in which there exists a depth dependent current for which there is a greater underlying than overlying current. Both media are considered incompressible and having non-zero constant vorticities. The governing equations are written in canonical Hamiltonian form in terms of the variables, associated to the wave (in a presence of a constant current). The resultant equations of m...

  17. Internal electric field profile in thin film hydrogenated amorphous silicon diodes studied by the transient-null-current method

    Energy Technology Data Exchange (ETDEWEB)

    Han, D.; Yeh, C.; Wang, K.; Wang, Q.

    1997-07-01

    The authors demonstrate that the internal field of a thin a-Si:H pin solar cells can be measured using the transient-null-current method. This method was previously developed to measure the internal field profile in a-Si alloy Schottky barrier. The internal electric field profile was determined by measuring the forward-bias voltages that tune the transient photocurrents generated by a pulsed laser at various wavelengths to zero. They adopt the same technique to a-Si:H p-i-n solar cells. In the case of p-i-n structure, they need to consider both space charge contributed by photogenerated carriers and carrier recombination which disturb the internal field. They use two critical conditions to minimize these effects. (1) To limit the contribution of photocarriers to space-charge distribution, the total charge collected is less than 10{sup {minus}10} C per pulse, and a repetition rate 1 Hz is used to ensure that the diode remains close to its equilibrium state, (2) The measuring time window is about 1--6 {micro}s following the displacement current. Typically the RC constant of diode is <1 {micro}s and the rise time of the forward-bias recombination current is 6.0 x {micro}s. They apply the signal average to process the forward-bias voltage. The error is within {+-}0.05 V. With this technique they can study the effect of variety of structure design or processing on the device performance.

  18. Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps.

    Science.gov (United States)

    Modave, François; Bian, Jiang; Leavitt, Trevor; Bromwell, Jennifer; Harris Iii, Charles; Vincent, Heather

    2015-07-24

    Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4

  19. [Guidelines for clinical practice].

    Science.gov (United States)

    Vleugels, A M

    1997-01-01

    Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete

  20. CONTRIBUTION GUIDELINES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Published by China Institute of International Studies, China International Studies is China’s first English-language journal on diplomacy and international politics for formal circulation. The magazine mainly publishes the latest research achievements of Chinese scholars and specialists on China’s diplomacy, international politics and international relations under such columns as China’s Diplomacy, International

  1. Enhancing transcranial direct current stimulation via motor imagery and kinesthetic illusion: crossing internal and external tools.

    Science.gov (United States)

    Bodranghien, Florian; Manto, Mario; Lebon, Florent

    2016-06-01

    Transcranial direct current stimulation is a safe technique which is now part of the therapeutic armamentarium for the neuromodulation of motor functions and cognitive operations. It is currently considered that tDCS is an intervention that might promote functional recovery after a lesion in the central nervous system, thus reducing long-term disability and associated socio-economic burden. A recent study shows that kinesthetic illusion and motor imagery prolong the effects of tDCS on corticospinal excitability, overcoming one of the limitations of this intervention. Because changes in excitability anticipate changes in structural plasticity in the CNS, this interesting multi-modal approach might very soon find applications in neurorehabilitation.

  2. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    OpenAIRE

    2008-01-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the ...

  3. Renewable energy sources for the world's poor: a review of current international development assistance programs

    Energy Technology Data Exchange (ETDEWEB)

    Ashworth, J. H.

    1979-10-01

    Foreign assistance funding of the creation, testing, and use of renewable energy sources concerning worldwide efforts to provide energy for Third World development is examined. Donor agencies and developing nations give serious attention to technologies that have been considered exotic and marginal: small-scale hydroelectric generation, solar water heating and distillation, biomass conversion to methane gas and alcohol, wind power, photovoltaic-powered small-scale irrigation, and village-level solar-powered absorption refrigeration. An initial effort to assist in the international coordination of donor activity and in the sharing of information generated by foreign-assistance projects that use renewable energy sources is reported. The report mainly provides information about specific development projects. It contains only a few of the projects that have been approved and funded by 1 June 1979. (MCW)

  4. THE CURRENT STATE OF APPLICATION OF INTERNATIONAL FINANCIAL REPORTING STANDARDS IN UKRAINE.

    Directory of Open Access Journals (Sweden)

    B. Zasadnyi

    2016-09-01

    Full Text Available The article analyzed the process of reforming the system of accounting and reporting in Ukraine in accordance with International Financial Reporting Standards. The main results of the tasks of the Strategy of application IFRS in Ukraine approved by the Cabinet of Ministers of Ukraine in 2007 are identified. The results of analysis showed that only 1% of the total number of enterprises form the financial statements in accordance with IFRS, the others apply national standards of accounting. The proportion of small enterprises is 95% that do not have the financial capacity, qualified staff and the necessary motivation for the formation of financial statements in accordance with IFRS. As a result, one of the main objectives of the reform of the accounting and reporting is to improve the legislation on accounting for small enterprises and develop national accounting standards of the simplified procedure for accounting of assets, liabilities, equity and financial results of the calculation for small enterprises.

  5. From laws relating to neighbouring owners to environmental laws: changes in international environmental law - illustrated by the UNEP guidelines on the utilization of jointly owned resources. Vom Nachbarrecht zum Umweltrecht: der Wandel des Umweltvoelkerrechts - am Beispiel der UNEP-Guidelines ueber die Nutzung gemeinsamer geteilter Ressourcen

    Energy Technology Data Exchange (ETDEWEB)

    Vogelsang, M.

    1992-12-01

    The guidelines initially apply international laws relating to neighbouring owners to put the principle of fair balancing of utilization into a more specific conceptual framework. Materially speaking this means most of all an obligation to prevent damages, and procedure-wise the obligation to offer information, consultation and cooperation. The guidelines contain elements of a future international environmental law which treats the environment per se as a good which is in need of protection. In this context the obligation to prevent risks, the tendency toward well-planned management and internationalization of limited ressources as well as prohibition of discrimination which is supported by according foreign citizens equal status in administrative and court procedures should be emphasized. (orig./HP).

  6. International development assistance for renewable technologies: current programs and institutional requirements

    Energy Technology Data Exchange (ETDEWEB)

    Ashworth, J. H.; Meunier, R. E.

    1979-05-01

    Within the last several years, foreign-assistance donor agencies have begun to provide significant aid for the search for renewable energy sources for developing nations. This paper reports preliminary results from a survey of development--assistance projects in renewable energy sources, indicating which areas are extensions of traditional assistance areas and which are new areas of involvement. The last two portions of the paper indicate certain shortcomings in the current effort, and linkages that must be emphasized in order to incease the effectiveness of the range of donor activities.

  7. The current skills gaps in analytical sciences are failing industry: debate at the 21st International Reid Bioanalytical Forum.

    Science.gov (United States)

    Spooner, Neil; Sangster, Timothy

    2016-07-01

    21st International Reid Bioanalytical Forum, University of Surrey, Guildford, UK, 7-10 September 2015 The 21st International Reid Bioanalytical Forum held between 7 and 10 September 2015, brought together over 100 scientists from around the world, representing industry, academia and vendors, for 4 days of engaging science at the University of Surrey in Guildford, UK. The scientific program consisted of 43 podium and 23 poster presentations from key opinion leaders and those just setting out on their scientific career. The latter being the focus of the meeting. One of the highlights of the forum was the debate. An expert panel helped spark off an active discussion among a passionate audience on the topic of 'The Current Skills Gaps in Analytical Sciences are Failing Industry.'

  8. Summary guidelines

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-09-01

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

  9. CURRENT SITUATION INHARMONIZATION OF TURKISH ACCOUNTING STANDARDS TO THE INTERNATIONAL ACOUNTINGSTANDARDS IN EUROPEAN UNION PROCESS

    Directory of Open Access Journals (Sweden)

    Murat KORKMAZ

    2012-06-01

    Full Text Available With the ending of the coldwar period, all world countries opened their countries to the foreign investorswith the purpose of having more share from the welfare all over the world, andthey even began to apply incentives encouraging investors to invest in their countries.Within this process which is called globalization, the most important factorfor investors to invest in these countries is that financial statements shouldbe prepared in accordance with the criteria accepted all over the world. With thispurpose, world accounting association gives utmost importance to thepreparation of accounting standards as related to the preparation of financialstatements. In recent years, significant developments have been experienced inthis field in Turkey due to both European Union process and pressures of globalizingTurkish investors. Firstly, International Accounting Standards were harmonizedwith the Turkish Accounting System and then they started to be applied asTurkish Accounting Standards. As depending on the last seen world economiccrisis, studies of harmonization of the changes in these standards with TurkishAccounting System continue. In this study, to which degree these rules appliedas a standard all over the world are tried to be applied in Turkey has beenanalyzed.

  10. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

    Science.gov (United States)

    Dornblaser, Emily K; Ratka, Anna; Gleason, Shaun E; Ombengi, David N; Tofade, Toyin; Wigle, Patricia R; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J; Ochs, Leslie; Jungnickel, Paul W; Abrons, Jeanine P; Alsharif, Naser Z

    2016-04-25

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

  11. International medical graduates (IMGs needs assessment study: comparison between current IMG trainees and program directors

    Directory of Open Access Journals (Sweden)

    Baerlocher Mark

    2008-08-01

    Full Text Available Abstract Background International Medical Graduates (IMGs training within the Canadian medical education system face unique difficulties. The purpose of this study was to explore the challenges IMGs encounter from the perspective of trainees and their Program Directors. Methods Program Directors of residency programs and IMGs at the University of Toronto were anonymously surveyed and asked to rate (using a 5-point Likert scale; 1 = least important – 5 = most important the extent to which specific issues were challenging to IMGs and whether an orientation program (in the form of a horizontal curriculum should be implemented for incoming IMGs prior to starting their residency. Results Among the IMGs surveyed, Knowledge of the Canadian Healthcare System received the highest mean score (3.93, followed by Knowledge of Pharmaceuticals and Hospital formularies (3.69, and Knowledge of the Hospital System (3.69. In contrast, Program Directors felt that Communication with Patients (4.40 was a main challenge faced by IMGs, followed by Communication with Team Members (4.33 and Basic Clinical Skills (4.28. Conclusion IMGs and Program Directors differ in their perspectives as to what are considered challenges to foreign-trained physicians entering residency training. Both groups agree that an orientation program is necessary for incoming IMGs prior to starting their residency program.

  12. Web Accessibility and Guidelines

    Science.gov (United States)

    Harper, Simon; Yesilada, Yeliz

    Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

  13. Evaluation capacity development in Africa: Current landscape of international partners’ initiatives, lessons learned and the way forward

    Directory of Open Access Journals (Sweden)

    Michele Tarsilla

    2014-12-01

    Full Text Available Despite the copious resources allocated by international development partners to enhance African countries’ capacity to evaluate the performance and impact of development programmes and policies, most evaluation capacity building (ECB efforts have not yielded the expected results. Time and energy have been focused on the measurement of short-term effects whilst long-term results have largely remained elusive. As a result, a variety of actors across the continent are calling for more innovative strategies. In particular, more efforts are currently being made to revitalise the evaluation function in international development at the global level and to enhance a shift from short-term training to more contextually relevant, systemic learning, equity and sustainability efforts. This article aims to provide a critical overview of ECB initiatives undertaken by international development partners in Africa over five years (2009–2014 that worked well and investigate how they could be improved. The common issues stress the need for harmonisation and collaboration between international partners and African institutions and more effective collaboration with in country institutions and organisations committed to evaluation capacity development (ECD. The analysis in this article is timely and relevant for both the strengthening of socalled made-in Africa evaluation methods and approaches and the roll-out of systemic and organic ECD strategies. The debate spurred by this article is likely to contribute to the current global debate on what strategies ought to be taken as part of the post-2015 agenda. This inturn will spur the debate on ECD to increase in importance and undoubtedly in intensity.

  14. Epetra developers coding guidelines.

    Energy Technology Data Exchange (ETDEWEB)

    Heroux, Michael Allen; Sexton, Paul Michael

    2003-12-01

    Epetra is a package of classes for the construction and use of serial and distributed parallel linear algebra objects. It is one of the base packages in Trilinos. This document describes guidelines for Epetra coding style. The issues discussed here go beyond correct C++ syntax to address issues that make code more readable and self-consistent. The guidelines presented here are intended to aid current and future development of Epetra specifically. They reflect design decisions that were made in the early development stages of Epetra. Some of the guidelines are contrary to more commonly used conventions, but we choose to continue these practices for the purposes of self-consistency. These guidelines are intended to be complimentary to policies established in the Trilinos Developers Guide.

  15. Former Soviet Regulations for seismic design of NPPs and comparison with current international practice

    Energy Technology Data Exchange (ETDEWEB)

    Kostarev, V.; Schukin, A.; Berkovski, A. [CKTI-Vibroseism Co. Ltd. (Cape Verde)

    1997-03-01

    This paper presents a summary of current earthquake design criteria used in former Soviet Regulations for equipment and piping systems of nuclear power plants in light of those used in United States and Japan. The detailed comparative seismic analysis of PWR (WWER) Primary Coolant Loop System (PCLS) according to Former Soviet (Russian) PNAE Code and ASME BPV Code with some comments regarding to Japan Code JEAG - 4601 was undertaken for better understanding of the differences and coincidences of seismic design criteria and requirements. The selection of these three guides for the study has very simple explanation: according to ASME BVPC, JEAG and PNAE the huge majority of existing NPPs has been designed. (J.P.N.)

  16. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    DEFF Research Database (Denmark)

    Renstrom, P; Ljungqvist, A; Arendt, E

    2008-01-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert...... clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery......) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular...

  17. Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

    NARCIS (Netherlands)

    M.A.E. Nobbenhuis (Marielle); C.J.L.M. Meijer (Chris); A.J.C. van den Brule; L. Rozendaal (Lawrence); F. Voorhorst (Feja); E.K.J. Risse (Elle); R.H.M. Verheijen (René); T.J.M. Helmerhorst (Theo)

    2001-01-01

    textabstractWe assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 1

  18. Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

    NARCIS (Netherlands)

    M.A.E. Nobbenhuis (Marielle); C.J.L.M. Meijer (Chris); A.J.C. van den Brule; L. Rozendaal (Lawrence); F. Voorhorst (Feja); E.K.J. Risse (Elle); R.H.M. Verheijen (René); T.J.M. Helmerhorst (Theo)

    2001-01-01

    textabstractWe assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 1

  19. Metadata Guidelines

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document provides guidelines on metadata and metadata requirements for ServCat documents. Information on metadata is followed by an instructional flowchart and...

  20. Current Perspective in the International Trade of Medicinal Plants Material: An Update.

    Science.gov (United States)

    Vasisht, Karan; Sharma, Neetika; Karan, Maninder

    2016-01-01

    The recent years have seen an increased interest in medicinal plants together with the therapeutic use of phytochemicals. Medicinal plants are utilized by the industry for the production of extracts, phytopharmaceuticals, nutraceuticals and cosmeceuticals and their use is expected to grow faster than the conventional drugs. The enormous demand of medicinal plant material has resulted in huge trade both at domestic and international levels. The trade data of medicinal plant material with commodity code HS 1211 (SITC.4, code 292.4) and their derived/related products which are traded under different commodity codes has been acquired from COMTRADE, Trade Map, country reports, technical documents etc for the period 2001 to 2014. The data was analyzed using statistical tools to draw conclusions. The significant features of the global trade; the leading source, consumer, import and export countries; and the striking trends are presented. The trade of the ten key countries and the selected important items is also discussed in detail. The conservative figure of trade of medicinal plants materials and their derived/related products including extracts, essential oils, phytopharmaceuticals, gums, spices used in medicine, tannins for pharmaceutical use, ingredients for cosmetics etc. as calculated from the global export data for the year 2014 is estimated at USD 33 billion. The average global export in medicinal plants under HS 1211 for the fourteen year period was USD 1.92 billion for 601,357 tons per annum and for the year 2014 it stood at 702,813 tons valued at USD 3.60 billion. For the studied period, an annual average growth rate (AAGR) of 2.4% in volumes and 9.2% in values of export was observed. Nearly 30% of the global trade is made up by top two countries of the import and export. China and India from Asia; Egypt and Morocco from Africa; Poland, Bulgaria and Albania from Europe; Chile and Peru from South America are important supply sources. The USA, Japan and Europe

  1. International evaluation of current and future requirements for environmental engineering education.

    Science.gov (United States)

    Morgenroth, E; Daigger, G T; Ledin, A; Keller, J

    2004-01-01

    The field of environmental engineering is developing as a result of changing environmental requirements. In response, environmental engineering education (E3) needs to ensure that it provides students with the necessary tools to address these challenges. In this paper the current status and future development of E3 is evaluated based on a questionnaire sent to universities and potential employers of E3 graduates. With increasing demands on environmental quality, the complexity of environmental engineering problems to be solved can be expected to increase. To find solutions environmental engineers will need to work in interdisciplinary teams. Based on the questionnaire there was a broad agreement that the best way to prepare students for these future challenges is to provide them with a fundamental education in basic sciences and related engineering fields. Many exciting developments in the environmental engineering profession will be located at the interface between engineering, science, and society. Aspects of all three areas need to be included in E3 and the student needs to be exposed to the tensions associated with linking the three.

  2. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.

    Science.gov (United States)

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2008-06-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

  3. CONTRIBUTION GUIDELINES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Published by China Institute of International Studies, China International Studies is China’s first English-language journal on diplomacy and international politics for formal circulation. The magazine mainly publishes the latest research achievements of Chinese scholars and specialists on China’s diplomacy, international politics and international relations under such columns as China’s Diplomacy, International Relations, International Politics, International Security, Regional Issues and World Economy. The journal pursues a serious and down-to-earth style and promotes academic democracy.

  4. The current status of endoscopy in transsphenoidal surgery: an international survey.

    Science.gov (United States)

    de Divitiis, Enrico; Laws, Edward R; Giani, Umberto; Iuliano, Sherry L; de Divitiis, Oreste; Apuzzo, Michael L J

    2015-04-01

    A survey-based study was designed to assess opinions related to transsphenoidal endoscopy, to evaluate the current global attitudes of neurosurgeons regarding the use of this procedure, and to solicit basic data from key institutions worldwide, with the advantage that large series of cases become available for analysis. A web-based multi-item questionnaire was distributed to the surgical departments of 393 neurosurgical centers by means of an invitation e-mail. The questionnaire was composed of 2 sections: section 1 focused on the surgical technique for pituitary adenomas (standard technique), and section 2 concentrated on surgery for skull base tumors (extended technique). Each section was composed of 2 parts: multiple choice questions and free textual responses. From a total of 393 neurosurgical centers, from 23 countries, that received the questionnaire, 87 of them (22%) submitted complete or incomplete responses. The surgical procedure, in 60 cases had been performed by a neurosurgeon, in 53 cases by a neurosurgeon and an otolaryngologist, and in 4 cases by an otolaryngologist only. The endoscope (2- and 3-dimensional) was used in 85.2% of transsphenoidal procedures versus the microscope in 14.8% of cases. The endonasal route was used for approach in 93.2% versus the sublabial route in 6.8% of cases. Computer-guided navigation was used by survey population in 71 cases, micro-Doppler in 51 cases, and Cavitron Ultrasonic Surgical Aspirator in 43 cases. Several hundreds of extrasellar tumors were operated using the extended technique. Transsphenoidal endoscopy for pituitary and anterior skull base tumors has become established as a routine method of dealing with a variety of lesions. The level of interest in the neurosurgical surgery community is reflected by the geometric expansion of contributions to the literature on endoscopic surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Space experiment BTN-NEUTRON on INTERNATIONAL SPACE STATION - CURRENT STATUS and future stages

    Science.gov (United States)

    Tretyakov, V. I.; Kozyrev, A. S.; Laygushin, V. I.; Litvak, M. L.; Malakhov, A. V.; Mitrofanov, I. G.; Mokrousov, M. I.; Pronin, M. A.; Vostrukhin, A. A.; Sanin, A. B.

    2009-04-01

    Space experiment BTN (Board Telescope of Neutrons) was suggested in 1997 for the Russian segment of International Space Station. The first stage of this experiment was started in February 2007 with instrumentation BTN-M1, which contain two separate units: 1) the electronics unit for commanding and data handling, which is installed inside the Station; 2) the detector unit, which is installed at the outer surface of Russian Service Module "Zvezda". The total mass of this instrument without cables is about 15 kg and total power consumption is about 18 Watts. Detector unit of BTN-M1 has the set of four neutron detectors: three proportional counters of epithermal neutrons with 3He covered by cadmium shields and polyethylene moderators with different thickness and stylbene scintillator for fast neutrons at the energy range 0.4 Mev - 10 Mev. There are three sources of neutrons in the near-Earth space. Permanent flux of neutrons is produced due to interaction of energetic particles of galactic and solar cosmic rays with the upper atmosphere of the Earth ("natural neutrons") and with the body of the spacecraft ("technogenic neutrons"). The third transient sources of neutrons are active regions of the Sun, which may sporadically emit energetic neutrons during strong flares. Some of these particles have sufficiently high energy to neutrons cover the distance to the Earth before decay Data from BTN-M1 after 2 years of space operations is sufficient for preliminary estimation of neutron component of radiation environment in the near-Earth space. BTN-M1 detector unit is equal to the Russian instrument HEND, which also operates now onboard NASA's Mars Odyssey orbiter since May 2001. Simultaneous measurements of neutron radiation on orbits around Mars and Earth give the unique opportunity to compare neutron radiation environment around two planets. The technogenic component of neutron background may be estimated by analysis of data for different stages of flight. After evaluation

  6. A HIgh Current Density Low Cost Niobium 3 Tin Titanium Doped Conductor Utilizing A Novel Internal Tin Process

    Energy Technology Data Exchange (ETDEWEB)

    Bruce A Zeitlin

    2005-02-23

    An internal tin conductor has been developed using a Mono Element Internal Tin (MEIT) with an integral Nb barrier surrounding the Nb filaments. High current densities of 3000 A/mm2+ at 12 T and 1800 A/mm2 at 15 T have been achieved in conductors as small as 0.152 mm with the use of Nb7.5Ta filaments and Ti in the Sn core. In contrast, conductors with pure Nb and Ti in the Sn achieved 2700 A/mm2 at 12 T. Two internal fins, developed and patented on the project, were introduced into the filament array and reduced the effective filament diameter (Deff) by 38%. Additional fins will further reduce Deff The conductor was produced from 152.4 mm diameter billets to produce wire as small as 0.152 mm. The process promises be scaleable to 304 mm diameter billets yielding wire of 0.304 mm diameter. The MEIT process wire was easy to draw with relatively few breaks. The cost of this conductor in large production quantities based on the cost model presented could meet the 1.5 $/kilo amp meter(KAM) target of the HEP community

  7. Internal structure and current evolution of very small debris-covered glacier systems located in alpine permafrost environments

    Directory of Open Access Journals (Sweden)

    Jean-Baptiste eBosson

    2016-04-01

    Full Text Available This contribution explores the internal structure of very small debris-covered glacier systems located in permafrost environments and their current dynamical responses to short-term climatic variations. Three systems were investigated with electrical resistivity tomography and dGPS monitoring over a 3-year period. Five distinct sectors are highlighted in each system: firn and bare-ice glacier, debris-covered glacier, heavily debris-covered glacier of low activity, rock glacier and ice-free debris. Decimetric to metric movements, related to ice ablation, internal deformation and basal sliding affect the glacial zones, which are mainly active in summer. Conversely, surface lowering is close to zero (-0.04 m yr-1 in the rock glaciers. Here, a constant and slow internal deformation was observed (c. 0.2 m yr-1. Thus, these systems are affected by both direct and high magnitude responses and delayed and attenuated responses to climatic variations. This differential evolution appears mainly controlled by (1 the proportion of ice, debris and the presence of water in the ground, and (2 the thickness of the superficial debris layer.

  8. [Reflections on residency training under the current recommendations of the European Union of Medical specialists and the European Board of Anaesthesia (UEMS/EBA guidelines)].

    Science.gov (United States)

    Sáez Fernández, A; Sistac Ballarín, J M; Martínez Torrente, F; Calvo Vecino, J M; Olmos Rodríguez, M

    2011-01-01

    The recent publication of guidelines for postgraduate training in anesthesiology, pain, and intensive care issued by the European Board of Anaesthesia (EBA) and the European Union of Medical Specialists (UEMS) (http://www.sedar.es/revistasedar/uems.pdf) specifies directions we must take with our residents. The training section of the Sociedad Española de Anestesiología y Reanimación (SEDAR) has decided to make the guidelines available on the association's website so that the UEMS/EBA proposals can be compared to the training program drafted by the Spanish national board for our specialty. Our aim is to identify points of convergence between the two proposals and to target gaps where improvements can be made so that Spanish residency training in this specialty is in harmony with the European framework.

  9. CONTRIBUTION GUIDELINES

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Published by China Institute of International Studies, China International Studies is China’s first English-language journal on diplomacy and international politics for formal circulation. The magazine mainly publishes the latest research achievements of Chinese scholars and specialists on China’s diplomacy, international politics and

  10. Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines.

    LENUS (Irish Health Repository)

    O'Kelly, R A

    2013-04-11

    BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.

  11. Dietary guidelines

    DEFF Research Database (Denmark)

    Jelsøe, Erling

    2015-01-01

    Dietary guidelines are issued regularly in most developed countries. In almost all cases they are concerned solely with the nutritional aspects of food and eating and are based on an understanding of food exclusively as a source of nutrients. In recent years, however, a growing number of proposals...... in a number of countries have addressed the issue of making dietary guidelines that integrate health and sustainability, but in all cases they have been met with different kinds of resistance. This article reviews the development towards an integrated understanding of health and sustainability in relation...... and the role of expert cultures for the elaboration and communication of messages about health and sustainability. Finally, the article briefly points to some answers to the complexity of issues surrounding the creation of dietary guidelines...

  12. New Asthma Guidelines: What You Should Know

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Special Section New Asthma Guidelines: What You Should Know Past Issues / ... and chairs the Expert Panel that established the new guidelines. The report gives health care professionals new ...

  13. Current practice vs. guideline based imaging in abdominal radiology in the German speaking area. Results of an online survey; Versorgungsrealitaet vs. leitliniengerechte Bildgebung in der Abdominalradiologie im deutschsprachigen Raum. Ergebnisse einer Online-Umfrage

    Energy Technology Data Exchange (ETDEWEB)

    Schreyer, A.G. [University Hospital Regenburg (Germany). Dept. of Radiology; Wessling, J. [Clemens Hospital Muenchen (Germany). Dept. of Radiology; Grenacher, L. [Diagnostic Muenchen (Germany). Diagnostic Imaging Center

    2016-03-15

    The working group for abdominal imaging within the German Roentgen Society (DRG) performed an online survey amongst radiologist concerning the current status of techniques for abdominal imaging. The results of this survey were compared with the most recent guidelines. We performed an online survey open for all members of the DRG during a 76-day period with 65 questions and an overall estimated time for finishing the questionnaire of 15 minutes concerning technical specifications for abdominal radiological imaging. The results were evaluated using descriptive statistics. 90 of all participants, who filled out the survey covering more than 80 % of the questions, were included in the statistical evaluation. 27 % of all participants were registered radiologists while 73 % represented radiologists working in a hospital. Most participants worked in a managerial position. The participants gave detailed information regarding the radiological techniques used in dedicated organ systems (esophagus, stomach, pancreas, liver, small intestines, colon) regarding acquired contrast phases and oral and intravenous administration of contrast medium. The results confirm that most radiologists participating in this survey perform their examinations and choose their modalities in conformity with the current existing clinical guidelines. Because most clinical guidelines do not specify radiological examinations in detail, there is a noteworthy heterogeneity of the acquired contrast phases and major divergence in terms of technical parameters. Therefore a joint radiological effort should be initiated for developing and publishing updated radiological parameters for abdominal imaging.

  14. Instructional Guidelines. Welding.

    Science.gov (United States)

    Fordyce, H. L.; Doshier, Dale

    Using the standards of the American Welding Society and the American Society of Mechanical Engineers, this welding instructional guidelines manual presents a course of study in accordance with the current practices in industry. Intended for use in welding programs now practiced within the Federal Prison System, the phases of the program are…

  15. Internal heating of lithium-ion batteries using alternating current based on the heat generation model in frequency domain

    Science.gov (United States)

    Zhang, Jianbo; Ge, Hao; Li, Zhe; Ding, Zhanming

    2015-01-01

    This study develops a method to internally preheat lithium-ion batteries at low temperatures with sinusoidal alternating current (AC). A heat generation rate model in frequency domain is developed based on the equivalent electrical circuit. Using this model as the source term, a lumped energy conservation model is adopted to predict the temperature rise. These models are validated against the experimental results of preheating an 18650 cell at different thermal insulation conditions. The effects of current amplitude and frequency on the heating rate are illustrated with a series of simulated contours of heating time. These contours indicate that the heating rate increases with higher amplitude, lower frequency and better thermal insulation. The cell subjected to an alternating current with an amplitude of 7 A (2.25 C) and a frequency of 1 Hz, under a calibrated heat transfer coefficient of 15.9 W m-2 K-1, can be heated from -20 °C to 5 °C within 15 min and the temperature distribution remains essentially uniform. No capacity loss is found after repeated AC p